ACP offers recommendations on ‘concierge’ medicine

ACP has issued a new policy position paper on “concierge” medicine, with a focus on ethical practice.

For the purposes of the policy paper, “concierge” medicine, or a direct patient contracting practice (DPCP), was defined as “any practice that directly contracts with patients to pay out-of-pocket for some or all of the services provided by the practice, in lieu of or in addition to traditional insurance arrangements, and/or charges an administrative fee to patients, sometimes called a retainer or concierge fee, often in return for a promise of more personalized and accessible care.” DPCPs were considered to have 1 or more of the following defining features: administrative service fees, payment in cash at the time of service, and a smaller patient panel.

The Medical Practice and Quality Committee reviewed the available evidence on the effects of DPCPs on care quality, cost, and access, as well as on the workforce, and applied principles from ACP's Ethics Manual, Sixth Edition. As a result of this review, the following recommendations were developed:

1. 1. ACP supports physician and patient choice of practice and delivery models that are accessible, ethical, and viable and that strengthen the patient-physician relationship.
2. 2. Physicians in all types of practices must honor their professional obligation to provide nondiscriminatory care, serve all classes of patients who are in need of medical care, and seek specific opportunities to observe their professional obligation to care for the poor.
3. 3. Policymakers should recognize and address pressures on physicians and patients that are undermining traditional medical practices, contributing to physician burnout, and fueling physician interest in DPCPs.
4. 4. Physicians in all types of practice arrangements must be transparent with patients and offer details of financial obligations, services available at the practice, and the typical fees charged for services.
5. 5. Physicians in practices that choose to downsize their patient panel for any reason should consider the effect these changes have on the local community, including patients' access to care from other sources in the community, and help patients who do not stay in the practice find other physicians.
6. 6. Physicians who are in or are considering a practice that charges a retainer fee should consider the effect that such a fee would have on their patients and local community, particularly on lower-income and other vulnerable patients, and ways to reduce barriers to care for lower-income patients that may result from the retainer fee.
7. 7. Physicians participating, or considering participation, in practices that do not accept health insurance should be aware of the potential that not accepting health insurance may create a barrier to care for lower-income and other vulnerable patients. Accordingly, physicians in such practices should consider ways to reduce barriers to care for lower-income patients that may result from not accepting insurance.
8. 8. Physicians should consider the patient-centered medical home as a practice model that has been shown to improve physician and patient satisfaction with care, outcomes, and accessibility; lower costs; and reduce health care disparities when supported by appropriate and adequate payment by payers.
9. 9. The College calls for independent research on DPCPs addressing several areas, including their effect on the patient-physician relationship, the health care workforce, and underserved populations.

“The growth of DPCPs seems to be principally motivated by physicians' frustration with paperwork, low reimbursement, and restrictions on time spent with patients. It is essential that policymakers address these and other factors,” the authors wrote. “Yet it must also be recognized that DPCPs potentially exacerbate racial, ethnic, and socioeconomic disparities in health care and impose too high a cost burden on some lower-income patients.”

The policy paper was published online Nov. 10 by Annals of Internal Medicine and is available free of charge.

Bob Doherty, ACP's senior vice president for governmental affairs and public policy, will host a Twitter chat about this topic on Thurs., Nov. 12, from 5 to 6 p.m. ET. Join the conversation by using the hashtag #ACPInternistschat.