Last Thursday Dr. L. Markham McHenry, a family physician, held a meeting with some patients to tell them about changes he was planning. After 15 years of working in a private practice, the Scottsdale, Ariz.-based doctor is in the process of transitioning to a subscription-based model.
His patients, who he said come from a range of economic backgrounds, will pay an annual fee of $3,000. In return, McHenry聽will limit his capacity to 400 patients a year, spend more time with each one,聽and be able to focus on preventing and treating chronic diseases like diabetes and obesity.
鈥淚 don鈥檛 think patients should just pay for convenience,鈥 he said regarding聽the new practice model that he adopted from . 鈥淚t wasn鈥檛 until I found the value added that I thought this was worth offering.鈥
A聽new聽report projects聽the number of physicians who practice independently — rather聽than聽become employed by medical groups聽 or聽systems, for example聽—聽will fall to聽36 percent聽by 2013, from 57 percent in 2000.聽And, for those聽who remain in private practice, one in three聽may choose this type of聽“subscription” approach over the more traditional formats, according to the , a research and analysis firm.
Based on a survey of 204 physicians split evenly between both primary care and other specialties, the聽researchers found doctors are increasingly open to new business models, especially those聽that might聽limit聽paperwork demands and overhead costs.
Subscription models can vary from聽concierge practices that may charge as much as $30,000 a year for a personal, readily available physician, to direct-pay models in which聽patients pay much less — usually an annual enrollment fee of about $200 or聽monthly membership聽and primary care fees that average about $60 a month. In exchange, patients have access to聽things like same-day appointments, 聽online prescriptions and e-mail聽communication with聽providers.
Dr. Kaveh Safavi, managing director of Accenture Health, pointed out two driving factors behind physicians’聽transition to these聽models:聽to stay independent rather than join a corporate group聽and聽to maintain or grow their salary.
鈥淏asically they鈥檙e saying, 鈥榃hy don鈥檛 we provide a higher level of service and still have a strong economic position,鈥欌 he said.
Business costs, managed care and electronic medical records led doctors’聽list of concerns. Physicians are also seeking to control the number of patients they see per day, since the models聽charge regular set聽fees to make up for a lower volume of patient visits.
For McHenry, the desire to better handle preventable diseases was one reason he chose to change his practice model. But he said the annual fee also allows him to maintain his current income and support the new technology he will need to practice independently.
Safavi said the subscription model is targeted toward higher paying customers, and providing more convenient, streamlined health care in exchange for the steeper cost. But he predicts it will have little impact on patients who rely on their insurance plans or on programs like Medicare and Medicaid.
鈥淚t鈥檚 not a one-size-fits-all model,鈥 he said.
