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Perspective

Concierge Medicine - Going Public

July 22, 2015| By Don Curtin | Professional Liability | English

Region: U.S.

The Affordable Care Act (ACA) changed many things about healthcare in the U.S., including how doctors and hospitals get reimbursed. For many years the system was “fee-for-service” and hospitals were most profitable when they were full. Now, under ACA and the creation of Accountable Care Organizations (ACOs), doctors and hospitals are being paid for the well-being of a population of people, not for the services provided.

This has generated some interesting behaviors: Hospital systems are merging to control larger populations; hospitals are buying doctor practices to gain access to those patients, and the operational model for hospitals is changing. Not only are hospitals being reimbursed at a lower rate, they’re also penalized for a bad outcome or if a patient gets readmitted within 30 days.

This development is also generating some creative approaches. In Seattle, Washington an interesting experiment no one expected to work seems to be working. Qliance Healthcare is successfully practicing “Direct Pay Primary Care” (DPPC), or you may have heard it called “Concierge Medicine,” on a broad scale. DPPC is essentially subscriber healthcare where you pay a monthly fee that includes all services, (no deductibles or co-pays!)  So far it appears to be a “win-win-win” for patients (better care), doctors (able to focus on care not administrative documentation) and employers (cost savings over fee-for-service plans).

The focus of the fee-for-service model for primary care doctors should also be all about preventive medicine and managing a person’s well-being, not managing the volume of visits/procedures performed in a day. The DPPC model, however, actually lets primary care physicians focus on doing what’s right for the patient. The Qliance model shows it can be done; it currently serves small employers as well as large self-insured employers that outsource the administration of their healthcare program - and it has even been approved for Medicare.

Other healthcare systems across the county are experimenting with the DPPC approach. If it continues to save money for employers and employees while producing very high patient satisfaction ratings, it’s a trend everyone should be watching and hoping is successful.

 

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