I just read about a troubling trend: Hospital-owned concierge medical practices. This is where hospitals establish a concierge practice for the purpose of attracting a few hundred wealthy members (I mean patients) willing to pay $2,000 to $4,000 apiece to be able to get quick access to their physician.
Why is this concerning? Because when doctors themselves turn to Direct Primary Care (DPC), they do it to enhance patient care and increase both doctor and patient satisfaction. When hospitals do it, it’s really just about the bottom line. Direct Primary Care and concierge medicine have similar origins. However, the former is about value and benefiting patients, while the latter is a luxury service at a premium price.
When DPC medical practices first began physicians who switched over to that type of practice tended to say they were burned out. They were tired of waiting rooms full of patients, who started filing in the minute the doors were opened and lingered well after the official closing time. Doctors were tired of only being able to spend a few minutes with their patients regardless of multiple chronic conditions. Patients’ stress with the situation affected physicians, who were looking for a way to provide the kind of care both they and patients wanted. A relative faced this dilemma when he moved to a new practice and discovered there was a surplus of seniors on Medicare wanting his time. With multiple chronic conditions, they all needed more time than he could afford to give them.
The problem when hospitals try to duplicate direct primary care is that it’s for the hospital’s benefit, rather than strengthening the doctor/patient relationship. This from Kaiser Health News:
“Every time we see these models expand, we are contracting the availability of primary care doctors for the general population,” said Jewel Mullen, associate dean for health equity at the University of Texas-Austin’s Dell Medical School. The former Connecticut health commissioner said concierge doctors join large hospital systems because of the institutions’ reputations, while hospitals sign up concierge physicians to ensure referrals to specialists and inpatient care. “It helps hospitals secure a bigger piece of their market,” she said.
The biggest concern for me is the incentive doctors have to refer patients to hospital-owned medical services. DPC physicians help their patients navigate the health care system. DPC doctors help their patients find lower-cost care, providing many services for free and even some generic drugs in-house. For instance, the following is an excerpt from the Direct Primary Care Coalition:
Direct Primary Care (DPC) is an innovative alternative payment model improving access to high functioning healthcare with a simple, flat, affordable membership fee. No fee-for-service payments. No third party billing. The defining element of DPC is an enduring and trusting relationship between a patient and his or her primary care provider. Patients have extraordinary access to a physician of their choice, often for as little as $70 per month, and physicians are accountable first and foremost their patients. DPC is embraced by health policymakers on the left and right and creates happy patients and happy doctors all over the country!
Affordable, transparent costs based on a periodic overall flat rate (i.e. membership or subscription). Patients pay for their care directly to the physician. No third parties or Fee for Service billing (“FFS”) to inflate costs. Most DPC memberships/subscriptions cost less than the average cell phone bill.
The above two paragraphs sound nothing like hospitals. Hospitals are not in the business of helping patients save on services. When hospitals buy physician practices, it’s to control the care delivered to patients, capture referrals and charge facility fees.
Some concierge physicians say their more attentive care means healthier patients. A study published last year by researchers at the University of California-Berkeley and University of Pennsylvania found no impact on mortality rates. What the study did find: higher costs.
Using Medicare claims data, the researchers found that concierge medicine enrollment corresponded with a 30%-50% increase in total health care spending by patients.
Hospital-owned concierge practices suffer the same problems as hospital-employed physicians in general. When the hospital is your doctor’s boss, your doctor does the hospitals bidding, rather than answering to their patients. Direct primary care physicians who are self-employed are competing for their patients’ business on price, service and convenience. Hospital-based concierge medical clinics are providing convenience for patients with deep pockets, who don’t care about cost.
Hospitals Cash In on a Private Equity-Backed Trend: Concierge Physician Care – KFF Health News