Concierge Physician Guide

Concierge Physicians goes by many names, boutique medicine, retainer medicine, executive health, VIP medicine, and personalized medicine. By any name, Concierge Physician is the solution for doctors trying to maintain their integrity and independence in today’s difficult healthcare environment. Concierge Physician is a new style of practice with old roots, in which doctors limit their patient base in order to provide patients with personalized service, high quality care, 24-7 availability, and other amenities. In exchange for this enhanced personal attention, patients pay physicians an annual fee. This concierge fee enables physicians to increase their compensation while managing their workload. In addition to receiving an annual fee, most concierge physicians continue to receive reimbursements from health plans and private pay clients.

Concierge Physicians is a relationship between a patient and a primary care physician in which the patient pays an annual fee or retainer. This may or may not be in addition to other charges. In exchange for the retainer, doctors provide enhanced care. Other terms in use include boutique medicine, retainer-based medicine, and innovative medical practice design. The practice is also referred to as membership medicine, concierge health care, cash only practice, direct care, direct primary care, and direct practice medicine. While all Concierge Physicians practices share similarities, they vary widely in their structure, payment requirements, and form of operation. In particular, they differ in the level of service provided and the amount of the fee charged. There are an estimated 5,000 concierge, or membership medicine doctors throughout the U.S. Concierge physicians care for fewer patients than in a conventional practice. All generally claim to be accessible via cell phone or email at any time of day or night or offer some other special service beyond the normal care provided. The annual fees vary widely, from $600 to $5,000 per year for an individual, with the lower annual fees being in addition to the usual fees for each service and the higher annual fees including most services.

Some concierge practices do not accept insurance of any kind. These are as cash-only or direct primary care practices. By refusing to deal with insurance companies, these practices can keep overhead and administrative costs low, thereby providing affordable healthcare to patients. They become concierge only if the practice assesses an annual or monthly fee instead of or in addition to a fee for each medical service. Other concierge practices do take insurance, even Medicare, but ask for an annual fee for additional services exclusive of insurance plans. This annual fee is not a substitute for medical insurance, and generally does not cover consultations outside the practice, laboratory procedures, medicines, hospitalizations, or emergency care from other providers.

Physician Ownership and Other Transparency - Affordable Care Act

SEC. 6001. LIMITATION ON MEDICARE EXCEPTION TO THE PROHIBITION ON CERTAIN PHYSICIAN REFERRALS FOR HOSPITALS.
(a) IN GENERAL.—Section 1877 of the Social Security Act (42
U.S.C. 1395nn) is amended—
(1) in subsection (d)(2)—
(A) in subparagraph (A), by striking   and’’ at the end;
(B) in subparagraph (B), by striking the period at the
end and inserting   ; and’’; and
© by adding at the end the following new subparagraph:
© in the case where the entity is a hospital, the hospital
meets the requirements of paragraph (3)(D).’’;
(2) in subsection (d)(3)—
(A) in subparagraph (B), by striking   and’’ at the end;
(B) in subparagraph ©, by striking the period at the
end and inserting   ; and’’; and
© by adding at the end the following new subparagraph:
(D) the hospital meets the requirements described in
subsection (i)(1) not later than 18 months after the date of
the enactment of this subparagraph.’’; and
(3) by adding at the end the following new subsection:
(i) REQUIREMENTS FOR HOSPITALS TO QUALIFY FOR RURAL
PROVIDER AND HOSPITAL EXCEPTION TO OWNERSHIP OR INVESTMENT
PROHIBITION.—
(1) REQUIREMENTS DESCRIBED.—For purposes of subsection
(d)(3)(D), the requirements described in this paragraph
for a hospital are as follows:
(A) PROVIDER AGREEMENT.—The hospital had—
(i) physician ownership or investment on December
31, 2010; and osection 10601(a)(1) amended this
clause by striking ‘February 1’ and inserting ‘August 1’;
section 1106(1) of HCERA further amended this clause
by striking ‘August 1, 2010’ and inserting ‘December
31, 2010’; shown to reflect probable intent.
(ii) a provider agreement under section 1866 in
effect on such date.
(B) LIMITATION ON EXPANSION OF FACILITY CAPACITY.—
Except as provided in paragraph (3), the number of
operating rooms, procedure rooms, and beds for which the
hospital is licensed at any time on or after the date of the
enactment of this subsection is no greater than the number
of operating rooms, procedure rooms, and beds for
which the hospital is licensed as of such date.