How concierge healthcare will affect doctors, patients, and health insurance.

According to a recent survey by Merritt Hawkins, a Dallas medical consulting and recruiting firm, it now takes an average of 29 days to get an appointment with a family care physician.

This is a significant jump from 2014, when the average wait time was 19.5 days. This figure is exemplary of the overcrowding and lack of one-on-one attention that plagues the American medical system, a source of frustration for doctors and patients alike.

One possible solution to these problems, at least for high-earning Americans, is the concierge system. This approach to medicine is also referred to as “direct patient contracting,” “cash-only,” “retainer,” or “boutique.” The characteristics of these practices include administrative service fees, paid monthly or annually, same-day cash payment for medical services, and smaller patient panels.

From the patient’s perspective, the main selling point of the concierge model of medicine is a more personalized level of care. Concierge practices provide amenities like all-hours access to physicians and the ability to make same-day appointments. In exchange for these amenities, patients pay an annual or monthly fee in lieu of, or in some cases in addition to, a traditional insurance policy.

Michael Friedlander of SpecialDocs Consultants, a concierge medical practice, estimates that these fees average between $1,200-$5,000 per year. The amount of the fee tends to correlate with the affluence of the area. Doctors in expensive communities can charge more per patient, and as a result are often able to limit their practices to fewer patients. Because of these smaller patient panels, patients at concierge practices are able to build closer relationships with their physicians and have access to a wider range of preventative procedures.

For those in the medical community looking to transition their practices to the concierge model may mean a different approach to medicine as a business. According to some physicians, the greatest barrier to success within the framework of this model is a lack of formal business training. Dike Drummond, a concierge practitioner and the founder of The Happy MD, describes this model as “inherently entrepreneurial,” and posits that it “will always involve a fairly sophisticated marketing program to be successful.”

However, not all concierge physicians approach the model in the same way as Dr. Drummond. Dr. Jordan Shlain, for one, seems to disagree with the necessity of Drummond’s marketing-heavy approach. Dr. Shlain’s private medical group in San Francisco doesn’t engage in advertising or have any significant web presence. All of their clients are word-of-mouth. They also charge $40,000 to $80,000 annually per family, a rate that stands out even in the relatively affluent context of concierge medicine. In accordance with their high fees, physicians in Shlain’s practice earn an annual salary between $500,000 to $700,000. This is approximately double the expected salary range for a successful internist in the Bay Area. Shlain’s group is an example of how a concierge medical practice can maintain a significantly smaller patient panel and still experience financial success.

When converting to direct patient care practices (DPCPs), medical groups often downsize their patient panels. A 2005 study from the U.S. Government Accountability Office found that retainer physicians serve an average of 491 patients. The year before starting their retainer-based practices, this same pool of physicians saw an average of 2,716 patients. This radical change raises the question of what happens to less-affluent patients when their physicians convert to a concierge model.

A major ethical issue surrounding the adoption of the concierge model is patient abandonment. There are some legal guidelines: local and state patient abandonment laws dictate how physicians should proceed when terminating relationships with patients during the downsizing process that inevitably comes with a concierge transition.

Furthermore, retainer practices could exacerbate preexisting racial and economic disparities in medical coverage. In a study for the Medical Practice and Quality Committee of the American College of Physicians, Robert Doherty found that the patient panels of concierge medical practices are less likely to include African American and Hispanic patients, as well as patients from lower income brackets.

Some DPCPs use their high retainer fees for wealthy clients to subsidize healthcare for lower-income patients. Some have even managed to make their services more accessible to economically vulnerable patients than traditional insurance-accepting practices.

Beyond the ethical consideration that goes into transitioning to the concierge model, physicians must also consider how their participation in this model might affect the larger medical landscape. The Association of American Medical Colleges estimates that by 2020, there will be a shortage of 91,500 doctors. Factor in the radical downsizing that is almost invariably a feature of a switch to the concierge model, and it seems that a large-scale shift to concierge medicine could result in a severe patient bottleneck in the traditional medical community


  1. Doherty, Robert. “Assessing the Patient Care Implications Of.
  2. Drummond, Dike. “Concierge Medicine Will Get Massive Boost from Obamacare.
  3. Gerstner, Lisa. “6 Things to Know About Concierge Medicine.
  4. Schwartz, Nelson D. “The Doctor Is In. Co-Pay? $40,000.

About the Author:

Madeline Woods is a freelance writer and researcher. She achieved a bachelor’s of art from Depaul University in writing, rhetoric, and discourse. Madeline can found on LinkedIn.

Medicare Access and CHIP Reauthorization Act Abbreviations

Here is a list for reference of commonly used abbreviations in the Medicare Access and CHIP Reauthorization Act of 2015.

  •  ABC – Achievable Benchmark of Care
  • ACA – The Patient Protection and Affordable Care Act
  • ACO – Accountable Care Organization
  • APM – Alternative Payment Model
  • BCPI – Bundled Payments for Care Improvement
  • CAH – Critical Access Hospital
  • CAHPS – Consumer Assessment of Healthcare Providers and Systems
  • CEHRT – Certified EHR Technology
  • CERT – Comprehensive Error Rate Testing
  • CFR – Code of Federal Regulations
  • CHIP – Children’s Health Insurance Program
  • CJR – Comprehensive Care for Joint Replacement
  • CMMI – Centers for Medicare and Medicaid Innovation
  • CPIA – Clinical Practice Improvement Activity
  • CPI – Clinical Practice Improvement
  • CPR – Customary Prevailing and Reasonable
  • CPS – Composite Performance Score
  • CPT – Current Procedural Technology
  • CQM – Clinical Quality Measure
  • DMEPOS – Durable Medical Equipment, Prosthetics/Orthotics, and Supplies Fee Schedule
  • DSH – Disproportionate Share Hospital
  • EHR – Electronic Health Records
  • EP – Eligible Professional
  • ESRD – End Stage Renal Disease
  • FFS – Fee For Service
  • FQHC – Federally Qualified Health Center
  • GAO – Government Accountability Office
  • GPCI – Geographic Pricing Cost Index
  • HHA – Home Health Agency
  • HHS – Health and Human Services
  • HIE – Health Information Exchange
  • HIPAA – Health Insurance Portability ad Accountability Act of 1996
  • HITECH – Health Information Technology for Economic and Clinical Health
  • HPSA – Health Professional Shortage Area
  • HRSA – Health Resources and Services Administration
  • IT – Information Technology
  • IRF – Inpatient Rehabilitation Facility
  • LTCH – Long Term Care Hospital
  • MA – Medicare Advantage
  • MA-PD – Medicare Advantage Prescription Drug
  • MAC – Medicare Administrative Contractor
  • MACRA – The Medicare Access and CHIP Reauthorization Act of 2015
  • MDH – Medicare Dependent Hospital
  • MEI – Medicare Economics Index
  • MedPAC – Medicare Payment Advisory Commission
  • MIPAA – Medicare Improvements for Patients and Providers Act of 2008
  • MIPS – Merit-based Incentive Payment Programs
  • MLR – Minimum Loss Rate
  • MSPB – Medicare Spending per Beneficiary
  • MSR – Minimum Savings Rate
  • MUA – Medically Underserved Area
  • MU – Meaningful Use
  • NPI – National Provider Identifier
  • NQF – National Quality Forum
  • NRDR – National Radiology Data Registry
  • OCM  – Oncology Care Model
  • ONC – Office of the National Coordinator for Health Information Technology
  • PAMA – Protecting Access to Medicare Act of 2014
  • PAYGO – Pay As You Go
  • PCPI – Physician Consortium for Performance Improvement
  • PECOS – Medicare Provider Enrollment, Chain, and Ownership System
  • PFPMs – Physician Focused Payment Models
  • PFS – Physician Fee Schedule
  • PHS – Public Health System
  • PQRS – Physician Quality Reporting System
  • PREP – Personal Responsibility Education Program
  • QDCR – Qualified Clinical Data Registry
  • QE – Qualified Entities
  • QI – Qualifying Individual
  • QP – Qualified APM Professional
  • QRDA – Quality Reporting Document Architecture
  • QRUR – Quality and Resource Use Reports
  • RBRVS – Resource-Based Relative Value Scale
  • RAC – Recovery Audit Contractor
  • RHC – Rural Health Clinic
  • RVU – Relative Value Unit
  • SGR – Sustainable Growth Rate
  • SNF – Skilled Nursing Facility
  • TCPI – Transforming Clinical Practice Initiative
  • TIN – Tax Identification Number
  • TMA – Transitional Medical Assistance Program
  • USC  – United States Code
  • VM – Value-based Payment Modifier
  • VPS – Volume Performance Standard

What is disallowance on my EOB?

Disallowance is an adjustment, which is defined by the RBMA Radiology Business Management Association as: Quotation From the RBMA Receivable Standard Definitions

“Amounts which are never expected to be collected, by virtue of laws regulations, contracts or internal policies applicable to the services provided by the entity.””

In most cases your physician has signed a contract with an insurance company to apply discounted rates for services provided. This discounted rate is the disallowance, or the difference between the actual amount of the procedure and the amount agreed upon by the insurance company and the physician.

Completing this type of contract will give the physician “in network” status. If you visit a physician that is “in network”, the amount you will be responsible for paying will generally be less than if you go to an out-of-network physician. In some case the insurance company will either pay less or not pay anything for services you receive from non-network physicians.