ACP Discusses Implications of Practice of Concierge Medicine

The American College of Physicians updated the guidelines for the practice of concierge medicine.

The American College of Physicians (ACP) analyzed the access, cost, and quality of concierge medicine practices and provided recommendations to minimize adverse effects for patients in a position paper published in the Annals of Internal Medicine.

Direct patient contracting practices (DPCPs), according to the ACP, are any practices that directly contract with patients to pay for services provided by the practice instead of or in addition to insurance or charge administrative fees to patients, like a retainer fee, in return for personal care.

“We found that physician interest in concierge, primary care, and other arrangements where physicians contract directly with patients for payment of services, is largely driven by frustration with reimbursement and billing hassles with payers and the strong desire voiced by physicians to spend more time with each patient,” said Wayne Riley, MD, MPH, MBA, MACP, president of the ACP, in a press release.

The ACP noted in their paper that the growing interest in DPCPs stems from the improved access to and quality of care that occurs when patients pay directly for services provided by physicians without third-party payer involvement. However, limited data are available to demonstrate the impact of DPCPs on quality and access to healthcare.

Although DPCPs can provide patients with better access, more personalized care, and fewer administrative obstacles, the ACP has concerns that DPCPs may cause barriers for patients who cannot afford to pay directly for healthcare.

The ACP listed 9 recommendations to ensure that lower-income and vulnerable patients have access to care through DPCPs:

  • They support patients and physicians in their choice of healthcare practice as long as it is accessible, ethical, and viable.
  • Physicians must honor their professional obligation to provide care without discrimination and assist all classes of people in need of medical care.
  • Policymakers should be aware of the factors that cause patients and physicians to turn away from conventional healthcare practices.
  • Physicians in DPCPs must be transparent to their patients and provide all details of payment and services provided by the DPCP.
  • Physicians who downsize should consider the effect on the local community and help all patients who do not stay with the practice find another healthcare provider.
  • Physicians who charge retainer fees should consider the impact on their patients, particularly from lower-income households.
  • Physicians who do not accept health insurance should be aware of the barrier this creates for patients with lower income and work to find ways to reduce barriers.
  • Physicians should consider the Patient-Centered Medical Home as a practice model that has been shown to improve physician and patient satisfaction and reduce healthcare disparities.
  • The ACP calls for independent research on the factors causing the growth of DPCPs, their impact on the healthcare workforce, cost, and access to care in vulnerable populations.

Dr Riley noted that the paper does not support or oppose concierge medicine and DPCPs but instead offers an assessment from the ACP for policymakers, researchers, physicians, and the public about the implications of this practice for patients.


Doherty R. Assessing the patient care implications of “concierge” and other direct patient contracting practices: a policy position paper from the American College of Physicians. Ann Intern Med. 2015; Nov 10. doi:10.7326/M15-0366.