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Direct primary care and concierge medicine - Spring 2015
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By Marcia Horn Noyes, Golden Asset Media, LLP

Attorneys and PR professionals work under retainers, so why not physicians? Doctors wanting to practice medicine the way they were trained to care for patients is driving increases in direct primary care and concierge medicine models. Association of Staff Physician Recruiters looks at this new model of care to see how it may affect our members in the future.

Jon and Harry Izbicki, both osteopathic doctors from Erie, PA, wanted to practice family medicine in the tradition of their grandfather, who for 38 years practiced with his brother in the same area. But after residency, the younger Izbicki’s entered private practice in a quasiemployed model. In time, the two doctors found their practice unsustainable. They then moved lockstep with a growing body of independent physicians who have sought the employed model to unburden themselves from overwhelming business costs. A 2012 Accenture report calculated independent physician numbers at 57 percent in 2000 and only 39 percent in 2012.

Jon Izbicki, D.O. says, “Within three to six months of practicing under the ‘cattle drive’ model, we’d had enough. We looked back on our decision to join a mega practice and found ourselves working 80 hours a week with a patient load that didn’t allow us to see patients in a timely fashion.” The two doctors wanted the relationship practice their grandfather and his brother had, where doctors make a real impact on the lives of those in their local community. “So we decided to keep working as employed doctors while working on development of a business plan to start our own practice,” Dr. Izbicki explains.

While working at their new traditional insurance-based practice of 3500-patients, the doctors saw two big trends, Firstly, collections and revenue spiraled downward, and secondly, insurance companies continued dragging out reimbursements. As a result, doctors had to increase productivity to offset decreasing revenue. That meant less time with patients.

The Izbicki’s first considered the concierge model, where high-income individuals pay an annual membership fee for better access to care. While this “boutique” level of care is becoming popular in places like California, Florida and Virginia, concierge was unlikely to thrive in fiscally conservative Erie. That’s when older brother Jon ran across the direct primary care (DCP) model, also referred to as a subscription or retainer model.

He says, “It’s like ‘blue collar’ concierge medicine – priced more affordably and a better fit for our community.”

After leaving the employment model, the two brothers ran an insurance-based private practice later transitioning to a non-insurance DPC model, the first of its kind in Pennsylvania. Afterward the doctors lost 85% of their practice, but at the same time, they also added 280 new patients that year. “People don’t like what they don’t understand, so we spent a lot of time educating people in the beginning.”

Now, the practice is flourishing and has recently attracted the attention of a Manufacturer and Business Association. “They liked what we were doing because they could offer a high deductible plan with a health savings account (HSA) upon which employees could tap for their DPC subscription fee,” says Dr. Izbicki. In return, patients receive benefits that have eroded under insurance-based medicine, such as:

  • Medications, lab testing and imaging services at wholesale prices
  • Unhurried appointments
  • Same day or next day scheduling
  • Unlimited access to doctors – email, phone, Facebook and Twitter
  • Annual comprehensive medical exam

“Patients receive all of this for less than a monthly cell-phone plan,” Dr. Izbicki says.

Flash in the pan or next wave of care?

This innovative alternative payment model has not only been patient embraced, but also found acceptance within the Affordable Care Act (ACA). This new model of care meets all the employer and individual mandates of the ACA as long as it is combined with a wraparound insurance policy provided by a qualified health plan (QHP). “Once a patient understands the win-win of subscription and lab fee savings, along with increased access, they get it,” says Izbicki.

While not the best option for those with lower deductible plans, Izbicki feels that those with higher deductible plans combined with an HSA will look to DPC for controlling everyday health costs. “Of course we are biased, but we do believe it will soon become the salient model for primary care because patients want a deeper and more meaningful relationship with their doctor.”

Izbicki says that his patients appreciate relaying all their ailments within a longer appointment time. “Under the employed model, I cringed whenever a patient mentioned a problem beyond the one they’d come in to have treated,” explains Dr. Izbicki. “With insurance, it became a documentation nightmare.” Now he sees chronic care patients for 30 minutes, those with annual physicals for one full hour and sick visit patients for 15-20 minutes.

Recruiting direct primary care doctors

Many of the DPC practices are single locations, but some larger DPC practices like Las Vegasbased MedLion are gaining a nationwide footprint. Dr. Izbicki says the president of that large practice maintains ongoing recruitment to fill positions in expansion areas.

However, Izbicki says DPC likely won’t penetrate hospital recruitment, unless hospitals decide to do a pilot in this type of care. Concierge might be the exception to that. Izbicki says he has heard of one employed hospital physician who also maintains his concierge business simultaneously.

Concierge and DPC are definitely practice models recruiters should watch, especially as these models evolve, and patients become more familiar with their advantages. For up-to-date news and industry reports on the two practices, recruiters can access Direct Primary Care Coalition and Concierge Medicine Today.

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