Thursday, July 4, 2013

Future of Direct Pay Medicine - A Conference

Direct Pay Independent Practices – How Real, How Common, How Defined

When in the Course of Human Events, it becomes necessary for one Profession to dissolve the Financial Arrangements which have connected them with Medicare, Medicaid, assorted Health Maintenance Organizations, and diverse Third Party Payers and to assume among the other Professions of the Earth, the separate and equal station to which the Laws of Nature and of Nature's God entitle them, a decent respect to the opinions of Mankind requires that they should declare the causes which impel them to the separation.
We hold these truths to be self-evident: that the Physician’s primary responsibility is toward the Patient; that to assure the sanctity of this relationship, payment for service should be decided between Physician and Patient, and that, as in all transactions in a free society, this payment be mutually agreeable. Only such a Financial Arrangement will guarantee the highest level of Commitment and Service of the Physician to the Patient, restrain Outside Influence on Decision-Making, and assure that personal information be kept confidential.
Physicians’ Declaration of Independence,  July, 2013, Richard Amerling, Internist, New York City, July 2013

The Fourth of July, Independence Day,  is an appropriate time to compose this blog post.  There is a growing movement among primary care physicians and surgeons to declare independence from third parties.   The purpose of this post is to define the dimensions and directions of this independence movement.

As nearly as I can tell, there exists in the United States about  4400 to 5000 direct pay practices, which declare themselves “independent” of third parties.  These practices,  also billed  as retainer practices, concierge practices,  boutique medicine, cash-only practices, or innovative medicine,   establish a new relationship between doctors and patients.   For a monthly or annual retainer, which usually varies from $50 to $150 a month, or $600 to $1800 a year,  the patient receives enhanced services – an annual physical,  24/7 access,  more time with the doctor, and referrals to preferred specialists. 
About 70% of physicians practicing this new brand of medicine are internists,  with  family physicians ranking second, followed by general surgeons, and other specialists.   Their average age is 40 to 59, they see 6 to 8 patients  a day, they make between $100,000 to $300,000 annually,  52% employ one to two people., and71% say they are doing better financially then before.  In surveys, about 10% of  primary care physicians say they will consider direct pay medicine. 
Will direct pay  practices ever go mainstream?  John Goodman, the conservative economist who heads up the National Center for Policy Analysis thinks so.  He thinks the rapid adoption of Health Savings Accounts,  will propel direct pay practices to new heights..  a February 18, 2011 Health Affairs Blog,  he wrote:
Over the next decade I believe we are going to see a major transformation of American medicine. It won’t be the kind of transformation that is normally discussed at health care conferences and at inside-the-Beltway briefings. Nor will it be the kind of change anticipated by the people who gave us the Affordable Care Act (ObamaCare). Instead, what I envision is a large migration of patients and doctors, and facilities and services out of the third-party payer system.
What prompts this blog post is a message from David Racer,  a St. Paul publisher , who asked to spread the word of  an August 10, 2013,  direct pay conference to be held in Minneapolis.   The conference , if previous conferences are any indication, will be sold out.  Registration fees are $99 for medical  practitioners, $49 for health care staff, $24 for anybody else who wishes to attend, and free for residents and students.  For registration details,  The American Association of Physicians and Surgeons (AAPS) and the Minnesota  Physicians and Patient Alliance  are sponsoring the conference.
The name of the conference is “Thrive, Not Just Survive,” with a subtitle of “How  to Build a Direct Pay Independent Practice.” It is a one-day conference, 8:30 AM, to 3:30  PM. It  will feature 14  speakers, 11 of whom are MDs who have been there and done that,  i.e. practiced direct pay, concierge, retainer medicine. Three of the speakers will be surgeons,
Is direct pay medicine the future?   How fast will it continue to grow? Or, is it a fringe movement, concentrated mostly among unhappy primary care physicians seeking refuge for the expenses and hassles of 3rd party bureaucracies?  Will it evolve into a two-tier system? Will it be affordable for most patients?  Are patients and their  physicians happy with their experiences with this new practice model?   These are some of the questions that will be addressed and answered at the conference/

Tweet:  A 1-day conference on “How to Build a Direct Pay Independent Practice” will be held August 10, 2013. For details:

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