a relationship between a patient and a primary care physician in which the patient pays an annual fee or retainer. This may or may not be in addition to other charges. In exchange for the retainer, doctors provide enhanced care, including principally a commitment to limit patient loads to ensure adequate time and availability for each patient.
The practice has been referred to as concierge medicine, retainer medicine, membership medicine, cash-only practice, and direct care. While all “concierge” medicine practices share similarities, they vary widely in their structure, payment requirements, and form of operation. In particular, they differ in the level of service provided and the fee charged. Estimates of U.S. doctors practicing concierge medicine range from fewer than 800.
Concierge physicians care for fewer patients than those in a conventional practice, ranging from 50 patients per doctor to 1,000, compared to 3,000 to 4,000 patients that the average traditional physician now sees every year. All generally claim to be accessible via telephone or email at any time of day or night or offer some other service above and beyond the customary care.
According to the Association of American Medical Colleges (AAMC) estimates, the United States faces a shortage of more than 91,500 physicians by 2020. The Patient Protection and Affordable Care Act (PPACA) or “Obamacare” will expand coverage to more than 30 million Americans in the next decade. After incorporating insurance expansion, the United States will require nearly 52,000 additional physicians and 8,000 primary care physicians (PCPs) by 2025. The total number of office visits to primary care physicians is projected to increase from 462 million in 2008 to 565 million in 2025. The federal government requires over 68,000 charging codes with the upcoming ICD-10 diagnosis coding system a fivefold increase from the current ICD-9 diagnosis coding system. In addition to these government requirements, physicians have the usual insurance filing.
The Physicians Foundation found that 9.6 percent of “practice owners” and 6.8 percent of all practices were planning to convert to cash/concierge practices in the next three years. In 2012, there were 4,400 private physicians – a 25% increase from 2011.