Between Mason City and Rudd, where I live, Mercy North Iowa has a billboard that reads, “Refer a Physician Earn $5000.” Demand for primary care services is projected to increase through 2020, largely because of the aging population and an increase in health insurance coverage following the implementation of the Affordable Care Act.
With necessity being the mother of invention, some new models for delivering healthcare have come on the scene. One model gaining popularity, in which there is a direct financial relationship between the medical practice and the patient, is referred to by many terms including: concierge medicine, direct primary care (DPC), retainer-based, or membership medicine. As the supply of doctors diminishes, this model strengthens the commitment between doctors and participating patients, ensuring patients’ access to services.
Concierge Medicine Iowa of Des Moines (first of its kind in Iowa) is part of a growing trend that has grown five-fold nationwide in the past five years. Concierge medicine is an approach to providing primary care in which the patient submits an annual or monthly fee or retainer to the physician directly. Fees range between $1200 to $10,000 per year depending on the practice and the patient’s age and marital status.
Women’s Wellness and West Side Family Medicine in Dubuque is one of 4,400 Direct Primary Care practices in the U.S, and is also the first of its kind in Iowa. There were only 756 DPCs in 2010 and even fewer in 2005 (146). In the last year, there has been a 30% increase the number of Direct Pay clinics. Instead of paying a deductible through health insurance, clients pay a monthly fee whether they visit the doctor or not. Similar to concierge medicine, the services covered by a physician vary, but patients can generally expect 24/7 access to doctors including same day appointments and the ability to reach doctors by email and/or phone. Additionally, office visits are longer (at least 30 minutes) and basic medical tests are no additional charge.
Neither DPCs nor concierge medicine have co-pays, deductibles, or co-insurance fees. The difference between a concierge medical practice and a DPC is that DPCs do not accept insurance; whereas retainer-based concierge might accept insurance.
The monthly fee paid to the medical practice essentially serves as a substitute for insurance coverage on the services provided. However, in a medical emergency or if need arose for specialty services outside those provided by the practice, the patient would have no coverage. Therefore, to meet the mandate for health insurance under the Affordable Care Act, individuals utilizing DPCs must also carry a catastrophic health insurance plan. The same would be true for participants in concierge medicine if they did not have other health coverage. Catastrophic plans typically have significantly lower premiums than the standard Bronze, Silver, Gold or Platinum insurance plans.
Some of these new forms of health care may seem expensive, but may actually not be much different than the cost of health care premiums plus deductibles and co-payments. Even if it does cost more, some consumers may decide it is worth the money if access to care is an issue. The cost is expected to drop as the availability of these models increases. ~Brenda
 Tetreault, M. (2014, February 20). Concierge medicine’s best kept secret, the price (revised). Concierge Medicine Today and Direct Primary Care Journal. Retrieved from http://conciergemedicinenews.wordpress.com/2014/02/20/concierge-medicines-best-kept-secret-the-price-revised/
 Chris Silva, “Concierge Medicine a Mere Blip on Medicare Radar,” American Medical News, September 30, 2010, http://www.amednews.com/article/20100930/government/309309997/8/ (accessed June 16, 2014)
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