With recent changes in healthcare and insurance costs skyrocketing a number of alternative practice models have developed. Patients are getting frustrated with long waits to see a doctor, the inability to see a doctor and are turfed to midlevel providers and limited time with their doctors. Typical face-to-face time with a physician usually only lasts 7-10 minutes. Many of these alternative models are memberships based, but just because models are built around a membership fee does not make them the same.
Here are 6 ways in which concierge medicine and direct primary care (DPC) membership practices differ:
(1) Membership Fee: In concierge medicine, there is an annual fee that can be paid in full or divided into smaller payments, but the contract is for the entire year. In DPC, members typically pay a much lower monthly fee and may drop out of the program at any time (usually with a 30 day notice to cover emergency care).
(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 (many times these are unnecessary). In DPC, the membership fee generally covers unlimited patient visits (annuals, sick and chronic care management), in-house testings, ECGs and some minor procedures. It also allows for access to discounted medications, laboratory and X-ray services and more.
(3) Cost: Concierge medicine membership fees tend to be much higher than DPC membership fees (upwards of $300/month). DPC membership fees are usually priced on a sliding scale, where younger patients pay less than older patients (many times less than a person’s cell phone or cable bill).
(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 (this makes them responsible for any copays). In DPC, the physician does not accept third party reimbursements. The membership fees paid by the patients cover their medical visits, access to the physician by phone, text or email, some offer home visits and in-house testing (some services are charged separately).
(5) 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. But as noted above, there are not out of pocket copays.
(6) Patient Profile: The average concierge medicine member is typically and older more affluent patient since concierge fees tend to be much higher. On the other hand, since DPC physicians tend to offer more affordable membership fees their patient population tends to be more diverse. Affluent and older patients appreciate the extra time DPC allows with immediate access to their physician. DPC offers more affordable care to those who are unable to pay for insurance or have high deductible plans. In the concierge models these patients would have to pay cash for their visits in addition to the higher membership fee. DPC levels the playing field, in that all patients regardless of their financial status can get great care with better access from their personal physician.