Direct primary care/Concierge care

[mursedylan]

I recently spoke with a few family medicine residents who when finished with residency are starting "direct primary care practices." This is where patients pay a monthly 'membership-like' fee for a broad range of primary care services including physicals, minor procedures, office visits, house calls, and access to your physician via phone, text, and e-mail- sometimes even advertised as 24/7 access. Also, these physicians work out deals to get medications at-cost (no markup... example: bottle of 30 lisinopril for $0.25), and lab tests for steep discounts (such as a CBC for $5). They cap off their practice at between 500-600 patient members, and they enumerate the details of services in a contract between the patient and physician. This works well with insurance plans that are dropping primary care services (which results in them cutting premiums by as much as 50% I have heard).

My question to any nurse practitioners or other readers is whether or not you have heard of nurse practitioners operating with the same or similar practice, with or without a collaborating physician (depending on which state). Anyone who does operate this way? Any thoughts and discussion about this direct primary care model?

[Pilot2RN]

This model works for nurse practitioners, and is the type of business I want to start up after I get my FNP and get some experience underneath my belt. Others are doing it quite successfully.

[futureeastcoastNP]

One thing to think about those is that often times those who pay this concierge service health fee are often of higher incomes. They typically prefer physicians to nurse practitioners.

One market that may be good for nurse practitioners is lower cost concierge services. Something with a lower annual fee than typical physician concierge thus open to middle and lower-middle class patients.

[Corey Narry, MSN, RN, NP]

I have experienced being a consumer/patient in a concierge primary care practice model. There is a group of clinics locally that is part of a national chain of concierge clinics with locations in NY, Boston, DC, Chicago, LA and San Francisco areas. We started going to them when we first moved here.

There is an annual membership fee and for that price you get a nicely appointed clinic lobby with plush sofas, beverages upon request, piped in classical music, young and preppy receptionists with bubbly personalities, and in most cases minimal wait times. There is on-site lab as well. The clinic accepts private insurances ours included.

However, I tend to value the provider-patient encounter more and felt that although the providers were very much willing to listen, it wasn't a great fit and we ended up going elsewhere for our primary care. This particular group does hire NP's and PA's and in some locations, there is even a licensed acupuncturist or dietitian on-site.

[SHGR, MSN, RN, CNS]

I know a physician who opened up such a practice (direct primary care)- just her, no MA, no receptionist, no nurse (and certainly not plushly appointed, but comfortable, at least in the photos I saw). Patients got her cell phone number and complete access. It takes a special kind of provider to open up such a practice. If she wasn't in a faraway state, she'd be my PCP now. I think it's a great model, but certainly more risk and more work than joining an established practice. I don't know of any NPs in direct primary care, and everything I've read about it focuses on MD's (haven't even seen any DO's even though the concept seems DO-friendly).

[mursedylan]

Good luck with your endeavors! I am interested in this model as well, but like you, I also hope to gain some experience and networking for a few years as an FNP before establishing a direct primary care practice, or even considering it. Keep in touch with me for anything you hear or see regarding NPs practicing this way, and I'll be sure to do the same. How long until you are done with FNP program, and what school are you at?

Thanks for your reply!

[mursedylan]

To Pilot2RN:

Good luck with your endeavors! I am interested in this model as well, but like you, I also hope to gain some experience and networking for a few years as an FNP before establishing a direct primary care practice, or even considering it. Keep in touch with me for anything you hear or see regarding NPs practicing this way, and I'll be sure to do the same. How long until you are done with FNP program, and what school are you at?

Thanks for your reply!

[mursedylan]

To FutureeastcoastNP:

Thanks for your reply! This was along the lines of how I was thinking. My personal opinion (and everyone is entitled to their own opinions and I will not condemn or belittle anyone else for having their own opinions as well) is that our government is very inefficient economically and practically at "providing" health care to those who cannot afford it. This is why I am interested in this model, but I understand that there may be some details that are difficult to work out when drawing up a business model to accommodate for those who cannot normally afford health care, but may be able to afford it with a direct PCP model such as this. Not only do I think our government doesn't do a good job with this, but the recipients of this "affordable care" often do not know how to appropriately utilize their access to health care. With this model, hopefully there is a platform to motivate, encourage, and educate the lower-income health care consumers so that they utilize the system correctly (stay out of the ER for non-emergencies, get the recommended health screenings, etc.) and begin to take pride in their own health and well-being. The majority of providers do not have time to listen to and adequately teach their patients, and it is often (but not necessarily always) very difficult to get a PCP appointment withing a reasonable amount of time, which this model also can accommodate for with same-day visits or even house calls if need be. The under-privilaged, low-income, low health literacy population are humans just like everyone on this forum, and NPs working in this model might be able to help the big picture of health care in this way.

Just my thoughts and opinions- I'm quick to admit to being wrong on political issues, and I'm always open to discussion!

Thanks! :)

[mursedylan]

To juan de la cruz :

Interesting! Sounds like a higher-end practice in terms of luxury! I value the provider-patient encounter as well and the time that this model may allow for more thorough and quality care. I also think that is neat to have an acupuncturist and dietitian on site. When I envision the possibility of opening a direct primary care practice, I think less along the lines of luxury and more along the lines of affordability, ease of access, and quality of care and provider-patient relationship.

Thanks for your reply!

[mursedylan]

To SHGR:

This sounds very similar to the practice of the physician I met with that is opening up his own direct primary care practice. Just him, no MA, no receptionist, no nurse, and like the one you described, the patients get his cell number with complete 24/7 access. Yes, it sounds crazy to sell yourself over to your patients, but this provider told me that he is confident that the professional boundaries will be maintained and the patients will respect the practice and not abuse it. He said he drafts a contract for him and the client to sign which states that if the client abuses the practice unnecessarily, he has the right to discharge the client from his services with a 30 day (i think) notice.

Also, this guy is a DO. So yes! This practice is very DO friendly. This particular physician finished a residency in a class of 8 I believe, in which there was a pretty even mix of MD and DO.

Thanks!