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Hybrid Concierge Medicine Offers Hope for Primary Care

Wayne Lipton, for HealthLeaders Media, February 26, 2009

The nation's physician leaders, legislators, and healthcare advocates are wringing their hands over a spate of articles highlighting the ever-decreasing number of primary care physicians (PCP).

 

It's an issue worthy of concern. According to a recent article in JAMA, "the United States faces a shortage of primary care physicians that could exceed 40,000 by 2025." Many areas of the country already face a severe shortage of PCPs.

It is commendable that the nation's healthcare leaders are aware and concerned about the problem, but it is time to do more than just talk about what can be done. It's time for an honest dialogue about realistic and viable options. While many solutions are being discussed, most agree that what we need is a system that promotes quality care while creating a realistic option for physicians and providing affordable and accessible choices for healthcare consumers.

As with any complex problem, there is no one answer and no single solution that will address all of the challenges related to the current primary care physician shortage. However, many physicians now believe that a small but growing practice model—hybrid concierge—should be added to the discussion.

Hybrid concierge models give patients the choice of the model within a practice—concierge or traditional insurance coverage—that best meets their needs. In addition, it gives physicians the opportunity to practice medicine the way they were taught and to be fairly compensated for their commitment and service to patients.

Options for Physicians and Patients
While the concept of concierge medicine holds much promise, the current model, also known as boutique or retainer medicine, has gained its share of detractors. Primarily they that claim it:

  1. Costs too much for the "average" healthcare consumer
  2. Creates multiple tiers of care
  3. Exacerbates the shortage of primary care physicians

However, a hybrid practice directly addresses all these points and more. For example, in terms of cost, the average price of a hybrid option within a primary practice is $100-$150 per month for a patient. While the price will not fit all budgets, it will fit many, particularly those who value a more personal relationship with their physician.

In addition, the hybrid model includes a Comprehensive Wellness Exam. This evaluation and a series of screening tests are the cornerstone of a preventive program designed to achieve long-term health goals. Combined with other services, the actual yearly cost of a hybrid practice option is less than what most patients would pay for a standard executive physical.

As to the argument of a multi-tiered system, the majority of medicine practiced today is already multi-tiered. Patients have many healthcare needs, as well as many personal preferences. As Americans, we don't want anything single-sized; we want choices. The hybrid model provides a reasonable, accessible product that allows the consumer to select the option that makes the best sense for him or her.

However, the aspect of the hybrid model that most intrigues physicians and consumer advocates is that it enables physicians to continue to see their traditionally insured patients and to remain in government and private plans.

Under a full concierge practice, many physicians simply stop seeing patients that don't opt to join and pay the monthly fee, leaving patients to find new healthcare providers (and causing some insurers to drop those providers). In addition, they often are dismissed from plans or elect to leave government plans like Medicare.

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