Concierge Medicine vs. Direct Pay Primary Care vs. VIP Medicine
When researching alternatives to traditional primary care, you will find more than a few options. And it can be confusing sorting them all out.
There’s concierge medicine. There’s direct pay primary care. And then there’s also luxury medicine. What’s the difference? What does each term mean?
At PartnerMD, we are a concierge medicine practice. However, we get questions like this all the time from confused patients, so we have set ways to explain the main categories of alternate care.
Not everyone shares our definitions, at least in the small details. Even experts in this field don’t use the same verbiage, so you may find different terms used elsewhere. To be clear and transparent with you, we want to walk through our use of some of these popular terms.
What is traditional primary care?
It’s the one you know and probably don’t love, the 7-minute medicine that has swept the healthcare industry in the U.S.
It’s a numbers game — a traditional doctor can have 2,000-3,000 total patients and might see 20 to 35 of them per day. The doctor gets reimbursed from contracts with insurance carriers, while patients pay whatever rates their carriers negotiate for them.
When we call this traditional primary care, we don’t mean that it’s old-school in any sense. Care used to be a lot more high-touch and personalized than this. But this high-tempo turnstile has become the norm, and not everyone knows there are other options.
If you’re fed up with traditional primary care, you’re liking experiencing one of the most common signs that it’s time to find a new primary care doctor.
What is concierge medicine?
Now we start to slow down with a style of care that puts patients in front of their physician for longer. In concierge medicine, doctors might have 400-600 patients rather than 2,000-3,000, and they might see 6 to 10 per day rather than 20 to 35.
Concierge members pay an annual membership fee to be a patient of the practice. The cost of concierge medicine varies, but it is usually somewhere between $1,500-$2,500 per year.
At PartnerMD, we transparently provide our monthly and annual prices on our concierge medicine cost calculator.
Do concierge medicine practices accept insurance?
Yes, most practices accept insurance just like a traditional primary care practice would. There are exceptions, but those are practices that we define in a separate category or label cross-category.
All concierge practices emphasize a better patient experience, but they do it in different ways. Some practices focus on low wait times, while other practices push access to physicians.
In some practices, you'll have a dedicated physician, and others may provide services via a panel of doctors and clinical staff, just to cite a few examples.
But whenever you hear “concierge,” you know it’s about attentive care and a membership model. Other terms get tossed around to describe this patient-focused approach.
It’s sometimes called retainer medicine, membership medicine, or boutique medicine. At this time, there are no guidelines for how these terms are used. It pays to be attentive and ask questions, as these terms are used interchangeably and as separate models of care.
What is direct pay primary care?
While concierge care is patient-focused medicine that cooperates with insurance, direct primary care is the patient-based approach that stays financially independent.
By not taking insurance, practices avoid the overhead costs associated with the management of insurance coding, billing, and reimbursements.
There are a few ways a direct pay primary care practice can operate.
For their flat-fee membership, patients receive extended visits as well as clinical and lab care. They also get comprehensive care management — communication and team-wide strategy among their physicians and specialists — as part of their membership fee.
These practices can include benefits such as unlimited office visits, clinical and laboratory services, consultative services, care coordination, comprehensive care management, phone or email access to care, or after-hours availability.
In this direct pay model, there is no membership fee. The practice charges an advertised rate for an office visit, lab work, or other services. The pay-as-you-go model allows you to see a doctor as much or as little as needed.
Typically, these practices do not offer additional perks, such as extended office visits, phone or email access to your doctor, or after-hours care.
A hybrid model blends these direct pay primary care models. Patients pay an annual membership fee as well as an advertised rate for specific services.
You get all the benefits of membership, but when it comes time to pay for services, you pay the doctor directly, rather than working through insurance. PartnerMD offers this model to patients without health insurance.
Patients don’t need insurance to receive any of these services. In fact, in many cases, patients are not allowed to have health insurance to participate in direct pay primary care.
That said, if you're considering this option, you should look for catastrophic insurance coverage in case of an emergency that requires hospitalization or significant medical care.
Because of the membership aspect to some direct pay practices, these models can be considered a type of concierge medicine.
We tend to think of direct primary care as its own model, not as a sub-category because its financial model is so different. However you hear a practice described, it’s good to double-check whether it accepts insurance.
What is VIP Medicine?
What happens when patient-focused care meets a top-floor lifestyle?
That’s the idea behind luxury medicine’s hyper-dedicated care. A doctor works with very few people, or even one person, in constant availability.
If that celebrity treatment sounds expensive, well, it is, with personal physicians charging as much as $10,000 to $50,000 per year.
VIP medicine requires a high-dollar retainer for perks that include private rooms or wings at hospitals and fast-track access to emergency specialists.
Many people use concierge medicine and VIP medicine interchangeably. Concierge medicine did begin as luxury medicine – it started in 1996 when two doctors in Seattle catered their practice to the ultra-wealthy – but the cost of concierge medicine has dropped considerably as its popularity has grown.
Today, we’d qualify concierge medicine and luxury medicine as completely different models.
Concierge Medicine vs. Direct Pay Primary Care vs. VIP Medicine: Sorting through your options.
You will hear a lot of these terms used interchangeably. Why all the confusion? Well, some practices are cross-category and blur the lines, and the genre’s increase in popularity hasn’t given us much time to agree on universal terms.
But as you look to better understand various models, we recommend asking three questions.
- Do you accept insurance? If not, it is almost certainly a direct pay primary care practice.
- Do you charge a membership fee? If so, it could be concierge medicine, direct pay, or luxury medicine.
- How much is the membership fee? If it’s somewhere between $1,500-$2,500 per year, it’s concierge medicine or direct pay. If it’s in the thousands per month, you’re looking at luxury medicine.