News: Access-fee model losing popularity

October 3, 2008

The model of charging patients "access" fees to cover administrative expenses has given way to the concept of "concierge" or "boutique" practices.

Earlier this decade, there was a lot of talk (including in Medical Economics) about practices charging patients annual $50 to $200 "access" or "administrative" fees to cover expenses that doctors felt they weren't being reimbursed. Since then, the trend has been overshadowed by the "concierge" or "boutique" practice model, in which primary care doctors limit their practices to fewer than 1,000 patients and charge upwards of $1,200 (and in some cases as much as $20,000) a year for non-covered services. While the concierge movement continues to grow, the less-expensive access fees, which would appear to be more affordable to a wider scope of patients, have not gained popularity, according to physician groups, perhaps because they risk violating insurer contracts and Medicare agreements. "I have not heard as much about it as I did three or four years ago," says William Jessee, MD, president and CEO of the Medical Group Management Association, who notes that his organization hasn't polled its 20,000 members specifically about the fees. "I don't know if that means people are quietly charging them, or the interest in that as a potential revenue stream has died down."

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