Medical Discount Membership Program Part 5b - Healthcare Reform and concierge practices

[Guest guest]

Actually, Marty already pointed us to an article back in April about how Healthcare Reform might impact various practice styles...especially the Fee for Care style practices - although it sounds like this is primarily related to the DME - Durable Medical Equipment.

 

http://wnj.com/new_health_care_act_deals_serious_blows_to_concierge_medicine-4-22-2010/

 

http://wnj.com/files/Publication/3528f35c-ec6f-449d-ba44-058b71964133/Presentation/PublicationAttachment/a54066b5-11e9-4e45-b19e-9cb1d246a93a/New_Health_Care_Act_Deals_Serious_Blows_To_Concierge_Medicine.pdf

 

New Health Care Act Deals Serious Blows to Concierge Medicine

 

April 2010 R. Marquis

There are generally two types of concierge1 medicine physician practices. In one, the physicians remain in Medicare and charge a periodic fee (usually on an annual basis)2 to patients in exchange for services that are not covered by Medicare (or in most cases by private insurance). These are often called " FNCS " practices (an acronym for Fee for Non-Covered Services).

In the second type, the physician opts out of Medicare and then charges the patient a periodic fee for providing all the medical care the patient needs and that can be provided by the physician himself or herself. The physician's agreement is only to offer the medical care the physician himself or herself can provide – a family medicine physician only agrees to provide family medicine services, for instance, not orthopedic or other specialized care from other physicians. This is a major factor in what distinguishes these forms of practice from insurance.

In large part, HHS and its enforcement arms have left legitimate FNCS practices alone. But the Patient Protection and Affordable Care Act (the " Act " )3 is going to cause serious problems for these practices and will require them to restructure in order to accommodate the Act. The Act creates other problems for the fee-for-care model, problems that are not as fixable.

snip/snip

IV. Conclusion

The provisions of the new Health Care Act discussed above are going to have serious consequences for both kinds of concierge medical practices. Those for FNCS practices can be adequately handled by restructuring patient agreements to modify how annual physicals and wellness plans are dealt with for Medicare patients. Fee-for-Care practices have more of a challenge due to the potential apparent blanket disallowance of Medicare payments for DME and home health orders by opted-out physicians.

 

Locke, MD

1 of 1 File(s)

Membership-New_Health_Care_Act_Deals_Serious_Blows_To_Concierge_Medicine.pdf