Concierge Medicine Versus Direct Primary Care: Here’s Everything You Need To Know
For decades, medicine in America has been dominated by the fee-for-service payment model, which incentivizes quantity of care over quality of care. Both doctors and patients are beginning to get fatigued by the bureaucratic nature of dealing with insurance companies and government mandates.
If you’re sick of not being able to spend as much time with your patients as you’d like to or are tired of administrative tasks, such as coding and billing, taking up you and your staff’s time, you should consider making the switch to either direct primary care or concierge medicine.
As a medical professional thinking about opening up your own smaller practice or making a switch to a different practice model, you should weigh the pros and cons of concierge medicine versus direct primary care in order to decide which type of practice model you should specialize in. That’s where we come in. We’ll be going over the similarities and differences of concierge medicine versus direct primary care while also giving you some actionable recommendations to get you started toward making the switch that works for you.
Concierge medicine versus direct primary care: What’s the difference?
While the two models are extremely similar, the primary difference is that concierge medicine is often more pricey, catered to a more wealthy clientele, and practitioners also expect patients to have insurance so that they can cover more than just primary care.
On the other hand, direct primary care is focused more on giving a wider range of patients the ability to get more personalized care without having to pay often costly fees, but it doesn’t cover as much as concierge medicine.
You’ll learn more about the intricacies of each of these models below.
What is concierge medicine?
Concierge medicine is a membership-based practice model that provides patients with more access to their healthcare provider. Patients pay a monthly or yearly subscription fee ranging from a few hundred dollars a month to thousands of dollars a month, but in turn get greater and faster access to their concierge doctor.
Patients who are seeking concierge medicine services will typically be on the wealthier side because they can afford both the luxury and personalization that concierge care provides while also being able to afford insurance copays and deductibles.
Concierge medicine physicians can charge health insurance companies for patient visits in addition to charging the membership fees which means that healthcare organizations which subscribe to this payment model will have two forms of revenue.
The benefit of being able to charge health insurance companies in addition to the subscription fee is that it allows a concierge practice to more confidently help patients with specialty services, such as an oncology appointment, that aren’t offered by direct primary care practices.
An important note on insurance:
Concierge doctors must never charge a patient’s health insurance company for services that are included in the patient’s concierge membership fee. Double billing is considered healthcare fraud.
What services do concierge medicine practices offer?
Under a more traditional primary care model such as fee for service, doctors might see 30 to 50 patients a day, which means patients only get a few minutes with their doctor. Additionally, patients might have to book several weeks ahead in order to get that small window of time with their doctor.
A practice which operates under a concierge medicine model isn’t solely reliant on health insurance companies because they make their money via the subscription fee, so they see fewer patients. A concierge medical practice might only see four to six patients a day, and those patients can often make same-day appointments. Additionally, because patients are paying a subscription, they can schedule as many visits a week or month as they want.
Patients typically also get access to their doctor’s direct phone number for medical questions and simple diagnostics.
Put simply, a concierge medicine practice is one which offers typical primary care services, such as check-ups, physicals, simple diagnostics, and simple lab tests. A patient who has a more serious medical condition that requires a specialist is not covered in this payment model and will need to either pay out of pocket or pay for insurance in addition to the subscription fee.
Concierge care is unique in that practices will often be able to help patients with some of these more specialized problems because they also deal with insurance companies, albeit on a smaller scale.
What kind of practice should consider concierge medicine?
If you’re thinking about starting your own practice and are unsure if concierge medicine is right for you, consider the following questions:
Are you often frustrated by how bureaucratic the healthcare system has become?
Do you still want to offer some specialty services such as blood testing?
Do you find dealing with billing and insurance companies to be the main stressor with your professional life?
Is your favorite part of being a physician helping and building connections with your patients?
Are you a general practitioner or family physician?
If you answered yes to any of these questions, it might be worth considering a concierge medicine practice model.
Keep in mind that if you’re a specialist, concierge medicine likely isn’t going to be a good fit for you because those services aren’t typically covered or sought after. Most patients who are looking for concierge medicine are looking for general practitioners because of the nature of services provided.
Additionally, if you already have a medical practice and are thinking about making a switch, consider your patient population. Concierge medicine is typically best for patients with chronic conditions who require multiple visits to the doctor a month who can benefit from a better patient experience. Patients who are generally older with a high-deductible healthcare plan are a great fit for concierge medicine.
In the interest of building better relationships with your patients, you might want to consider investing in patient engagement software. With the software, you’ll get enhanced patient satisfaction, improved quality of care with fewer readmissions, and have access to better patient data to make better decisions.
What is direct primary care?
Direct primary care is a membership-based payment and practice model where patients are charged a yearly or monthly fee to gain access to a doctor instead of going through health insurance.
Much like concierge medicine, direct primary medical care is centered around providing a better patient experience while giving healthcare organizations consistent revenue without forcing them to spend time coding and billing.
Unlike concierge medicine, direct primary care practices do not accept any insurance whatsoever which means patients who do not have insurance or do not want insurance are much more likely to subscribe to a direct primary care physician.
Additionally, unlike concierge medicine, patients aren’t locked into year-long contracts and can opt into monthly contracts instead of yearly contracts which gives them more flexibility and autonomy.
The Affordable Care Act explicitly states that direct primary care is a suitable non-insurance option for patients while concierge medicine is not, which means your patients won’t be charged any state-mandated fees for being uninsured as long as they pay into your practice model.
Patients who are seeking direct primary medical care are those who are looking for a personalized physician experience for a more affordable price compared to concierge medicine or traditional fee-for-service services. A typical direct primary care patient might be someone without any serious medical conditions who enjoys having greater access to their doctor.
What services do direct primary care practices offer?
Direct primary care, or DPC, practices will offer very similar services to those offered by a concierge medicine practice.
Instead of waiting weeks for an appointment, patients get same-day or next-day appointment availability for non-emergency urgent care and routine preventative care. Additionally, patients receive telemedicine consultations via voice, video conferencing, text messaging, and, in some cases, at-home visits.
When patients subscribe to a DPC practice, they never have to worry about meeting high deductibles, paying on-the-spot copays, or completing complicated insurance forms in order to receive the primary healthcare services they need.
However, like concierge medicine, direct primary care cannot help a patient who has a more serious medical condition which requires a specialist.
What kind of practice should consider direct primary care?
The considerations about starting a direct primary care practice are very similar to those of starting a concierge medicine practice, but with a few key differences:
Because you won’t be accepting insurance, such as Medicare or Medicaid, do you want to treat typically younger, middle-income patients?
Are you often frustrated by how bureaucratic the healthcare system has become?
Do you find dealing with billing and insurance companies to be the main stressor on your professional life?
Is your favorite part of being a physician helping patients and building connections with your patients?
Are you a general practitioner?
If you’re tired of dealing with administrative tasks, such as coding and billing, or want to build stronger relationships with your patients, you should consider direct primary care as a payment model if you’re starting your own practice. Direct primary care practices do not need to maintain staff dedicated to organizing, reviewing, filing, and managing payment claims to third-party payers.
A traditional fee-for-service practice who is thinking about making the switch to direct primary care should poll their physicians to see if they align with the new direction. Ask the above questions to determine if they are interested in spending more time with their patients while also seeing less patients on average. Poll your patients about their interest in the new payment model. The reality is that if you do make the switch to direct primary care, you’re going to lose patients, but what you gain is a patient population who is more dedicated to your practice.
Finding which payment model is right for your new practice is crucial
Both concierge medicine and direct primary care offer you greater access to each and every one of your patients so that you can provide an enhanced patient experience while also making payment much less complicated because you do not have to go through insurance companies.
If you want more information about concierge medicine, check out A Concierge Medicine Guide: Definition, Salary, and Set-Up Info.
And if neither direct primary care nor concierge medicine seems like the right fit for you, but you still value patient health outcomes and patient experience, you might be interested in value-based care: The Ultimate Guide to Value-Based Care for Medical Practices or Value-Based Care vs Fee-for-Service: The Ins and Outs You Need to Know.