The Nurse Practitioner Will See You Now

Transcription

1 The Nurse Practitioner Will See You Now An Overview of Concierge Medicine for the Nurse Practitioner 5 th Annual Nurse Practitioners Conference November 7, 2015 Hyatt Regency Hotel Houston, TX Presented By: Daphne R. Robinson, JD Health Law & Policy Institute University of Houston Law Center

2 Road Map An Example of the New Normal The Problem That s Driving the Innovation Overview of Concierge Medicine Three Models of Concierge Medicine National Statistics

3 Road Map Benefits for the Public Ethical Issues Legal Issues Is Concierge Care for you?

4 An Example of Concierge Practice

5 The Problem Shortage of Primary Care Providers

6 Overview of Concierge Care Also known as Origins of Concierge Care Definition of Concierge Care

7 Array of Services Open access scheduling Twenty-four hour access consultations Extended office visits Preventive care consultants Home visits Other services

8 Premium Services Unlimited Spa Appointments Same Day Appointments consultations All physicians offices covered Other premium services

9 Common Characteristics Primary care Fixed monthly or annual fee Limited number of patients 300 to 800 Special services/attention Greater physician access Amenities No retainer/no services

10 Advantages Personal care Satisfaction Affordable and accessible Access Less stress Compensation

11 Disadvantages Not completely autonomous On call 24 hours

12 Three Models of Concierge Care Fixed Model Variable Model Non-Participation (cash) Model

13 Fixed Model Accepts payment from private and government payers Retainer paid by patient for non-covered services Non-covered services Additional or extra-ordinary services

14 Fixed Model Concerns Maintains contracted payer relationship Covered services Payments by Medicare beneficiaries = access NO!!

15 Fee for services Variable Model Patients with high-deductible insurance for other than PC May or may not accept payment from private and government payers

16 Variable Model Concerns May or may not maintain contracted payer relationship Covered services Payments by Medicare beneficiaries = access NO!! Pay per visit is a disincentive for patients to visit

17 Non-Participation Model No private or government payer payments Yearly or monthly fee Provider provides all PC needed Patient must deal with their own insurance

18 Non-Participation Model Concerns Perpetuates health disparities Provider free to recommend treatments questions of necessity Patients don t want to deal with their own insurance company Opting out of Medicare

19 National Statistics No national studies of NP concierge models Medicare Payment Advisory Commission (MedPac) Study of physician concierge models

20 National Statistics Typical retainer $1,500 to 2,200 Home and hospital visits Patient load was 100 to such practices in 2010 Mostly in urban areas Primary care Practices in all, but 11 states

21 Benefits for Public Primary care Better health outcomes Better patient satisfaction Superior quality of care Reduces overutilization of ER Superior preventive care and education May lessen load of colleagues in traditional PC practice

22 Ethical Issues Health Disparities Continuity of care Unnecessary testing

23 Legal Issues Scope of Practice Medicare Patient Abandonment Patient Inducement Insurance Concerns

24 Is Concierge Practice for You? Consider the following Strong bond with patients Check State Regulations Do Your Homework Work with Experts

25 Is Concierge Practice for You? More Considerations Plan carefully and build supports Seek contract advice

26 Questions?? The Nurse Practitioner Will See You Now An Overview of Concierge Medicine for the Nurse Practitioner 5 th Annual Nurse Practitioners Conference November 7, 2015 Hyatt Regency Hotel Houston, TX Presented By: Daphne R. Robinson, JD Health Law & Policy Institute University of Houston Law Center