Direct Care vs. Concierge Care

Posted by: Alok Prasad

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There is a glaring difference between direct care and concierge care – but many people don’t realize that they are not the same type of physician experience. Depending on the type of care you receive, you may find yourself sitting in a waiting room (sometimes for hours) to see your doctor for five minutes. Other care settings provide same-day appointments, quick turnaround, and direct contact with the physician – where do we sign up?

What is Direct Care?

Direct care is a healthcare model in which participating physicians do not deal with insurance companies – instead, their agreements are with the patient themselves - and therefore reduces administrative overhead while leading to more predictable revenue for providers and improved patient satisfaction due to reduced bureaucracy and potentially lower healthcare costs.Direct Care

Direct care practices:

  • Do not accept money from insurance companies
  • Rely mainly on the monthly fee (often $100 or less) charged to their patients
  • May have larger patient panels of 400 to 800 patients per provider
  • Focus more on saving money than on offering premium services

What is Concierge Medicine?

Concierge medicine, also known as boutique medicine, retainer-based medicine, or membership medicine, is a relationship between a patient and a primary care physician which provides patients with on-demand access to a physician (day or night) via phone, email, and same-day appointments. Concierge providers, unlike direct care, often accept insurance but are overall more expensive. Under concierge medicine, the patient pays an annual retainer fee which can be in addition to, or in place of, other charges. 

Concierge care practices:

  • Often accept money from insurance companies for services rendered
  • Charge higher monthly payments in addition to collecting insurance money
  • May have a smaller patient panel, between 200 and 300 patients (sometimes less)
  • Focus more on premium services – like vascular scans, “executive” lab panels, extended office visits, and even accompanying patients to their specialist visits

Benefits of Direct Care

Despite the differences and the increased number of patients, there are benefits to utilizing direct care physician practices for your healthcare needs. Each practice offers a spectrum of services, but the goal of using direct care models is to reduce the use of insurance and lower overhead to keep costs down. Why should you consider the direct care model over concierge for your practice?

Fewer Patients Results in More Time Per Patient

Although there is a difference between the number of patients in direct care and concierge care – it still presents fewer patients per day with longer appointment times than traditional fee-for-service models. Traditional fee-for-service practices often see between 25 to 30 patients per day and only average 15 minutes per patient, falling behind by up to 90 minutes by the middle of the day. On the other hand, direct care practices may only schedule up to ten patients per day, reserving 30 minutes or more for their care. This means that most of the time spent face-to-face with your physician is focused on your care. With concierge models, the numbers are lower, and the amount of time is more personal.

In the fee-for-service model, doctors are practically incentivized to keep patients sick – with more focus on the bottom line and not the patient. Direct care takes this model and flips it over, driving focus to the patient and their healthcare. That is the major appeal of this structure and concierge care, despite the higher costs required by the patient in concierge situations.

Less Stress Overall

Medical providers face stressful situations – from seeing patient after patient to documenting charts and keeping all the data straight. Traditional fee-for-service professionals see mounds of paperwork and long hours, but if they consider the option of direct or concierge care – some of this stress can melt away. The more stress that is present, the more likely physicians are to get burnt out – what good is a burnt-out physician? Taking on practices like direct care and concierge reduces the number of patients and the time spent documenting everything from the day (playing catch up with medical records).

Medical providers (young to retiring age) are fascinated by the direct care and concierge models – with many leaving the fee-for-service models and creating practices designed for the direct care model. It is through these models that they are gaining better control over their practices, reducing costs on both sides of the table, and reducing the amount of paperwork.

Lower Pricing Models

Direct care practices focus on more affordable healthcare options, whereas concierge services are reserved for higher rates that cater to premium healthcare services. Depending on the physician’s practice, fees may range from as low as $30 per month to $100 per month, but many physicians find that offering lower prices bring in the more desirable patients, those without serious health problems. Direct care fees also make it feasible for those doctors who want to serve the vulnerable and elderly populations, too.

No Insurance Billing

Direct care describes the infrastructure perfectly – physicians and patients working directly – without a third-party intermediary, like insurance. This is a benefit because there are no pre-authorization to file, services to get approved, and so on, like with insurance companies present. Imagine how much time a fee-for-service provider spends (and has its own department) billing insurance companies – going back and forth to verify insurance coverage and get payments. Through the direct care structure, patients pay the provider directly each month and then make their appointments accordingly—no intermediary to contend with.

Most insurance companies have rules that medical providers must abide by – when they do not, it leaves costly amounts for the patient to pay, and many of them may not be able to do this. In the end, it is the physician’s office that bears the brunt of these unpaid medical bills. Direct care takes away these hoops that insurance makes providers and patients jump through. For a monthly fee, regular healthcare is provided to the patient – concierge takes it one step further, providing premium services but at a higher monthly fee and often on-demand.

Significant Differences in Direct Care and Concierge Care

While several fine details separate direct care and concierge care, one of the biggest is the amount of time that the practice has been around. Concierge care is not a new concept in the medical community. In fact, television has portrayed the concierge model for decades – remember the show featuring the doctor serving Hampton’s finest?

Direct care is not a concept that has been around for as long. Direct care gained considerable recognition when mentioned in a provision of the Affordable Care Act. The provision was featured on the news at the time and has even been recommended as a cost-savings tool by Consumer Reports. Direct care is more like a movement, whereas concierge care has created its own niche in the medical industry.

Who Supports Direct Care?

The direct care movement has gained a significant amount of excitement from multiple groups – including liberals, conservatives, young physicians, physicians nearing retirement age, insured populations, uninsured populations, and people of all socioeconomic classes.

The popularity of direct care puts healthcare back in the hands of those who need it most, without the influence of the hospitals and insurance companies pressuring for higher returns. The use of direct care may even help eliminate the rising costs of healthcare, which is troubling in both physician and patient communities.

Hybrid Model Practices

As direct care becomes a popular alternative to traditional healthcare methods, some practices incorporate a hybrid model to accommodate those with insurance coverage. Although the practice will bill insurance, they will create a contract pricing with the patient, providing them services under direct care and fee-for-service methods. These models require review by legal counsel to ensure that insurance regulations are being met, or else the hybrid model cannot exist.

Is Direct Care the Right Model for My Practice?

This question may pop up more often than you realize. The easiest way for a physician considering direct care to determine their benefit is to discuss it with other physicians who have chosen to go with this practice model.

Physicians have to look at their current practice situation as well. Working too many hours? Lack of connection with patients? It might be time to consider what direct care or concierge care has to offer your practice. Depending on your patient panel, opting for direct care may create higher cost savings, fewer patients, better connections, and so on.

Improve Your Practice – Improve Your Life

Many of us forget that our physicians have lives outside of their offices. We wind up in the waiting room, irritated by the wait – and we take it out on them and their staff, especially in fee-for-service settings. What if there was a practice model that satisfies both patients and the physicians treating them – like direct care! Physicians can take a new approach to how they are handling their practice, by converting to a direct care model or concierge care. When making this move, check out and request a demo of RevenueXL’s EHR for direct and concierge care practices!


Topics: EHR Selection, Provider/Physician, Consultant

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