News & Releases

The buzzwords of health care reform we focus on – Accountable Care Organizations (ACOs), Patient-Centered Medical Homes (PCHMs), Health Information Technology (HIT), Medical Loss Ratios (MLRs), etc. – are all ideas with (mostly) good intentions but none of them will change health care in America to actually improve patient care and reduce health care costs.  Direct Primary Care (DPC) is the only good idea I’ve heard with the potential to ensure access to health care, decrease health care costs, and improve health outcomes.

The idea behind DPC is simple: pay your doctor a monthly fee for your care.  In other words, your doctor charges you say $50-$100 per month and provides your care. Usually when this model is discussed, it is in the vernacular of “concierge” medicine.  The word concierge brings with it a sense that such a health care system is only available to the wealthy. However, DPC is actually a way in which we can help everyone care regardless of their socioeconomic status. It’s like a membership.  You already pay (or your employer pays) insurance premiums each month and those premiums are well over $100 per month.  In fact, on the individual market, insurance is easily above $400 per month per person.  If employers and government invested in this model of care, the savings would be overwhelming.

Health care is in crisis. Reimbursements from insurance companies continue to dwindle, while the expenses of running an office continue to rise.  Looming cuts in Medicare are only weeks away, and many physicians may stop taking Medicare.  If these cuts go into affect, it is possible that primary care physicians could lose up to 50% of their salary.  Just recently CNN reported that some doctors are going bankrupt.

How to fix our health care system is an ongoing debate, but not surprisingly, many physicians have decided not to wait for the government to solve this problem and have taken matters into their own hands. One solution is to simply stop taking insurance altogether.  “Cash only” doctors are now commonplace in many major metropolitan areas.  Another solution is charging a regular, out of pocket fee (usually) in addition to what insurance will pay for treatment.  A version of this model that is becoming popular is called retainer medicine.  Sometimes, retainer medicine is referred to a “boutique” or “concierge” even by physicians and others involved in health care (as evidenced by this article in American Medical News, which prompted me to post on this topic).

However, “retainer”, “concierge” and “boutique” are not the same thing. Names are important, and the terms “concierge” and “boutique” tend to have negative connotations. Thus, it is important to describe the differences.