Concierge Medicine and Direct Practice Business Models in Canada

Is Canada the only country of 195 countries in the world where people are not free to choose which services and how they wish to purchase healthcare?

The Alberta-based College of Physicians and Surgeons reported that new rules passed recently (last week) will require doctors who join or form concierge medical practices to continue relationships with existing patients for their routine medical needs, regardless of whether they agree to pay for extras.

The December 2014 message that the regulators want to transmit is that physicians cannot discriminate against patients for any number of reasons, including socio-economic status.  This is interpreted to mean that a physician cannot discharge a patient who does not want to participate in the new business model.

Under the new rules, a patient whose doctor relocates to a concierge medicine and direct practice business models in Canada will have to be given written notice 45 days in advance, and will have an additional year to decide whether to continue seeing the physician at his or her new practice.  In the USA, where the model is growing in popularity, physicians must give a minimum 30 days’ advance notice and assist with the transfer and continuity of care and medical records to the new chosen provider. The one year decision period is not a consideration.  Many physicians actually give much more than 30 days’ advance notice.

For Canadian physicians, these new rules could have major strategy and start up implications for the concierge medicine and direct practice business models in Canada.

For Canadians in Alberta, the only exceptions are for cases where doctors substantially alter the scope of their practice or who relocate a year after closing or leaving a previous location.  But how is “substantially” measured?  One could also look at options where a physician launches a new concierge medicine practice start up where there is no previous practice for comparison or from which one might relocate.  This applies to both primary care and specialist physicians.

We were curious about this development because we have been engaged by several Canadian physicians who decided to investigate concierge medicine and direct practice business models in Canada

For Canadian physicians, these new rules could have major strategy and start up implications for the concierge medicine and direct practice business models in Canada. Many start ups are launched to solve the demand for prompt and “drive-through” appointments, and where family physicians can spend more time with fewer patients, and charge additional service fees for uninsured amenity-oriented services.  The irony is that while the CPSA’s governing council took aim concierge medicine and direct practice business models calling it a two-tier primary care system, it rejected a broader definition of insured services that would have implicated the ethics of Alberta’s private diagnostic imaging industry.

The CPSA considers insured services as services listed on the Schedule of Medical Benefits used to bill the province’s health insurance plan. The Alberta Medical Association, which represents doctors’ financial interests along with other special interest groups (SIGs) will be invited to participate in a working group that is expected to report back to the council in March 2015 with clearly defined lists of insured and uninsured services.  One thing that will be different from the start up and design of these practices from their US counterparts is that unlike in the USA where a physician can designate part of the membership that covers some “covered services” that are eligible for insurance reimbursement according to the subscribers’ benefit plan (except for Medicare beneficiaries) the Canadian model cannot include those “insured services” included in the Schedule of Medical Benefits.  That just means that we have to adjust the offer a bit in order to meet compliance when we brainstorm the brand promises and membership sales offer.  It probably means that the Direct Practice model will be far more challenging in Canada.

The bottom line:

For Canadian physicians considering concierge medicine as a new or transitional business model, proper planning, good product and marketing strategy, and respect for province-by-province regulatory compliance is required. Get good guidance, follow the rules, and don’t let these actions by regulators dash your dreams and creativity to design the brand of medicine you want to offer.  To discuss your options and your dreams, call us for help or ask your questions below.

Together we’ll design your new brand of healthcare in Canada as a goal for 2015.

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