Short Takes On News & Events

Physicians Swap Traditional Practices For New Models

By Ankita Rao

October 31st, 2012, 1:47 PM

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 will limit his capacity to 400 patients a year, spend more time with each one, and be able to focus on preventing and treating chronic diseases like diabetes and obesity.

“I don’t think patients should just pay for convenience,” he said regarding the new practice model that he adopted from n1Health. “It wasn’t until I found the value added that I thought this was worth offering.”

A new report projects the number of physicians who practice independently — rather than become employed by medical groups  or systems, for example – will fall to 36 percent by 2013, from 57 percent in 2000. And, for those who remain in private practice, one in three may choose this type of “subscription” approach over the more traditional formats, according to the study conducted by Accenture, a research and analysis firm.

Based on a survey of 204 physicians split evenly between both primary care and other specialties, the researchers found doctors are increasingly open to new business models, especially those that might limit paperwork demands and overhead costs.

Subscription models can vary from concierge practices that may charge as much as $30,000 a year for a personal, readily available physician, to direct-pay models in which patients pay much less — usually an annual enrollment fee of about $200 or monthly membership and primary care fees that average about $60 a month. In exchange, patients have access to things like same-day appointments,  online prescriptions and e-mail communication with providers.

Dr. Kaveh Safavi, managing director of Accenture Health, pointed out two driving factors behind physicians’ transition to these models: to stay independent rather than join a corporate group and to maintain or grow their salary.

“Basically they’re saying, ‘Why don’t we provide a higher level of service and still have a strong economic position,’” he said.

Business costs, managed care and electronic medical records led doctors’ list of concerns. Physicians are also seeking to control the number of patients they see per day, since the models charge regular set 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.

“It’s not a one-size-fits-all model,” he said.

12 Responses to “Physicians Swap Traditional Practices For New Models”

  1. Helen says:

    Great news for the 1 percent! More great new! The article seems to indicate that these docs will treat high cost patients with chronic diseases exactly the same as they would the healthy patient. That’s BS! My guess? They will cherry-pick the healthiest patients they can find and will not accept any sick people. It’s the exact same thing we see in the Canadian system, in the UK and in most European systems. Wealthy people can buy what they want while the rest of the population gets single-payer health care. The upside? Concierge practices will rob the rest of the risk pool of the most healthy people which will bring on single-payer at a much faster clip for the rest of us. Concierge practices are the best thing to happen for the proponents of single-payer healthcare. We will get to single-payer much sooner than we first thought. Maybe within the next ten years!

  2. What are the legal ramifications of this approach in NY and NJ. How will insurance that patients have play into this. What will this fee include?

  3. Robert says:

    What you Liberals don’t like is the right of a physician to dicide how he/she wants to practice medicine. A one payer system will fail by limiting poor quality care to everyone, “everyone shares the misery”. Currently in the US, everyone who is sick gets the highest quality care without regard to the ability to pay. Just look at any Emergency Room on any Saturday night. If you like the Canadian system then apply for a citizenship and move on. Happy Trails, Helen!

  4. W Khalifa says:

    Why the selfish hate, Robert?

  5. Jenna says:

    My family and I don’t have to worry when we get sick. Dr.Singh’s office in Bloomfield Hills shopping center is right around the corner and she is always there for us. I would not hesitate in recommending her.

  6. Ray says:

    I completely agree with Robert. I am tired of these physician bashing liberals who really have very little understanding of what physicians acually do.

  7. Eric says:

    Helen – What you are missing is that the concierge doctors still charge insurers or Medicare for the care provided. The $3,000 fee is for access to the provider and is not a type of insurance. As a result, the concierge physicians are still incentivized to care for patients with health problems (chronic or otherwise) because the payment structure for the physician does not change. In fact, most concierge physician practices will need more complex patients to make the model work. The physician won’t survive on 400 patients who only come in for a physical once a year. You are correct that this is a service for those that can afford it, but it won’t change the risk pool.

  8. rich says:

    Hey Eric,

    You say some people will choose to pay $3000 over and above what they pay today to see a doctor? What planet are you talking about? I see a doctor four times a year and pay a $15 copay each time I go. He manages my diabetes. He adjusts my medicines at times, most times he doesn’t. I’m with him for about 15 minutes. He bills my insurance about $150 for the visit. You are telling me I need something better than that? Why would I need better access than that? If you ask me, paying $3K per year just for better or longer access is for the patient that wants to hog up the doctor’s time. Patients like that would be better of seeing a shrink! Morons!

  9. Carl says:


    You may be right no one will pay $3,000 to review ones meds, but they most likely will pay $3,000 to try to prevent getting diabetes in the first place.

  10. rich says:


    You’re kidding, right? If you think a primary care doctor can reverse the genetic code that you got from your parents and their parents and their parents, you are delusional. Even a quack knows that people don’t get diabetes from lifestyle anywhere near as much as they do from the DNA they inherit. Not even close! My primary is much more interested in my family history than he is worried that I’m a few pounds overweight. If you think I’m going to be duped into shelling out $3K extra to some gold-plated prima donna concierge dummy just so I can hear the exact same words that I already hear for a $15 copay, your are completely nuts!

  11. Sarah says:

    Rich, you are delusional if you think that your out-of-pocket costs will stay at the rate you currently are paying. Your employer has been picking up the increasing cost of health insurance and not making that trickle down to you. If you think that your having diabetes is not something your employer knows about, think again. Your condition makes their group plan rates go up. I know this first hand because my son, at the age of 4 got diagnosed with type I diabetes. We had an employer plan and my husband’s employer chose to go from a plan with similiar co-pays as yours to a high deductible health savings account. That meant we had to pay $5000 before the insurance company picked up any portion.
    Since you are diabetic, you know that it is an expensive condition. . . (our son tests 8-10 times/day, is insulin dependent and wears an insulin pump) We met that deductible every year as well as paying for our share of the premiums. Our family was going backward financially and yet, when we shopped for private insurance, insurance companies wouldn’t even submitt my 4 year old son to underwritting. (So, at the very time we needed insurance it was not accessible to us.) We remedied the situation by moving to a larger city that had companies with larger health insurance group plans.

    While, I agree with your comments on the genetic code, you need to wake up and recognize that our healthcare system HAS to change. It economically is not feasible to continue in the direction we have been headed. Obama Care is about transparency, inclusiveness, cost-savings and improved outcomes. Do your homework. While it is not anywhere near “perfect” it is a step in the right direction. Health reform has been purposed over and over again and has gone nowhere. The Afforable Care Act is controversial because it cuts into the bottom-line of the 1% ers. And may I advise you to start thinking about whether your employer is looking at you as an assest or liability because your health is draining their bottom line.

  12. rich says:

    Hey Sarah; Wake up! Smell the coffee! When did I say Obamacare was a bad idea? This discussion began with the insane notion that some primary docs are dumping traditional fee-for-service delivery in favor of a dopey idea that paying a $3K per year fee will get you unrestricted access to a new model of primary health care. Never mind that only healthy people, people with no chronic illnesses or no family history of such, need apply. In my mind, if you take their formula of 400 patients at $3K per year membership fee, a primary doctor with 400 perfectly healthy “cherry-picked” patients means he can stay on the golf course all day every day and still rake in $1.2 million bucks. If, by some remote chance, one of these healthy “cherry-picked” patients get a cold or the flu, he doesn’t need an office to work from, he can do all of his work with a laptop over a cell phone at the golf course, right? As far as Obamacare, it’s a start, but it’s feeble! The law was written by the industry lobby groups. The pharma lobby, the medical device lobby, the doctor lobby, the hospital lobby, the private insurance lobby, they were all in the room when the law was being written. They all had a say! That’s why Obamacare is a watered down piece of crap. If you want real reform, you need single-payer health care. Obamacare just dances around the real problems. Obamacare is like fiddling while Rome continues to burn. Real reform means we go to the kind of healthcare they have in the UK or in Canada or in many of the European countries. Capitalism and the free markets will never work for health care. It’s not like buying a car. It’s not like buying groceries. Healthcare is about life and death. Any time a private insurance company has the power to allow someone to die by refusing to sell them affordable health insurance, it’s time to end the private insurance model. Private insurers have been allowing people to die for decades. It’s time to end that kind of power over our lives. It’s time to end the abuse.