It is fair to say that it has been a tough few years for doctors, bombarded with quality improvement and payment reform programs and watching the structure of their profession change from independent practices to one owned by hospitals, practice management companies and even health plans. (Kareo Survey) The survey sought to compare doctors in traditional practices which largely sought reimbursement from third-party payers with those in concierge-type practices which largely are funded by patient membership fees or direct payments from patients. There were 862 respondents, about a quarter of whom were in the concierge-direct pay model. These clinicians were slightly more likely to be male and older, but had similar number of years practicing medicine, were equally likely to be board-certified and more likely to be practicing alone.
Almost half of the respondents not in a direct-pay model say they are somewhat or highly likely to move to one in the next three years. Top reasons for making the switch include spending more time with patients, getting away from the third-party payer system and improving work-life balance. Physicians in the concierge-like models report significantly more patient visits lasting 30 minutes or more than do doctors in traditional practices and concurrently they tend to see many fewer patients a day and to have much smaller total patient panels. Surprisingly, the direct-pay doctors say they spend 76% of their time on clinical as opposed to administrative matters, while in traditional practices it is 71%. I would have thought the gap would be larger. Both forms of practice rank employers and advertising as the most important source of new patients. Concierge models rank attracting new patients and staying financially viable as their top challenges while in the traditional practice the top challenges are staying financially viable, finding and keeping qualified staff and regulatory compliance.
Direct-pay practices have had that model for 8 years on average and about half started as direct-pay from scratch and half converted from the traditional form. 71% of concierge models use a fixed fee for a service and the rest charge by visit time to some extent. The average annual membership fee charged is just over $2000. Many offer monthly or quarterly payment plans and discounts for couples or families. Most have at least some patients who are not paying the membership fee. Many will accept out-of-network insurance payments and Medicare opt-out payments. They often offer a wide range of services and are more likely to offer telemedicine and /or kiosk services. It will be interesting in a few years to see if the doctors in the direct-pay models are as satisfied with that model as they thought they would be, but currently many physicians seem very attracted to it.