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
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
Road Map Benefits for the Public Ethical Issues Legal Issues Is Concierge Care for you?
An Example of Concierge Practice
The Problem Shortage of Primary Care Providers
Overview of Concierge Care Also known as Origins of Concierge Care Definition of Concierge Care
Array of Services Open access scheduling Twenty-four hour access Email consultations Extended office visits Preventive care consultants Home visits Other services
Premium Services Unlimited Spa Appointments Same Day Appointments Email consultations All physicians offices covered Other premium services
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
Advantages Personal care Satisfaction Affordable and accessible Access Less stress Compensation
Disadvantages Not completely autonomous On call 24 hours
Three Models of Concierge Care Fixed Model Variable Model Non-Participation (cash) Model
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
Fixed Model Concerns Maintains contracted payer relationship Covered services Payments by Medicare beneficiaries = access NO!!
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
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
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
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
National Statistics No national studies of NP concierge models Medicare Payment Advisory Commission (MedPac) Study of physician concierge models
National Statistics Typical retainer $1,500 to 2,200 Home and hospital visits Patient load was 100 to 424 756 such practices in 2010 Mostly in urban areas Primary care Practices in all, but 11 states
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
Ethical Issues Health Disparities Continuity of care Unnecessary testing
Legal Issues Scope of Practice Medicare Patient Abandonment Patient Inducement Insurance Concerns
Is Concierge Practice for You? Consider the following Strong bond with patients Check State Regulations Do Your Homework Work with Experts
Is Concierge Practice for You? More Considerations Plan carefully and build supports Seek contract advice
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