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 or concierge practice – or some hybrid model of direct primary care.

Doctors coast-to-coast are thinking it over. The 2014 Great American Physician Survey, published by Physicians Practice and 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 done so.

The terms “private medicine,” “concierge” and “direct pay” refer to practices that do not rely solely on insurance revenue and collect a retainer fee that averages $50 a month in the United States. All kinds of models exist, and the lines become blurred when trying to define 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.

More services offered
All offer enhanced services, such as same-day appointments, longer visits, direct phone and email access to the physician and even telehealth. Most physicians using this model have significantly fewer patients, making it possible to provide more personalized care.

Andrew Hector, MD, of Hector Family 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 may be lower than insurance-based practices.

Dr. Hector started his practice in February 2014, after years of working for two different health systems. It was originally called Honey Grove Concierge Medicine. “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.

“There is a private medical model to fit anywhere in the country,” said ISMA member and AAPP President Matthew Priddy, MD, of Priority Physician PC in Carmel. 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 Dr. Hector and Dr. Priddy are quick to note that, because they spend more time with them, they get to know patients – as well as their families and their circumstances – better. “I not only do a patient medical history but also a social history, which is now mostly overlooked,” Dr. Hector said. He explained that all visits last 30 minutes.

“When you talk with a patient longer, very important things come up that would not if a doctor was rushed,” he noted. “My patients are usually the ones who end an appointment – not me.”

Dr. Priddy said the benefits have been extensively studied by national-brand direct primary care companies such as MDVIP and SignatureMD. “Patients in private physician practices are admitted less and spend less time in the ER,” he said. “We keep our patients healthy and decrease use of critical care.”

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

However, both physicians caution their patients to have some insurance that covers specialty procedures and hospital stays. Many 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.”

In an upcoming issue of ISMA Reports, Indiana physicians practicing direct primary care offer advice to others who are considering it.