Industry support is building for the direct-pay model in primary care, and the trend has made its way into certain specialties as well. Earlier this year, Christopher Stephenson, M.D., became the first cardiologist in Charlotte, North Carolina, to start a membership-based practice, the Charlotte Observer reported.
As with many concierge or retainer practices, patients at Pure Cardiology pay a monthly fee for enhanced, unlimited access to the practice, in addition to other lifestyle-related services. The practice accepts no insurance except Medicare and aims to limit its panel to 300 patients. Since launching in July, 25 patients have signed on.
In addition to criticisms and challenges facing boutique medicine in general, such as patient affordability and doctor shortages, Stephenson is contending with specialty-specific risks. "I just think it's going to be tough for him to make a go of it," Jordan Lipton, M.D., founder of Signature Healthcare, told the newspaper. "Everybody should have a primary care doctor, but not everybody needs a cardiologist."
Stephenson emphasizes nutrition and other preventive approaches to heart problems and has stopped performing procedures such as cardiac catheterizations, according to the article. However, he will refer and coordinate those interventions as necessary.
Tom Blue, chief strategy officer for the American Academy of Private Physicians, shared support for the doctor's plan. By helping people prevent heart disease, he can also play a role in reducing diabetes, obesity and other health problems for his patients, Blue added.
Cardiologist Brian Forrest, M.D., medical director of Access Healthcare, was among the first physicians to succeed in a direct-pay specialty micropractice. The keys to making the model profitable, FiercePracticeManagement reported previously, are keeping practice overhead extremely low while investing in efficiency- and quality-boosting technology.
Nonetheless, physicians considering a switch must take the potential pitfalls seriously. "It's a critical moment in a physician's career," Rob Lewis, vice president of marketing at Specialdocs Consultants Inc., told the Sacramento Bee. "If they change their business model, you're going from thousands of patients to hundreds of patients. If you don't do it right, you can lose patients and not get them back. Then you're left with a broken practice."