Medscape Business of Medicine — Concierge, Direct Pay, or Hybrid: Is One Right for You?

Membership-Driven Practice Models

Physicians frustrated with having to see large numbers of patients in fast visits are showing greater interest in new practice models that allow for more time with patients in exchange for an extra fee from them.

These so-called membership models include concierge practices, direct pay, hybrid, and other versions.

Concierge, the oldest and most common of these membership models, involves reducing a physician’s patient panels to a much smaller size and providing patients with amenities like same-day appointments, longer sessions, and quicker access to the physician.

Concierge physicians typically bill insurers. But a newer model—direct pay or direct primary care—drops insurance and relies entirely on the membership fee to generate the physician’s income.

Beyond those basic models, physicians can choose all sorts of permutations. For example, some doctors don’t want to completely convert to a concierge practice, so they choose a hybrid model that lets them keep traditional patients.

In some other approaches, the practice might drop commercial insurance but not Medicare, or it might contract with companies to treat their employees. Physicians also can join large direct-pay or concierge practices, either as employees or franchisees. Typically, membership models are geared to primary care physicians, but specialists are also trying them out.

The variations seem endless, but they boil down to basic goals: providing better access for patients and a more satisfying practice for the physician. According to John R. Marquis, an attorney in Holland, Michigan, who helps physicians convert to these models, “To me, there’s one essential reason why patients sign up—to be able to see their doctor at any time, day or night,” he says.

Below are some descriptions of these different models and what you should keep in mind if you are considering using them.

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