October 10, 2012

Affordable Contract Medicine

The more I read and research about concierge medicine, the more I become concerned that I have missed an important point. Some of this I know is me, but the rest is really muddied up in so many ways. I even made a mistake, when I wrote this blog. I used printed sources to pull together four areas of concierge medicine and there may be more definitions. I was using concierge medicine as a cover term for all types including concierge medicine. For now, I will stay with the four terms and add the term “contract medicine”. Contract medicine may be the correct cover term 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. The contract is the result of a fee the patient pays at the first of each billing cycle to have access to that doctor for the coming period and if you wish to keep the doctor under contract and available to you. This does not mean that you, as the patient, will physically see the doctor that cycle, but the fee still must be paid. The fee is for only you and does not include other family members. Family members may be part of a family fee structure or handled on an individual patient basis.

There are several terms for the fee paid and include, contract fee, retainer fee, subscription fee, access fee, medical care fee, and the list goes on. Much of this naming depends on how the doctor wishes to describe it, and I will not attempt to list all possible terms. Most practices request the fee to be paid monthly, but some do collect on a yearly, semiannual, or quarterly basis.

An area that is still confusing (to me and 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 accept medical insurance, there are some exceptions. To protect yourself in all forms of contract medicine, be sure to ask if insurance is accepted as many doctors, of all types of contract medicine do not accept medical insurance, will not be submit insurance claims for you, and you are entirely responsible for all expenses not covered in the contract fee paid.

Boutique medicine generally has the highest fee range as could be expected. I cannot give the range, as I do not know what the highest fees are. Concierge medicine is generally considered the next highest monthly fee, but this is experiencing some lower fees. Retainer medicine is the confusing category. Some doctors do not want the label of boutique or concierge and use the term retainer medicine. The fees are broad ranging and can vary from $50 per month to several thousands of dollars per month.

Direct care medicine or direct primary care medicine is probably the lowest consistent fee. The majority range from $50 to $100 per month. No, this is not a firm range as some can be as high as $200 per month, but the $200 fee is generally considered out of the normal range. There are other terms for contract medicine, but few are mentioned or talked about and seem to be limited to certain specialties in medicine or what a few doctors are using to separate themselves from the normal forms of contract medicine. 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 using telemedicine to meet the needs of the patients. Some doctors include house calls in the fee, but this is variable depending on the location and the time available to the doctor. Most contract medicine doctors have a patient count of 300 to approximately 1200 or slightly higher. Most, but not all, doctors will work on preventive medicine and treat illness or disease when it happens. The majority of doctors will be working hard to prevent illness and disease from happening in the first place.

Before signing any contract, check whether some or all lab tests will be covered by the contract fee. Some lab tests will probably be covered, but frequency and test costs will affect coverage. In addition, it is important to determine how hospital visits will be handled. Some may be covered by the monthly fee, but most will not. The lower the contract fee is, be alert for unusual expenses to creep into the cost factor.

The direct primary care model, especially, has drawn insurance industry opposition in part because the health insurer middleman is cut out of the equation. Insurers may benefit from direct primary medical care because patients who want insurance are still purchasing high deductible health plans for specialized care and hospitalizations. In addition, there is even talk that some insurance giants are actually talking to direct primary care pioneers MedLion of Monterey, Calif., and Seattle-based Qliance about providing patients in their practices with access to “wrap-around plans” that would cover their specialist and hospital needs. This “wrap-around plans” is gaining support in other areas of the country, particularly in areas where contract medicine is becoming more popular.

There is even some in Congress that are picking up on the contract medical care model and it is gaining momentum is a surprising bipartisan way. Even the New York Times has had stories of “concierge medicine for the masses.”

There will be more written about this in the coming months and I will blog about this when it happens. For those that want to follow a doctor in his change from group practice to a “direct primary care” practice, follow Dr. Rob Lamberts who posts about it here, here, and follow him on Facebook here or if you love twitter, he is here. On the two blogs, read the comments please as there is some excellent information in some of them.

The next blog will continue this discussion.

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