While the merits and drawbacks of concierge medicine are often debated, the similarities between it and the Patient-Centered Medical Home (PCMH) model of care are seldom acknowledged.
Yet there are many similarities. As internist Floyd Russak, who recently transitioned to concierge practice, told Physicians Practice, “There’s really a blurring or a crossover between concierge medicine and primary-care medical homes. People don’t see it that way, but there really is.”
In fact, Russak’s Highlands Ranch, Colo.-based practice (which he shares with three fee-for-service based physicians) is “ramping up” to go through the PCMH transition process, and Russak said he’s at an advantage because he’s already a concierge doctor. “From looking at what it takes [to transition] it will be very easy for me.”
Here’s a look at some of the key similarities between the PCMH and concierge:
• Similar standards. Perhaps the easiest way to identify the similarities is to start with the 2011 PCMH-recognition criteria set forth by the National Committee for Quality Assurance (NCQA), a nonprofit organization dedicated to improving healthcare quality. Practices can achieve one of three levels of medical home recognition based on their ability to fulfill objectives in six categories: enhance care access and continuity; identify and manage patient populations; plan and manage care; provide self-care support and community resources; track and coordinate care; and measure and improve performance.
While concierge practices are not officially held to the same standards, successful ones take similar steps, such as providing patients 24/7 access to care, ensuring patients can schedule same-day or next-day appointments, allocating more time to patient visits, and working to improve the quality of care patients receive. That’s because patients pay concierge practices an additional fee for these additional services — if they don’t get what they pay for, they will go somewhere else.
• Similar goals. Both models also lower healthcare spending and improve care quality (or at least strive to do so). The medical home, for instance, takes steps to increase prevention and management of chronic diseases and therefore, prevent small health problems from escalating; it works to improve care coordination so that care is less fragmented; and it aims to increase patient engagement and improve the physician-patient relationship so that patients make smarter healthcare choices.
The concierge model also has many of these objectives. For instance, Russak provides his patients 24/7 access to care, home visits, and access to mobile technology (such as mobile X-rays). As a result, he is able to better manage patient conditions and more thoroughly track and care for them outside his practice. For example, when one of Russak’s patients recently had a small pneumonia, he was able to treat her at home rather than sending her to the hospital. That saves the system a “tremendous amount of money,” said Russak.
• Similar funding. A discussion about concierge practice wouldn’t be complete without noting the fee patients pay for increased access to care on top of holding regular insurance. This fee ranges greatly, depending on the practice. Russak’s patients pay a $1,500 annual fee.
Many medical homes also receive an additional payment for their services (though it is likely a lower fee that comes from a different source). Some payers, for instance, provide special incentives to NCQA-recognized practices. Other medical homes receive per member per month stipends for participating in medical home demonstration projects.
• Similar opportunities. Family physician Bruce Bagley, medical director for quality improvement for the American Academy of Family Physicians as well as for TransforMED, a nonprofit subsidiary of the physician organization that specializes in helping practices transition to medical homes, told Physicians Practice he sees no reason a concierge practice would be precluded from becoming a medical home — as long as it meets all the PCMH recognition criteria.
• Big differences. Still, Bagley said the typical concierge practice looks a lot different than the typical medical home. “Concierge practice, I think, usually involves a relatively low-overhead practice in a sense that there’s usually only the physician along or with one or two employees,” he said, noting that concierge physicians also treat a smaller number of patients. The medical home model, on the other hand, embraces more of a team-based approach to care and the transition to it does not limit the number of patients the practice serves.
“I guess the problems [with concierge] are that, although it’s good for a physician who chooses that path and for patients who can afford and have access for that, it’s not really good for health policy, primarily because we don’t have the capacity to do it that way,” said Bagley. “So we have a physician shortage in the traditional model, but this actually takes physicians out of the pool, if you will, to serve the greater community.”
What similarities and differences do you see between the medical home and the concierge model?