Sunday, June 15, 2014

Finding and Identifying Direct Pay/Concierge/Retainer Physicians

People who like this sort of thing will find this sort of thing they like.

Abraham Lincoln (1809-1865)

I shall begin by saying the movement towards direct pay/concierge medicine  is in its early stages.  Doctors entering these types of practices are scattered unevenly throughout the country.  There are still few of them.  And they are not clearly visible or easily identifiable.

Estimates  of the number of direct pay/concierge  practices vary from 5,000 to 100,000, The 5,000 figure  generally indicates doctors who practice “pure” direct pay 3rd party free medicine. The 100,000 number  may includes hybrid practices who offer concierge and traditional practices, or who accept direct cash for their services, or who anticipating a switch to direct pay practices.

That said,  it should come as no surprise that no comprehensive directory exists  of  these new types of  physicians.   There are simply too many variants of the theme of doctors not taking insurance and too many hybrid practices evolving in too many specialties , to name a few,  primary care,  family medicine, cardiology, dermatology, obstetrics and gynecology,  general surgery, orthopedics, and pediatrics (see Concierge Medical Directory).     

There are a handful  of companies who offer listings of direct pay independent practice  or who will give you advice on what doctors to go to.    These include, among others, MDVIP, MD2,  Signature Health,  Concierge Choice Physicians,  Pinnacle Health,  and more recently,  Castle Connolly Medical  Ltd.    

From these companies and other Internet listings under “concierge medicine” or “concierge physicians,” you will be able to find physicians listed in your locality under  concierge physician headings.   Not all of these physicians will practice pure direct pay/concierge medicine.  Not all will offer the same array of services.  You will have to call to find out what is offered, for what price, under what conditions,  and what is included.   

You may not be able to find these doctors from traditional sources -  the Yellow Pages,  local medical societies,  hospital referral services,  or such grading companies as   And your employer,  if you are one of 160 million  Americans whose health insurance is offered by those employers,   may not know what concierge services are available.

If you have the time, you may want to search the Internet for  recent articles in national and regional publications: The New York Times,   Forbes, Departure Magazine, Town & Country,  The Wall Street Journal,   Business Week, Journal of American Medicine,   Salon, Dallas Business Journal, San Francisco Business Journal , CNBC, New York Daily News, Portland Monthly,  and Bloomberg News.

There is no shortage of news of the subject of direct pay/ concierge/retainer medicine.    Indeed, there may be too much news to digest.    Nevertheless,   ordinary people and employers are actively looking for ways to lower  health costs,  gain quick access,  and cut through the paperwork  and bureaucratic  paperwork required to see doctors  or to have a surgical procedure performed. 

And doctors  and ambulatory surgery centers are looking for ways to make their services known.   Those engage in outpatient medicine are doing so by contacting local media to generate stories on their practices,  by contacting self-funded businesses on the availability and low costs of their services,   by notifying retail clinics and other nontraditional providers of their services, and, of course, by encouraging their satisfied customers to spread the word.

Direct Pay/Concierge/Retainer/ Boutique/ Surgicenter/Direct Primary Care,  by any name,  has its pros and cons.     Its pros are direct/quick/personal /transparent/choice of care by a physician who has time to get to know you and your family.   Its cons are you have to pay out-of-pocket for what you get,  difficulty finding a physician in your area,   troubleverifying his/her credentials and track record. 

These new types of practices may well the wave of the future,   if for no other reason than the premiums and deductibles of ObamaCare health exchange and other other health plans have become unaffordable.   

A four  tier  overlapping health system  appears  to be evolving:  one,  for the  traditionally insured  covered by employers,  two,  for those on health savings accounts with catastrophic lids,  three,  for those who choose to pay directly  out- of- pocket for service, quality, and convenience, and four,  for  one-third of the population who will be Medicare and Medicaid and ObamaCare sanctioned plans.

 Direct pay/concierge/ retainer/surgicenter  medicine  based on free market principle that people will willingly pay for quality convenient service as an alternative to ObamaCare and other forms of bureaucratic  health care is growing rapidly.

Finally, but not least,  a note of Ambulatory Surgery Centers (ASC).   These centers are emerging as leaders in the direct pay movement.   Ambulatory surgical procedures are a major cost for employers, and many  major self-funded companies, like Walmart and GE, are responding by paying directly for procedures rather than channeling them through hospitals and traditional insurance plans. Cost savings are considerable with savings of 30% to 50%.

 Because of their size¸ revenue base,  number of  participants,  out-of-network issues, credentialing,  capital requirements,  hospital participation,   profitability and magnitude of specialties involved (ENT, GI endoscopy, general surgery, ob/gyn, ophthalmology, oral surgery, orthopedics, pain management ,  plastic surgery,  and podiatry – the issues are more complicated and require more sophisticated management.  The political ramifications, such as how hospitals will respond and participate,  are of a greater magnitude than with primary care practices.    Surgical procedures,  after all, are the bread and butter of hospital profitability.

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