With the Affordable Care Act now a reality, many physicians are looking for ways to improve their bottom line. Providers are concerned that shrinking reimbursements and more complicated insurance requirements are going to whittle away at their profit margins. The public sees doctors as a part of the elite upper class, but doctors face money worries as well. Hundreds of thousands in student loans, overhead for a practice, malpractice insurance and their own bills all weigh heavily on physicians. The reality of being paid less to see more people is frightening and has many providers looking for an alternative. For up to 5,000 of those doctors in the United States, concierge medicine has been the answer.
Concierge medicine goes by many names: direct care, retainer medicine, boutique practices, and private doctors. The patient pays an annual fee in return for patient-centered care with lots of perks. These perks range from having the doctor’s private contact information, round-the-clock care, extended appointments, and little-to-no wait time. In a world where time is money for many people, having a doctor who can see them any time of the day is a huge improvement on waiting for hours. For doctors, it is an attractive option because the annual fees are straight profit. Also, there is less pressure to see as many patients as possible in a day. Most boutique providers only have between 100 and 500 patients on their roster, so there is more time for each patient and less time spent coding and billing.
There are several things that must be considered when changing from a traditional practice to one that is focused on concierge medicine. The most basic decision is whether all insurance contracts will be severed. The alternative is to have what is called a “mixed practice.” A portion of patients pay the retainer for concierge services, while the remainders are traditional patients who either pay an out-of-pocket fee for services or have insurance. This may feel like a safer option since you can count on reimbursements from insurance, but it can actually be more complicated when it comes to billing and insurance regulations. Consulting with your attorney at this step of the process is imperative so the limitations of this type of practice are fully understood.
The cornerstone to practicing concierge medicine is the fee arrangement between patient and doctor. The key aspects of the contract include laying out what the annual retainer fee covers, what will be charged for additional services, and how fees will be structured. The average annual cost per patient is between $1500 and $1800 and normally includes basic well care, as well as “luxuries” like the physician’s email and cell phone number, same day or next day appointments, and after-hours appointment times. Items that are often not included in the basic fee are additional tests and sick visits. Different models include paying for “levels of service” in addition to the retainer, and some use a “pay-as-you-go” system. The contract that patients sign should be in very clear and concise language. It is also imperative that the provider has a delegate to help guide patients through the enrollment process so all questions can be answered and concerns addressed. In a “mixed practice” it must be very clear what will and will not be filed with insurance. Once the provider changes the practice into a boutique practice, the AMA Code of Medical Ethics states that any patients who do not choose to pay the retainer must be transferred to another physician.
A survey of 501 doctors in 2011 by the Deloitte Center for Health Solutions showed that 64% believe a concierge medical practice that does not take insurance has the greatest chance of financial success with the new healthcare reforms. With this sentiment rising, the number of private doctors will likely grow in the next several years. If this is something that you are thinking about for your own career, it is vital to meet with an attorney to discuss the best ways to transition your practice. Careful structuring up front will create a smooth conversion for the practice and its patients.
Revolution Law Group is located in Greensboro, NC, and serves individuals and small businesses throughout the Triad and surrounding areas. To contact us please visit Revolution.law or call 336-333-7907.
The information included here is for informational purposes only, is not exhaustive of all considerations when creating documents, is not intended to be legal advice, and should not be relied upon for that purpose. We strongly recommend you consult with an attorney and do not attempt to create your own documents.
DuBois, James M. et al. (September 3, 2012). Will Concierge Medicine’s Image Improve as it Evolves? American Medical News. Retrieved December 11,2012. https://www.ama-assn.org/amednews/2012/09/03/prca0903.htm
Harris, Steven H. (October 8, 2012). What to Consider before Switching to Concierge Medicine. American Medical News. Retrieved December 11,2012. https://www.ama-assn.org/amednews/2012/10/08/bicb1008.htm