Once the bastion of high-end specialists, more and more primary-care and family physicians are launching concierge practices for middle- and lower-income patients.
By Alan Neuhauser
A growing number of primary care physicians have stopped accepting insurance in favor of a membership-based “retainer” or “concierge” model.
APRIL 1, 2014 -
No insurance? No problem.
A small but growing number of primary-care physicians has stopped taking insurance — and they may be radically reshaping how American families get their medicine.
“We’re running a business that’s profitable and caring for patients the way we’ve been trained to care for patients,” says Dr. Jonathon Izbiciki, owner of Izbicki Family Medicine in Erie, Pa. “We have our voices back, and we’re masters of our profession. There’s nothing better than that.”
For years, the no-insurance — or “retainer” or “direct-care” — approach was almost exclusively reserved for the wealthy. Specialists or physicians who catered to deep-pocketed patients would charge a lofty monthly “membership” fee, and in exchange, offer “luxury” amenities like same-day appointments, little to no wait times, more time with the doctor and consultations by phone, email, Skype or even text-message.
But with industry changes looming and the implementation of the Affordable Care Act bringing an influx of newly insured low-income and Medicare patients, some primary-care and family-practice physicians have set out to change this so-called “concierge” model: in short, by offering the very same services at a mere fraction of the cost.
“We’re like the blue-collar concierge,” Izbicki says.
About 6 percent of physicians were in concierge or cash-only practices last year – up from 4 percent in 2012, according to the health information website MedScape. Nevertheless, that number is “growing very rapidly,” says Mark Pauly, a professor of health care management at the Wharton School at the University of Pennsylvania.
“They think this is a more noble way to deal with a patient population than trying to run everything through insurers,” Pauly says. “It’s a way to keep it affordable and keep it accessible.”
Izbicki and his brother, Dr. Harry Izbicki, embraced the retainer model in September. For years, they’d worked under a traditional insurance model, first as employees of another practice in Erie, and then at the doctor’s office they opened in April 2010.
The work, they found, was relentless.
“My office hours would start at 8 o’clock in the morning, and I wouldn’t get home until 8 o’clock at night,” Jon Izbicki says. “I’d see patients from 8 to 5, and then be at the office another three hours doing paperwork or typing up my notes.”
The reason, he said, was patient volume. Insurance companies essentially keep their reimbursements at a fixed rate, so one of the few ways to keep up with rising overhead — from salaries and taxes to medical malpractice insurance — was to see more and more patients.
