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The more I read and research aboutconcierge medicine, the more I become concerned that I have missed animportant point. Some of this I know is me, but the rest is reallymuddied up in so many ways. I even made a mistake, when I wrote this blog. I used printed sources to pull together four areas ofconcierge medicine and there may be more definitions. I was usingconcierge medicine as a cover term for all types including conciergemedicine. For now, I will stay with the four terms and add the term“contract medicine”. Contract medicine may be the correct coverterm for the other terms that I am discussing.
Let me review the terms – boutique,concierge, retainer, and direct care (or direct primary care - DPC. All of these, by practice, are contract medicine or care. Thecontract is the result of a fee the patient pays at the first of eachbilling cycle to have access to that doctor for the coming period andif you wish to keep the doctor under contract and available to you.This does not mean that you, as the patient, will physically see thedoctor that cycle, but the fee still must be paid. The fee is foronly you and does not include other family members. Family membersmay be part of a family fee structure or handled on an individualpatient basis.
There are several terms for the feepaid and include, contract fee, retainer fee, subscription fee,access fee, medical care fee, and the list goes on. Much of thisnaming depends on how the doctor wishes to describe it, and I willnot attempt to list all possible terms. Most practices request thefee to be paid monthly, but some do collect on a yearly, semiannual,or quarterly basis.
An area that is still confusing (to meand others) is who is accepting medical insurance and who is not. Some of all types of contract medicine are accepting insurance. However, in general, doctors in direct primary care will not acceptmedical insurance, there are some exceptions. To protect yourself inall forms of contract medicine, be sure to ask if insurance isaccepted as many doctors, of all types of contract medicine do notaccept medical insurance, will not be submit insurance claims foryou, and you are entirely responsible for all expenses not covered inthe contract fee paid.
Boutique medicine generally has thehighest fee range as could be expected. I cannot give the range, asI do not know what the highest fees are. Concierge medicine isgenerally considered the next highest monthly fee, but this isexperiencing some lower fees. Retainer medicine is the confusingcategory. Some doctors do not want the label of boutique orconcierge and use the term retainer medicine. The fees are broadranging and can vary from $50 per month to several thousands ofdollars per month.
Direct care medicine or direct primarycare medicine is probably the lowest consistent fee. The majorityrange from $50 to $100 per month. No, this is not a firm range assome can be as high as $200 per month, but the $200 fee is generallyconsidered out of the normal range. There are other terms forcontract medicine, but few are mentioned or talked about and seem tobe limited to certain specialties in medicine or what a few doctorsare using to separate themselves from the normal forms of contractmedicine. Having said that, the American Academy of Private Physicians (AAPP) does use the terms “private” and “personal”for many discussions of contract medicine.
In all types of contract medicine,patients have greater access to their doctor via phone, Internet,immediate appointment availability and some doctors are usingtelemedicine to meet the needs of the patients. Some doctors includehouse calls in the fee, but this is variable depending on thelocation and the time available to the doctor. Most contractmedicine doctors have a patient count of 300 to approximately 1200 orslightly higher. Most, but not all, doctors will work on preventivemedicine and treat illness or disease when it happens. The majorityof doctors will be working hard to prevent illness and disease fromhappening in the first place.
Before signing any contract, checkwhether some or all lab tests will be covered by the contract fee. Some lab tests will probably be covered, but frequency and test costswill affect coverage. In addition, it is important to determine howhospital visits will be handled. Some may be covered by the monthlyfee, but most will not. The lower the contract fee is, be alert forunusual expenses to creep into the cost factor.
The direct primary care model,especially, has drawn insurance industry opposition in part becausethe health insurer middleman is cut out of the equation. Insurersmay benefit from direct primary medical care because patients whowant insurance are still purchasing high deductible health plans forspecialized care and hospitalizations. In addition, there is eventalk that some insurance giants are actually talking to directprimary care pioneers MedLion of Monterey, Calif., and Seattle-basedQliance about providing patients in their practices with access to“wrap-around plans” that would cover their specialist andhospital needs. This “wrap-around plans” is gaining support inother areas of the country, particularly in areas where contractmedicine is becoming more popular.
There is even some in Congress that arepicking up on the contract medical care model and it is gainingmomentum is a surprising bipartisan way. Even the New York Times hashad stories of “concierge medicine for the masses.”
There will be more written about thisin the coming months and I will blog about this when it happens. Forthose that want to follow a doctor in his change from group practiceto a “direct primary care” practice, follow Dr. Rob Lamberts whoposts about it here, here, and follow him on Facebook here or if youlove twitter, he is here. On the two blogs, read the comments pleaseas there is some excellent information in some of them.
The next blog will continue thisdiscussion.
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