Shifting Practice Model of Some PCPs

In the United States, physician practice acquisitions were on the rise over the past few years as healthcare reform incentivized hospitals to do so.  During this time, however, studies have questioned the relationship between physician employment and quality of care.  Physicians of all specialties have been impacted by healthcare reform legislation and the subsequent acquisitions, perhaps most notably are the primary care physicians.  Consequently, there has been an increase of these physicians converting their practices into concierge medicine or direct primary care.  A recent study by Kareo and the American Association of Private Physicians sought to study key trends in some independent medical practices.  Rob Pickell, Chief Strategy Officer of Kareo, notes:

“The majority of Americans continue to receive their care from independent medical practices due to the superior combination of patient focus, healthcare outcomes, and lower costs. Emerging practice models such as direct pay and concierge medicine represent exciting new ways to preserve and enhance the independent practice model.”

The survey targeted physicians who are adding or converting to a direct primary care or other membership model for payment rather than a conventional fee-for-service practice model.  Here are some brief points found in the survey:

70% of respondents reported they wanted to spend more time with patients; 41% wanted to improve their work/life balance; 40% wanted to separate from the insurance payer system

65% of respondents using some variation of a concierge medicine membership model reported their cost for membership was under $2,000 per year; 32 % have one quarter of their patients in membership; 30% have all their patients in membership

58% of respondents are out-of-network with health plans; 57% participate in Medicare; 54% participate in health plans in network


Virtual care has its place in many practices currently and is certainly gaining momentum, though there are many things to consider before jumping in with both feet.  This survey also demonstrated the growing use of telemedicine.

23% of respondents currently use telemedicine

42% plan to grow and expand the use of telemedicine

Conventional vs Concierge/DPC

Along the lines of different practice models, Rob Pickell stated:

“These newer models also address patient and physician demand for more proactive care, care coordination, and wellness programs. For these reasons, these new practice models should be of interest to both healthcare professionals and patients.”

The survey also shines some distinguishing light on the different models.

79% of physicians employing concierge medicine membership or direct primary care payment models spend an average of 30 to 60 minutes or more on each patient visit

75% of physicians in conventional fee-for-service practices spend 30 minutes or less with each patient

60% of physicians in conventional fee-for-service practices have a patient panel of over 1,000; nearly all of physicians employing concierge medicine membership or direct primary care payment models have a patient panel of less than 1,000

38% of the direct primary care private practices call recruiting new patients their single biggest hurdle

35% of conventional practices said their biggest challenge is remaining financially viable

The survey can be downloaded here.


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