Direct Primary Care, Direct Care and Concierge Medicine Defined

What is does Direct Care Group do and how is it different from concierge medicine? Or, more generally, what is direct care/direct primary care and how is it different from concierge medicine?

We receive this question frequently. Since we are operating in a relatively new niche within a growing industry there are many terms used to reference our business. A century or so ago, the automotive industry was in a similar stage of development and their products carried many different names. Automobile. Wagon. Cab. Motorcar. Jalopy. It’s generally understood that each of these terms is synonymous with “private, personal, internal combustion transportation machine.”

In the medical industry, references to concierge medicine include: direct primary care, celebrity medicine, private doctors, personalized medicine, private medicine, elitist-sounding phrases, or direct care (as we prefer). Direct primary care (or simply direct care) is just another term for concierge medicine.

A broad definition of concierge medicine includes several key attributes. By any name, it is a format in which: doctors see fewer patients; patient access to a doctor in person, by phone or email is enhanced; an ‘executive physical’ is included; and patients are charged an annual or monthly fee. Benefits to patients consist of a better relationship with their doctor, more preventative medicine including wellness and nutrition, and overall enhanced wellbeing as demonstrated by fewer trips to the hospital. Physicians see an improved lifestyle, ability to focus on their craft, and stability of income.

Within the current discussion and nomenclature surrounding the product, there is little to no differentiation or coherent brand identity. There is no standard for a “premium” concierge offering nor is there a clear “entry level” version. In fact, there is little product development or marketing outside of broad, generic themes. As the industry grows, however, these types of distinctions will become more and more apparent and dichotomies will evolve.

At present, the most easily identifiable differentiator is price. Independent doctors charge from $1,000-$6,000 per year per patient, MDVIP doctors charge $1,500-$2,000, and at the high end, MD Squared charges about $50,000 per year per family. Features and benefits generally trend with the expenditure to some degree. But… these practices are indiscriminately referred to as concierge medicine, direct primary care, and etc. regardless of price or offering.

Upon close inspection two major distinctions emerge. Surprisingly (or not) they are rarely identified by how a practice is referenced and neither is clearly explained or promoted.

First: Hybrid vs. Pure (Patient Conversion)

In most cases, a doctor will complete a process whereby his patient base is solicited to join a new concierge arrangement. In a pure practice, patients’ options are to either continue on with their current doctor in the new program with 24/7 access, same or next day scheduling, longer appointments, wellness and nutrition, and more or to find a new doctor. In the hybrid model, the doctor retains those patients which do not wish to convert to the new format. While the ratio of hybrid to pure concierge practices is unclear, the differences are not.

Consider a long, transoceanic flight with a hybrid passenger cabin. Coach passengers are directed past roomy, premier lounge chairs on their way to tight, upright seats. Imagine the same flight attendants prioritizing between serving champagne flutes in first class and stale peanuts in steerage. Hybrid concierge practices are the healthcare embodiment of this system. In these practices, doctors are awkwardly juggling two classes and a large number of patients. While concierge patients get a special contact number, they cannot truly get the same quality of care as in a pure model since their doctor is still seeing upwards of 1,000 patients.

In pure practices, a clear distinction is made upon conversion that a doctor’s practice is at once a concierge practice. Each of her patients receives the same treatment and no uncomfortable jockeying takes place at the office. Each patient has 24/7 access and the doctor does not have to make the precarious – and ethically questionable – judgment call of the urgency of a patient’s condition versus their established payment arrangement.

Second: Insurance (Revenue Streams)

Not all concierge bills are built the same. Some concierge doctors rely on private insurance and Medicare for a portion of their revenue. By taking insurance, they may also be subjecting their patients to co-pays and co-insurance. When reviewing an annual $1,800 fee, it may be easy to overlook the additional per visit fees and find it a bargain compared to a $3,000 sticker price.

Health insurance (as it exists today) in concierge medicine complicates the relationship for patients and increases financial and regulatory risk for doctors. As Washington changes the face of healthcare delivery (including Medicare’s inclusion of executive physicals as a covered expense) the window for concierge doctors to find revenue outside of direct patient billing is closing. This means one of two things: doctors out of business or hefty rate hikes for those practices relying on insurance reimbursement.

Like price point, hybrid/pure and insurance factors create divergent experiences, yet practices across the spectrum are collectively referred to as concierge medicine, private medicine, direct primary care, etc.

Conclusion

In practice, we at Direct Care Group define direct primary care (or direct care) as a concierge medicine experience where each patient has the potential for the same direct relationship with their health care providers. Patients have enhanced access, are given the time necessary for quality treatment, and receive whole-lifestyle care of a primary care physician and his team. Our doctors’ all-inclusive fees are moderately priced, their offices are pure concierge practices, and we do not require insurance for visits.

How long will hybrid operations in which a doctor provides some patients with a “Cadillac” product and others “Chevy” service last? How many offices depending on co-payments, co-insurance, and reimbursement from private or public health insurance will continue to operate successfully? Will these healthcare models go the way of the steam engine? We’re not sure, but we believe the solution is direct care – which is why we’ve based our business on it.

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