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Alternative practice, payment models have growing appeal
e-Reports, Nov. 3, 2014
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If you’re frustrated by declining reimbursement, complex insurance contracts and reduced time with patients, you may be looking at alternatives to traditional fee-for-service medicine. Perhaps you’ve considered transitioning to a direct pay, private medicine, concierge practice – or some hybrid model. Doctors coast-to-coast are thinking it over.

The 2014 Great American Physician Survey published by Physicians Practice, sponsored by Kareo, reported 44.5 percent of respondents were considering changing to a direct pay practice or something like it; 8.3 percent had already changed.

The terms private medicine, boutique, concierge and direct pay refer to practices that do not rely solely on insurance revenue and collect a retainer fee, a national average of $50 a month. All kinds of models exist and the lines become blurred when defining each one. Some bill a few insurance plans or just Medicare; others charge a per-visit fee, plus a retainer or a combination of the two.

But all offer enhanced services like same-day appointments, longer visits, direct phone and email access to the physician, and even telehealth services. Most physicians have a significantly smaller patient size, making it possible to provide more personalized care.

Dr. Hector
Andrew Hector, M.D.
Honey Grove Concierge Medicine

Andrew Hector, M.D., of Honey Grove Concierge Medicine in Center Grove explained, “Some direct pay practices are trying to get away from the terminology ‘concierge medicine’, but there aren’t currently other good terms for direct pay practices.” A growing number of practices are embracing

what is being called “blue collar concierge medicine” with fees that can be lower than insurance-based practices.

An ISMA member, Dr. Hector started his practice in February, after years of working for two different health systems. “In our practice, we decided to keep the ‘concierge’ term in order to make it clear to our patients that our practice offers something different than a traditional insurance-based practice,” he said.

The idea of refusing insurance payment started in the 1990s. According to the American Academy of Private Physicians (AAPP), direct pay practices in the U.S. now number more than 5,000.

Dr. Priddy
Matthew Priddy, M.D.
Priority Physicians PC

Carmel’s Matthew Priddy, M.D., with Priority Physicians PC, who is currently president of the AAPP and an ISMA member, said. “There is a private medical model to fit anywhere in the country.” Some of his AAPP colleagues live in small towns and charge a retainer of $40 a month. “People who make their health care a priority can afford it,” he said.

Benefits to patients
Both physicians are quick to note that because they spend more time with patients, they get to know them better – as well as their families and their circumstances. “I not only do a patient medical history but also a social history, which is now mostly overlooked,” said Dr. Hector.

He explained that all his visits are 30 minutes and added, “When you talk with a patient longer, very important things come up that would not if a doctor was rushed. My patients are usually the ones who end an appointment – not me.”

Dr. Priddy said the benefits have been much studied by national brand companies like MDVIP and SignatureMD. “Patients in private physician practices are admitted less and spend less time in the ER. We keep our patients healthy and decrease use of critical care.”

Patients also avoid having their care dictated by the whims of insurers. “It’s like medicine was 50 years ago,” said Dr. Priddy.

However, both physicians caution their patients about having some insurance to cover specialty procedures and hospital stays. Many of their patients have plans with health savings accounts or very high deductibles.

“Direct pay practices can be very good for a community,” Dr. Hector said. “Many patients with high deductibles or no insurance can actually find high quality medical care for lower cost than they can in a traditional insurance-based practice.

We are seeing many patients who have not had medical care for years.”

Dr. Hector is interested in helping other doctors “out of an inefficient system” and into some form of direct pay.

Read the next ISMA Reports for more cautions and suggestions on this topic.

Other options now available for patients
Self-pay patients or those with health savings accounts have new options you might want to know exist. Options are made possible by new technology.

Medibid works like online travel auction companies Priceline and Hotwire. Patients needing nonemergency services search for physicians who have quoted their charges, terms and conditions. Patients shop online based solely on price or examine full-service offerings to find what best suits their needs. Bidders are assured the physicians are licensed. Patients must verify credentials and research quality.

Physicians' monthly charges to appear on the websites are determined by the number of bids expected or categories where their names appear.

Insurers are now paying for remote conferencing or telemedicine, allowing those services to grow. Teladoc is one company enabling such consultations for patients in rural or underserved areas or those who can’t visit in person. Teladoc hires U.S. board-certified primary care physicians who add telehealth to their current practices, following training to be effective with audio and video treatments.

United Telehealth Services does the same for specialty care, providing physician practices with the technology needed to participate.

More companies exist or will exist; this article serves as an introduction, not a comprehensive list. Companies named illustrate what is available and are not endorsed by the ISMA.

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