Practices consider the pros and cons of offering membership programs and DPC to patients

As the idea of concierge medicine and membership programs gain steam, MGMA members have been discussing how to implement such programs in their own practice. A recent conversation on the MGMA Member Community started off with a question from Trudi Noppenberger about what kinds of benefits her practice could offer as part of a membership program. 

“Obviously, I don’t want to run afoul of the contract terms, and this is all hypothetical, but if I am still treating Patient A the same medically as I am treating Patient B but Patient B gets some ‘freebies’ that have nothing to do with care, is this kosher?” the practice administrator at Women’s Health Center of Lebanon (Pa.) LTD asked. 

Some respondents were unsure if offering a membership program was a good idea because it could alienate patients. “If I’m your patient and you approach me with this offer, I would say no and I would be much offended that others who pay more are getting more,” Anna Hoetling, RN, MHA, MGMA member replied. 

“The patients with Medicare, Medicaid or ACA plans have less expendable income so they won’t be able to afford it. This would create two classes of patient,” she continued. 

Hoelting also pointed out that it could add up to more work for staff. “Also, it seems like a big hassle for staff to constantly distinguish which patients are which and explain why the patient who arrived after you is called back before you.” 

Some MGMA members, on the other hand, have embraced different payment models, including memberships and concierge service. 

“The concierge practice limits the number of ‘club’ members and guarantees special coverage and availability,” says Paul I. Berkley, FACMPE, MGMA member. “Now we are starting to see some hybrids. The doctor offers fewer ‘club’ benefits but still charges a club membership. This arrangement often requires the patient to pay co-pays, etc., but offers greater access and availability.”

“You can offer anything you want to your patients in terms of access; which means if you are part of the club you can come in anytime, etc. You can, at the same time, limit access to non-club members,” continued Berkley, the administrator and chief executive officer at Healthcare Associates in Medicine, P.C., Staten Island, N.Y. 

Others are using Direct Primary Care as a model for their family practices. 

“The direct primary care (DPC) model gives family physicians a meaningful alternative to fee-for-service insurance billing, typically by charging patients a monthly, quarterly, or annual fee (i.e. a retainer) that covers all or most primary care services including clinical, laboratory and consultative services, and care coordination and comprehensive care management,” explains Casey Crotty, chief executive officer, San Juan IPA and Affiliates, Farmington, N.M. 

Aaron Monson, MBA, CMPE, MGMA member, chief operating officer, Riverton Family Health Center, has started DPC in his practice. By setting up the membership program as a separate company, the practice’s clinics are “participating clinics.” “This allows our clinics to honestly state that they are just accepting payment from another third party – just like any of the other insurance companies,” he explains. “The flow of money from the one to the other is based on actual care events that are fully documented.” 

However, Monson also makes clear in the membership agreements that membership is not insurance and only entitles the member care rendered at participating clinics. 

It’s clear that there is no one way to approach membership models and direct pay, but it may be an idea for your practice to consider. “This is a great option for docs and patients with high deductibles,” says Susan Childs, FACMPE, MGMA member, president, Evolution Healthcare Consulting, Rougemont, N.C. “Doctors are choosing a lifestyle of seeing patients the way they want to.”