Physician practices described as “membership medicine” have been springing up across the country during the past decade. These practices, in which patients pay a monthly or annual retainer to their doctor or medical office for a contracted bundle of services, offer an alternative model for physicians who hope to spend less time on paperwork and more time with patients.
Jay Keese, executive director of the Direct Primary Care Coalition and a lobbyist with Capital Advocates in Washington, D.C., says those who switch from medicine-as-usual to membership medicine typically reduce their patient panel size from about 2,500 to 600.
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Patients in membership medicine practices typically pay about $60 per month for the bundle of services, which are usually standardized within a practice and not individually negotiated, Keese says. With 600 patients, that “adds up to a pretty good revenue stream, and you can probably cut down on administrative personnel,” resulting in cost savings, he says.
In addition to benefitting from improved income stream, more time with patients and less paperwork, those who have gone the membership medicine route say they’re happy they don’t need to participate in the Quality Payment Program established under the Medicare Access and Chip Reauthorization Act of 2015 (MACRA).
Eric Potter, MD, who practices internal medicine and pediatrics in Franklin, Tennessee, under the name Sanctuary Functional Medicine, was pleased when the business consultant who helped him set up his business told him that the new Medicare reimbursement program didn’t apply to his new practice.
“How much time do we need to spend documenting things rather than just taking care of patients?” he says. Given how relatively new and unregulated membership medicine is, he adds, “It’s a little like cutting down the forest and building a log cabin. You feel like a little bit of a frontiersman.”
Kylie Vannaman, MD, a primary care physician and co-founder of Health Suite 110 in Overland Park, Kansas, says she’s also glad to be avoiding MACRA. Otherwise, when dealing with Medicare, doctors have to spend time on paperwork “and checking boxes to prove what kind of care [they’re] giving, rather than actually giving care,” she says. “It’s exhausting, and not worth it.”
Benefits of Membership
Among the benefits of membership medicine is the flexibility it affords in communicating with patients, because physicians no longer need to figure out how they’re going to bill for a visit, Keese says.
“Texting over secure text applications is very prevalent. You’re really raising the level of the experience, so the relationship between the doctor and the patient is less defined by a visit,” he says. “You can have a consult using technology—phone, e-mail, any of these things—rather than having to come in and see the doctor.”
Vic Wood, DO, a primary care doctor in Wheeling, West Virginia, is among the earliest practitioners of membership medicine, having opened a practice in 2003 after reading in Medical Economics about a type of membership practice called concierge medicine (see sidebar for definitions).
He initially aimed his program, which he calls Primary Care One, at the working poor—those making a bit more than minimum wage and incomes below the poverty line—but after the Affordable Care Act passed and many of his initial patients became eligible for Medicaid, Wood’s population shifted to more affluent patients whose deductibles had risen over the years.