The growing popularity of concierge healthcare among doctors, nurses and other healthcare professionals can be explained in two words: quality care.
Giving patients the time and attention they need becomes increasingly difficult in “volume-driven” healthcare environments, according to Healthcare Finance. A “retainer” or membership practice allows physicians, family nurse practitioners (FNP) and other nursing professionals to provide in-depth medical care that enhances their careers while benefiting patients and saving lives.
Concierge healthcare is seen as a way to address the critical shortage of primary care doctors. In the 2019 National Resident Matching Program, known as “the Match,” there was a record number of internal medicine positions: 8,116, as Kaiser Health News reports. Yet only 41.5 percent of internal medicine positions were filled by seniors earning their M.D.s at U.S. medical schools, while similar declines were recorded in the primary-care fields of family medicine and pediatrics.
By contrast, concierge medical services are gaining in popularity. It is difficult to determine the number of private, subscription-based healthcare delivery services operating in the U.S. because there is no registry or database of doctors and other medical professionals using the pay-as-you-go business model. However, Concierge Medicine Today estimates that subscription-based healthcare, which is also referred to as direct primary care (DPC), increases by 3 percent to 6 percent each year, particularly in the areas of family medicine and internal medicine.
Concierge medical services are evolving in ways that make them suitable for potentially more patients. The trend also creates career opportunities for nurses and FNPs, in large part due to the growing range of healthcare services that now fall under the concierge medicine umbrella. This guide explores the career potential of concierge healthcare from the perspective of nursing students looking for a promising specialty to pursue.
New Services Proliferate as Concierge Healthcare Expands
According to DPC Frontier, there are now 1,186 DPC providers in 48 states and the District of Columbia, compared to 273 locations in 39 states in 2015. Consumer Reports states that about 500,000 patients receive care from DPC providers, primarily for screenings, wellness visits, diagnostic tests and other general medical services. DPC providers also offer minor urgent care; but surgeries, emergency services and other more extensive care require a comprehensive health insurance plan.
The primary benefit of concierge healthcare for caregivers and patients alike is the extra time and attention patients receive. The average amount of time a primary care physician spends with a patient during a typical visit is 15 minutes, but the average visit to a DPC physician is 35 minutes, according to a study by the Population Health Institute. Similarly, a primary care practice will likely have 1,000 to 2,000 patients per physician, while a DPC practice has an average of 600 patients per caregiver.
Here’s a quick look at some of the popular categories of concierge healthcare services.
Boutique Concierge Healthcare Services
This is the original concierge healthcare model, dating to the launch in 1996 of MD2, a program that offered residents in Oregon and Washington state a patient-to-doctor ratio of 50 to 1 (compared to ratios as high as 3,400 to 1 for typical primary care practices) at a price of $13,200 per year for individuals and $20,000 for families. As Healthcare Dive reports, MD2 has since expanded to California, Illinois, Texas, New York City and Washington D.C.
In exchange for the high fees, boutique concierge healthcare plans provide patients with direct, unlimited access to their doctors and other healthcare providers, as well as what Verywell Health refers to as “full coordination of care.” Under the current health insurance model, doctors are paid to diagnose patients and perform procedures; they are not paid for the time they spend with patients, nor are they reimbursed for coordinating their patients’ care. The boutique concierge model, which is also called retainer medicine, flips this model by paying physicians in cash for the type of “benevolent healthcare” that was practiced before insurance industries dictated the rules of medical care.
Concierge Healthcare Subscription Model
A defining characteristic of concierge healthcare’s subscription model is the retainer fee: rather than having to bill insurance companies after treating patients, healthcare providers are paid all or some of their fees up-front. The retainer fee financing model takes two forms, as Healthleaders Media explains: patients may pay a relatively modest amount monthly or annually and their insurance carrier or Medicare will be billed separately for the covered healthcare services they receive, or patients pay a higher retainer fee that covers all of the medical treatment they receive.
The primary benefit of the subscription model for patients is that physicians are able to spend more time with them than they receive under typical health insurance plans. This allows the doctor and patient to have a “deeper, one-to-one relationship,” according to Healthcare Finance. However, retainer fees vary from as low as $1,500 per person per year to $5,000 annually for each person, according to , although most concierge healthcare subscriptions cost between $160 and $200 per person per month.
The DPC model adopted by some healthcare providers reduces the fees patients pay to between $20 and $80 a month, but the plans cover only primary care services such as annual checkups and routine monitoring. At the opposite end of the spectrum, a handful of elite medical practices charge as much as $80,000 annually per family in exchange for the undivided attention of teams of medical professionals who manage their health the way financial managers safeguard their money, as the New York Times reports.
Virtual Concierge Medicine
Instant access to a healthcare provider is only one of the benefits of online medical services, which is also referred to as distance medicine. Online Medical Care explains that patients also benefit from the transparent pricing of online healthcare services, as well as the convenience of in-home consultations, which is particularly helpful when patients don’t feel well. Healthcare providers are able to keep the cost of their services low because they don’t need to maintain extensive facilities and medical equipment.
Online Medical Care’s top pick for virtual healthcare services is SteadyMD, which is designed to replace patients’ general practitioner rather than to supplement their existing medical providers. SteadyMD allows patients to interact with their physician via an application. Their doctor is chosen for them based on the patients’ characteristics, interests and goals, according to the Advisory Board. The service costs $99 per month for individuals and $169 per month for families; it includes an initial one-hour “comprehensive” appointment, unlimited texting, same-day phone and video chat appointments, and a remote-monitoring platform operated in conjunction with tests conducted at local medical laboratories.
Population-Based Concierge Healthcare
One of the criticisms of concierge healthcare is that it limits access to care for underserved populations, especially poor people and the elderly. Rheumatology Advisor points out that as more healthcare providers choose to follow the concierge model, the shortage of physicians grows worse, especially in the primary care areas of internal medicine, family medicine and pediatrics.
In response, a number of organizations are establishing concierge healthcare services targeted at the most vulnerable populations. For example, ChenMed is designed to provide seniors who have moderate to low incomes with “VIP treatment” for their complex chronic diseases in conjunction with their Medicare Advantage plans.
Other examples of concierge healthcare services that target at-risk groups are BetterHelp, which offers mental and behavioral health services and currently serves 4 million patients; First Opinion, a free service that provides 24/7 messaging to allow patients to pose health-related questions to a “matched doctor team”; and Zipnosis, a smartphone application that for a one-time fee of $25 allows patients to receive diagnoses and advice from a clinician after they submit a detailed questionnaire describing their health condition.
Benefits of Concierge Healthcare for Healthcare Professionals and Patients
The healthcare industry and healthcare professionals are taking advantage of the concierge healthcare trend to improve the quality of service they provide to patients while simultaneously generating new sources of revenue. For doctors and nurses, concierge medicine presents new avenues for them to improve and advance their careers.
Concierge healthcare services are seen as a way for medical providers and professionals to mitigate the tough economic times now facing the healthcare industry. For example, the acute shortage of primary care providers is blamed in part on the pressures placed on clinicians by insurance providers to spend less time with each patient, not to mention the time and cost of billing and coding for insurance purposes. Increased reliance on DPC services and expanded roles and responsibilities for nurse practitioners are two approaches that address the need for improved primary care during times of shrinking healthcare revenues.
While hospitals were initially concerned that concierge healthcare services would hurt their bottom line by depriving them of patients most able to pay, many are now planning or have begun to offer their own concierge services. This trend is driven in large part by the increasing willingness of consumers to pay extra in exchange for improved healthcare services. Healthcare Dive describes concierge programs offered by Massachusetts General Hospital, the Cleveland Clinic and Inova Health System.
In addition to allowing them to spend more time treating each patient, concierge healthcare benefits doctors, FNPs and other nursing professionals by giving them more control over their practices, which reduces burnout and depression, as Healthcare Finance reports. However, a common misperception among caregivers is that concierge healthcare allows them to make more money. Instead, physicians and other healthcare providers are more likely to retain their practice under the DPC model because it increases their satisfaction, in part by allowing them to maintain their existing income levels while seeing fewer patients.
From a patient’s perspective, concierge medicine delivers a higher-quality healthcare experience in exchange for increased financial responsibility, as Patient Engagement Hit explains. Patients don’t have to wait as long to be seen by their healthcare providers, and their administrative burden is reduced because there’s less insurance and other paperwork to complete. However, the greatest benefit of concierge healthcare for patients, just as with providers, is the improved quality of care, simply because caregivers are able to spend more time with each patient.
How Concierge Healthcare Can Advance the Careers of Nurses
Nurse practitioners are at the center of the search for solutions to the shortage of primary care providers. By making healthcare professions more attractive to potential nursing and medical students, concierge healthcare helps address the critical shortage of clinicians, particularly those in primary care.
Medical Economics explains that extending concierge medicine, DPC, retainer-based medicine and membership-based practices to FNPs and other nursing professionals would improve the quality of care patients receive while simultaneously addressing the growing shortage of primary caregivers. For example, one of the cornerstones of concierge medicine is shrinking practice sizes from the current standard of 1,500 to 3,000 patients per caregiver to a more manageable 400 to 800 patients for each primary care provider. Achieving this goal requires expanding the roles of FNPs and other nursing professionals to include provision of primary care.
Much of the growing demand for concierge healthcare is driven by patients’ desire for more convenient access to their primary caregivers. points out that FNPs and other nurse practitioners meet the needs of these patients more efficiently than physicians, and at a lower cost.
The primary benefit of concierge medicine for all healthcare providers is the opportunity to develop closer relationships with their patients, which leads to improved health outcomes. As the cost of concierge healthcare declines via specialization and automation (such as “nurse lines” that are becoming popular in DPC services), more patients are able to benefit from concierge medicine.
Times of tremendous change, such as those now occurring in healthcare, are also times of great opportunity for nursing professionals who are prepared to lead the change and deliver high-quality care to all patients in need. They do so by taking full advantage of all the healthcare options available to them, one of the most important of which is concierge healthcare.
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