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The sweeping changes in healthcare have spawned a number of alternative practice models, and several are membership-based. But just because models are built around a membership fee does not make them the same.
Here are 10 ways in which concierge medicine and direct primary care (DPC) membership models differ:
(1) Membership Fee: In concierge medicine, there is an annual fee that can be paid in full or split up, but the contract is for the entire year. In DPC, members typically pay a monthly fee and may drop out of the program at any time.
(2) What the Membership Fee Covers: In concierge medicine, the annual fee covers an in-depth comprehensive physical with screenings that go beyond what traditional insurance or a government program would support. In DPC, the membership fee generally covers unlimited patient visits.
(3) Cost: Concierge medicine membership fees tend to be higher than DPC membership fees. DPC membership fees are usually priced on a sliding scale, where younger patients pay less than older patients. Sometimes family rates are available.
(4) Third Party Payers: Most traditional concierge medicine physicians continue to accept insurance plans and government programs, and patient visits are billed in the traditional manner. In DPC, the doctor does not accept third party reimbursements. The membership fees paid by the patients cover basic visits, and some services are charged separately.
(5) In-Network Referrals: A concierge medicine physician generally remains affiliated with insurance networks and, therefore, can refer to specialists who are also within the patient’s network. A DPC doctor is an out-of-network provider, so referrals to specialists or for special lab testing may not be accepted by the insurance carrier.
(6) Deductibles: The annual fee a patient pays to a concierge medicine physician generally cannot be deducted, but any copays or related health costs can be deducted as the concierge physician is in-network. Because the DPC doctor is out-of-network, the annual fees a patient pays for membership or lab fees, etc., cannot be applied to their deductibles.
(7) Services Included: Both concierge medicine and DPC tend to offer easily available appointments with more physician connectivity. As an in-network provider, a concierge medicine physician can serve as a patient advocate with outside specialists, hospitals, or other health providers. However, since DPC is out-of-network, a DPC doctor does not have referral relationships, making it difficult to advocate for patients with outside specialists.
(8) Patient Profile: The average concierge medicine member is an empty nester over 50 years of age. Since DPC doctors don’t accept Medicare, the members may tend to skew younger.
(9) Income: Physicians who research properly before getting started generally increase their revenue when they start a concierge medicine program. DPC is still an emerging practice model so there aren’t solid numbers to reference. However, according to the DPC Journal, 80% of DPC physicians moonlight outside of their DPC practice in order support themselves.
(10) Viability: Concierge medicine is a niche market that has been steadily growing for the last 15 years. The programs are most common in affluent areas, but flexible models are becoming increasingly popular in a wide variety of demographics. DPC practices are most common and most successful in rural communities where there are physician shortages. The number of concierge medicine practices far outnumber the relatively small number of DPC practices.
Wayne Lipton is Managing Partner for Concierge Choice Physicians, LLC, and one of the most experienced and successful executives in concierge medicine. Lipton graduated from Harvard College in 1973 with a degree in Biochemistry. He attended the University of Chicago Business School and the Boston Architectural Center. He was formerly a chief operating officer for PhyMatrix, a public healthcare company; chief operating officer for Physicians Choice, a Connecticut IPA and practice management company; and president and principal of Richmond Way Stores, a local chain of drug stores that he operated for 20 years.