The rise of private pay or “concierge” medical practices brings a new, personalized model to the healthcare marketplace for those who can afford it. Jennifer Newton examines the pros and cons.
You know the feeling. You finally decide you need to see your doctor for that nagging issue, only to call and be told that you can’t get an appointment for weeks, even months. Or, you finally make it to the doctor, and she only spends eight minutes with you, most of it spent looking at a computer screen.
Many doctors have felt the same discontent. In fact, two new practice models have emerged in response to physicians’ desire to get back to focusing on patients’ needs. These two models – concierge medicine and direct primary care – have similar benefits, but different costs and purposes.
Compare these two models with traditional primary care to see which type of practice might be right for you:
Each concierge practice is different, but at Louisville Concierge Medicine, patients pay an annual $2500 access fee per person or $4000 per couple. The fee does not cover medical services, which are billed to insurance just like traditional practices.
Concierge medicine provides a full complement of primary care services with additional benefits, such as coordination of subspecialists, wellness consultations, same day appointments and 24/7 access, including cell phone calls and email. Dr. Karageorge also admits to the hospital and follows patients on an inpatient basis.
Dr. Karageorge now has 200 patients as opposed to 2000. Coordinating subspecialist care is one of Dr. Karageorge’s priorities: “Medicine has become so super-specialized that patients literally can have five or six different physicians. My job is to coordinate all the consultations so nothing falls through the cracks.”
Direct Primary Care (DPC)
At both Bluegrass Family Wellness and OneFamilyMD, DPC, monthly fees are age-based ranging from $10 for children to $50-$100 for adults. The fees cover medical services. DPC practices do not bill insurance.
The monthly fee for both Bluegrass Family Wellness and OneFamilyMD includes annual wellness evaluations, unlimited office visits, same day appointments, technology visits, house calls and hospital visits, collaboration with sub-specialists as needed and most in-office procedures. Tracy Ragland, MD, founder of OneFamilyMD, estimates she manages 90 percent of her patient’s health care needs within the practice.
DPC physicians typically serve 400-800 patients rather than the traditional 2000-3000. In addition to access and service, cost savings may be a surprising benefit. DPC practices negotiate wholesale pricing on labs and pathology reports, and Drs. Rutherford and Ragland also offer a wholesale in-office pharmacy. (Controlled substances are not offered.)
Traditional Insurance-Based Primary Care
Costs vary based on insurance carrier and plan. All services are billed to insurance or the patient .
According to Medline Plus, a website of the National Institutes of Health, a primary care provider’s role is to oversee common medical issues, provide preventive care and refer to a specialist when needed. This can include everything from treating a cold to routine gynecologic care to managing chronic conditions, such as high blood pressure.
The traditional practice is still the most common model in Kentucky.
How Do I Choose?
If you visit the doctor frequently, have a chronic condition or take multiple prescriptions, it may be worth considering a concierge or DPC practice.
Many of these practices offer complimentary meet and greets. Ask questions and consider costs carefully. It’s important to note that DPC practice fees do not cover specialist or inpatient care, so physicians typically recommend patients maintain high-deductible plans or alternatives like health sharing or limited benefit plans.
Jennifer Newton is a writer and project manager with WordsFresh.