The nation's leading provider of hybrid concierge medicine, Concierge Choice Physicians (CCP), sees historic opportunities for patients and physicians under the recently enacted healthcare law. Hybrid concierge practice models emphasize prevention and wellness and give physicians a way to offer a concierge option while continuing to care for all of their patients.
“The new healthcare law represents a tremendous opportunity for patients and physicians”
"One of the most significant aspects of the new healthcare legislation is a fundamental shift in Medicare's current coverage philosophy, from a system that pays for the treatment of illness to one that now encourages and offers some coverage for prevention and wellness services," notes Wayne Lipton managing partner for CCP.
Under the new healthcare law, Medicare patients may continue to receive an "introductory" physical within the first twelve months of eligibility, but they will also be eligible to receive an annualized wellness visit and limited preventive services. There is also a mandate for the creation and use of a standardized wellness assessment.
While applauding the move toward preventive care, Lipton notes that the challenge will be helping physicians fulfill the promise of the new legislation with the current shortage of primary care physicians, the economic limitations within the bill (e.g., limited funding and physician reimbursement levels) and the ongoing need for cost containment in healthcare.
Because of these issues, Lipton and industry analysts predict that privately funded practice models, like Hybrid Concierge, will continue to play an important role in the nation's healthcare system.
"The new healthcare law represents a tremendous opportunity for patients and physicians," said Lipton. "However, there are a few serious concerns. Given the need for containing health care costs, will there be adequate provider compensation rates for preventive services? If not, then the effectiveness of those services may be limited. If it is challenging to deliver treatment to patients in a volume environment, it is even more difficult to deliver effective preventive services in that environment."
Lipton and other healthcare leaders have additional concerns. Many believe that the legislation could end up depersonalizing primary care by incenting volume care and emphasizing the use of lower level providers to care for patients in the Medicare system. Others are concerned that some physicians may drop out of Medicare and commercial insurance programs because they necessitate taking care of more patients, while not providing a compensatory level of reimbursement.
While the new legislation does provide a bonus of 10 percent for Medicare primary care visits, there still remains a high probability of an overall compensation reduction to meet budgetary requirements. In addition, physician leaders note that the bonus incentive only amounts to a one-time cost of living adjustment.
Still, Lipton sees tremendous potential and reason for optimism within the medical community.
"This bill gets so much right," says Lipton. "Anything that encourages wellness is an important step. What it may not be addressing adequately is the economic reality faced by physicians today and the desire of patients to maintain their relationship with their chosen physician. We have to find a way to make it financially viable and possible for physicians to provide this additional level of preventive care. Hybrid models can make it happen."
Many patients want and need much more emphasis on wellness and prevention. The hybrid model gives patients annual preventive physicals and the option of additional visits for wellness while also ensuring availability of the patient's chosen physician. In return for a modest fee, concierge patients also get convenient scheduling, less waiting time, direct access to their physician through private phone lines and cell phones, and many more non-covered care services.
Typically about 5 to 10 percent of a practice opts to join the concierge option. The additional revenue means physicians will be less likely to drop out of insurance programs and that they can continue to see all of their patients. Full model concierge programs don't provide that option; only patients that opt to join the full concierge model remain with the practice, the remainder must find new physicians (a challenge in today's market).
"CCP has always been an advocate for patients and primary care physicians (PCPs)," said Lipton. "We've been promoting prevention since our inception. We applaud the initiatives within the current healthcare bill that strive to improve access to prevention and wellness programs. Our goal is to help ensure that patients and physicians can see this important promise become a reality."
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