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New American College of Physicians Policy Paper Makes Nine
(Washington, November 10, 2015) - The American College of
Physicians (ACP) today released a position paper exploring the
factors driving the growth of "concierge" and other "direct patient
contracting practices" (DPCPs) and the "limited" evidence on their
impact on patient care. A summary of the paper, Assessing
the Policy and Patient Care Implications of 'Concierge' and Other
Direct Patient Contracting Practices, is in today's
Annals of Internal Medicine online edition, with a link to
the full paper.
"We found that physician interest in concierge, direct primary
care, and other arrangements where physicians contract directly
with patients for payment of services, is largely driven by
frustration with reimbursement and billing hassles with payers and
the strong desire voiced by physicians to spend more time with each
patient," said Wayne J. Riley, MD, MPH, MBA, MACP, president of
ACP, "yet there is limited evidence on the impact of such practices
on quality, cost, and access to care. This paper provides practical
recommendations that physicians who are considering DPCPs should
consider, especially to mitigate any potential adverse impact on
access for lower-income patients. We propose a robust agenda for
additional research on the efficacy of this expanding practice
For the purposes of this paper, ACP defines a DPCP as any
practice that: (1) directly contracts with patients to pay
out-of-pocket for some or all of the services provided by the
practice, in lieu of, or in addition to, traditional insurance
arrangements and/or (2) charges an administrative fee to patients,
sometimes called a retainer or concierge fee, often in return for a
promise of more personalized and accessible care. This definition
of DPCPs therefore encompasses retainer, "concierge," "boutique,"
cash-only, direct primary care, and direct-specialty-care
The paper found that growing physician interest in DPCPs is
based on the premise that access and quality of care will be
improved if patients have a greater responsibility to pay directly
for services provided by physicians and other health professionals
in the practice, without third-party payers imposing themselves
between the patient and the physician. Yet, ACP notes that there is
little in the way of high quality, independent research on the
impact of DPCP models on quality and access.
While a review of the literature notes that there are potential
benefits to DPCP models-including providing patients with better
access and more time with physicians and fewer administrative
burdens on the practice -- there are concerns that DPCPs may cause
access issues for patients, especially among patients who cannot
afford to pay directly for care.
The paper offers policy, practical, and ethical issues that
should be considered by physicians who are considering entering
into such a practice model, as well as steps they should take if
they are already in a DPCP, to ensure that lower-income and other
vulnerable patients are not disadvantaged.
In the paper, ACP offers the following recommendations:
"This paper neither endorses nor opposes concierge and other
DPCPs, rather, it offers ACP's assessment of the evidence on the
policy and patient care implications of DPCPs," Dr. Riley
concluded, "in order to inform discussion among policymakers,
researchers, the public, and physicians themselves about the
potential implications of DPCPs."
The American College of Physicians is the
largest medical specialty organization and the second-largest
physician group in the United States. ACP members include 143,000
internal medicine physicians (internists), related subspecialists,
and medical students. Internal medicine physicians are specialists
who apply scientific knowledge and clinical expertise to the
diagnosis, treatment, and compassionate care of adults across the
spectrum from health to complex illness. Follow ACP on Twitter and Facebook.
Contact: David Kinsman, (202) email@example.com