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Talking About Health: The Official PMG Blog

An online journal authored by top health experts from Principal Medical Group. Topics can include concierge medicine, healthcare, medical advice and eHealth, doctors, physicians, pharma, wellness, the best treatment options for chronic conditions and more.

What's the Difference? Concierge vs. Direct Primary Care

10/27/2014  |  Posted By: Dr. David Jones

Since founding Principal Medical Group in 2011, I’ve discovered that there is a lot of confusion about what concierge medicine is and is not. Most frequently, it is confused with direct care.

To help lessen the confusion, here is quick break down of the main types of primary care practices:

  • Traditional: At a traditional practice, primary care physicians have between 3,000-5,000 patients each in their patient pool. They are paid for their services by charging health insurance companies and collecting co-pays. While that may sound like a simple arrangement, every health insurance company’s reimbursement rates and documentation requirements are different. Since most practices take multiple insurance plans, this creates a significant administrative burden for the practices.
  • Direct: At a direct primary care practice, the patients pay the doctors directly for their services instead of the practice billing insurance. Although patients are paying for office visits directly, it is important they try to have health insurance coverage to help cover lab work, hospitalizations or appointments with outside physicians or specialists.
  • Concierge: At a concierge medical practice, patients pay a membership fee to the practice in exchange for specific benefits. This fee may or may not be in addition to other charges. The most common benefit is increased access to the physician by limiting the patient pool to between 250-1,500 patients per doctor. This allows the doctor to spend more time with each patient because they can afford to take few appointments a day. It also typically results in shorter wait times.

The reason these terms are often confused is because it is common for a concierge practice to also be a direct care practice. But not every direct care practice is a concierge practice and vice versa. There are concierge practices that still bill insurance and direct care practices with large patient pools.

At Principal Medical Group, we are a concierge, direct primary care practice. We limit our patient pool to less than 350 patients and every member also receives my contact information, including home and mobile phone numbers and email address, so they can reach me 24/7. The membership fee includes office visits, an annual comprehensive physical exam, a personalized wellness plan, and physician referrals.

Because every concierge and direct care medical practice is different, it is important to learn exactly what is – and is not – included when selecting a primary care provider.