More Doctors Offering Small Monthly Fee for Services

Dr. Maribel Aviles gave up after years of frustration over insurance paperwork and a yearlong effort starting a cash-only medical practice. After years of volunteering and missionary work, she opened one of the first direct primary care practices in Central Florida. The idea behind it is simple: pay the primary-care doctor a monthly fee for full access. This fee enables doctors to have fewer patients instead of balancing low insurance reimbursements with a higher number of patients. George Bliss coined the term when he created one of the first direct primary care practices back in 1997 and is the founder of Seattle-based direct-care company Qliance, serving individual patients.

Dr. Aviles has 200 member and nonmember patients in her first year and does not take insurance. On the other hand, Dr. Neha Doshi owns a concierge practice that takes insurance and charges a $1,500 annual fee per person for her 200 member patients. Doshi says dealing with insurance takes more than half of her office manager's time. However, insurance has its plus side such as bringing in additional income and making specialty care more affordable for her patients.

The model is slowly receiving more attention partly because of the Affordable Care Act and recent studies showing better outcomes for patients who go to direct-care practices. There are now enough doctors practicing both direct care and concierge medicine that they have their own professional society, American College of Private Physicians, which held its first national meeting this year. The ACPP and societies like it are conducting information sessions about direct primary care during their annual meetings. These sessions increase awareness about the benefits and growth of direct primary care, which is causing more growth and even inspiring current practices to consider converting. 

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Alison Killian is a recent graduate of Grove City College who majored in Business Management and minored in Biology Studies. She is a contributor to Medical Groups and passionate about all facets of healthcare. She plans on continuing work in the healthcare field especially in management. She is very interested in healthcare innovation and finding ways to improve the current system. She hopes to go back to school in a few years to earn a degree in medicine.