We likely have a couple of things in common. For starters, we feel frustrated by our experience with status-quo traditional primary care. There has to be a better solution than the increasingly common experience of not having enough time with your doctor, having to wait, and then feeling rushed.
You know what else we share? We hate confusing terms and inconsistent definitions. So as we talk about creative alternatives to status-quo medicine, we should be clear in the ways we describe different care models.
At PartnerMD, we have set ways to explain the main categories of alternate care. Not everyone shares our definitions, at least in the small details. Even experts in this field don’t use the same verbiage, so you may find different terms used elsewhere. But to be clear and transparent with you, we want to walk through our use of some popular terms.
Traditional Primary Care
It’s the one you know and likely don’t love, the 7-minute medicine that has swept the healthcare industry in the U.S. It’s a numbers game — a traditional doctor can have as many as 5,000 patients and might see 30 to 40 of them per day. The doctor gets reimbursed from contracts with insurance carriers, while patients pay whatever rates their carriers negotiate for them.
When we call this “traditional” primary care, we don’t mean that it’s old-school in any sense. Care used to be a lot more high-touch and personalized than this. But this high-tempo turnstile has become the norm, and not everyone knows there are other options.
Now we start to slow down with a style of care that puts patients in front of their physician for longer. In a concierge practice, doctors might have 300 to 600 patients rather than 5,000, and they might see 4 to 10 per day rather than 30 to 40.
Concierge members pay a fee to get more access to their doctors, on average $1,500 to $3,600 per year. Fees help doctors offset what they voluntarily forfeit by slowing down and spending plenty of time with each patient.
Most of these practices accept insurance just like a traditional primary care practice would. There are exceptions, but those are practices that we define in a separate category or label cross-category. Generally speaking, concierge practices take insurance.
For all of the traits concierge practices share, they also vary greatly when it comes to fees and benefits. Whether it’s pediatrics, senior care, sports medicine, or anti-aging — if there’s a specialization you’re seeking, there’s likely a concierge practice out there for you.
All concierge practices emphasize a better patient experience, but they do it in different ways. Some practices focus on low wait times, while other practices push access to physicians. In some practices you'll have a dedicated physician, and others may provide services via a panel of doctors and clinical staff, just to cite a few examples. But whenever you hear “concierge,” you know it’s about attentive care and a membership model.
Other terms that get tossed around to describe this patient-focused approach. It’s sometimes called retainer medicine, membership medicine, or boutique medicine. At this time, there are no guidelines for how these terms are used. It pays to be attentive and ask questions, as these terms are used interchangeably and also as separate models of care.
Direct Pay Primary Care
While concierge care is patient-focused medicine that cooperates with insurance, direct primary care is the patient-based approach that stays financially independent. It operates solely from membership fees and/or payment-for-service and doesn’t accept insurance or government programs.
By not taking insurance, practices avoid the overhead costs associated with the management of insurance coding, billing, and reimbursements.
There are a few ways a direct pay primary care practice can operate.
Membership Fee Only
For their flat-fee membership, patients receive extended visits as well as clinical and lab care. They also get the same comprehensive care management — communication and team-wide strategy among their physicians and specialists — as part of their membership fee. These practices can include benefits such as unlimited office visits, clinical and laboratory services, consultative services, care coordination, comprehensive care management, phone or email access to care, or after-hours availability.
In this direct pay model, there is no membership fee. The practice charges an advertised rate for an office visit, lab work, or other services. The pay-as-you-go model allows you to see a doctor as much or as little as needed. Typically, these practices do not offer additional perks, such as extended office visits, phone or email access to your doctor, or after-hours care.
A hybrid model blends these practice models. Patients pay an annual membership fee as well as an advertised rate for specific services. You get all the benefits of membership, but when it comes time to pay for services, you pay the doctor directly, rather than working through insurance. PartnerMD offers this model to patients without health insurance.
Patients don’t need insurance to receive any of these services. In fact, in many cases patients are not allowed to have health insurance to participate in direct pay primary care. That said, if you're considering this option, you should look for catastrophic insurance coverage in case of an emergency beyond primary care.
Because of the membership aspect to some direct pay practices, these models can be considered a type of concierge medicine. We tend to think of direct primary care as its own model, not as a sub-category, because its financial model is so different. However you hear a practice described, it’s good to double-check whether it accepts insurance.
What happens when patient-focused care meets a top-floor lifestyle? That’s the idea behind luxury medicine’s hyper-dedicated care. If you’ve seen TV shows like “Royal Pains” or “Rush,” then you get the picture. A doctor works with very few people, or even one person, in constant availability.
If that celebrity treatment sounds expensive, well, it is, with personal physicians charging as much as $10,000 to $50,000 per year. This style, which is sometimes called VIP medicine, requires a high-dollar retainer for perks that include private rooms or wings at hospitals and fast-track access to emergency specialists.
We like to think that all alternative care makes you feel like a VIP. But the luxury approach brings plenty of extravagance to your medical and hospital experience.
Use Membership and Insurance to Sort Your Options
You will hear a lot of these terms used interchangeably. Why all the confusion? Well, some practices are cross-category and blur the lines, and the genre’s quick rise hasn’t given us much time to agree on universal terms.
But as you look at practices, the biggest gap to understand is between traditional and membership models. Then, if you find a membership model, your next question is whether it cooperates with insurance. Answer these questions about any potential practice and then delve into specifics to find your best fit.
We hope these categories help you picture and discuss your care options. Let us know in the comments if there are other terms you want us to include and explain.
To learn more about concierge care and the key terms that surround it, check out our free guide to Understanding Concierge Medicine.