A Viable Solution For Doctors and Patients to the Third-Party Payer Mess: Concierge Medicine

June 2, 2013

1047190_instrument_collection.jpgThe concierge practice of medicine is the wave of the future. This is very good news for the American consumer and tax payer.

As the price tag for Medicare has increased, so has the pressure on federal lawmakers to do something to avoid the looming fiscal disaster that attends rising health care costs. Since the U.S. Taxpayer demands that Medicare costs somehow be contained while, ironically, the U.S. Voter (same person, different hat) views Medicare as a sacrosanct entitlement to consume health care, the lawmaker "solution" has thus far focused the cost-cutting pressure on the supply side of health care, including cutting physician reimbursement. See, e.g. The Plea for Repeal of the Medicare Sustainable Growth Rate, May 4, 2013 post, this Blog. The trend of private insurers and other non-government payers is to follow what Medicare does (at least with respect to setting physician reimbursement rates and billing rules). An unintended consequence of the downward pressure on physician reimbursement together with modern health care's increasing red tape/regulation and associated costs and headaches has been to drive primary care physicians out of private practice altogether. They are fed up. Many doctors have found (or are looking for) hospital employment. Others have retired. This trend has been referred to as the "silent exodus" of physicians and threatens to profoundly impact patient access care in a negative way. See National Survey Points to a "Silent Exodus" of Physicians, Merritt Hawkins, September 24, 2012.

Thankfully, some physicians are discovering that the concierge practice of medicine can be a smart, rewarding way to own and operate a private medical practice as a business that, rather than suffering the severe strains of the third-party-payer model, is free to actually focus on practicing medicine. For many doctors, the concierge medical practice model is returning private practice to its correct state -- a real practice of medicine, medical judgment and care that is patient focused and free from the intrusion into the business of rendering care that a commercial or governmental third-party payer necessarily creates.

In the typical concierge arrangement, the physician declines to take insurance or Medicare and, instead, contracts directly with the patient to provide a menu of primary care or urgent care services, including in-person visits and consultations with 24-hour access to doctors through electronic means, such as email or video conferencing. For such services, the physician is paid by the patient an affordable fixed fee (paid annually or monthly). For patients, the concierge model is advantageous in many ways. Above all, the model allows real access to a doctor (or group of doctors) that the patient has chosen and who can render necessary care without the severely complicating impediment to care of the middle man (an insurer). Often a concierge medical practice is limited by design to a smaller universe of patients per doctor and affords doctors more time with their patients and real opportunity to emphasize wellness rather than treating acute conditions, without long office waits. Concierge practice patients still need a limited amount of insurance (for specialists, hospital care, or catastrophic health events). But such insurance tends to be far less expensive than comprehensive health care insurance. High deductibles can be paid with pre-tax dollars in a Health Savings Account. In the coming years, the right combination of lower-cost of catastrophic insurance protection with a concierge plan for primary or urgent care will increasingly be an attractive alternative to traditional health plans for many individuals, families and businesses.

For the doctor, the absence of the third-party payer can actually be a much happier money-making opportunity than the third-party payer model, according to recent studies. A recent national survey of 14,000 doctors conducted by Merritt Hawkins, a physician staffing firm, determined that approximately one in ten medical practice owners are planning to transition their practices to concierge practices within the next one to three years.

The concierge medical practice trend is a very good thing. And concierge plans are no longer for the rich, but are readily affordable for most individuals and families. For the health care system, the concierge practice will likely be a solution to the expensive, third-party payer mess that plagues health care today.
Kevin Little is a Georgia and South Carolina, AV-rated, health care lawyer, with offices in Atlanta and Augusta, Georgia. You can contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta) or info@ksllawfirm.com.


*Disclaimer: Thoughts shared here do not constitute legal advice.