More time, less paperwork: The quiet revolution in primary care

Modern Healthcare – Tuesday, August 26, 2025
By Alex Kacik

Concierge and direct primary care practices are gaining traction among physicians, employers and patients increasingly frustrated with traditional care pathways.

The growth of these practices, where patients pay membership fees in exchange for increased access to physicians, is a symptom of Medicare and Medicaid reimbursement that has not kept pace with inflation, advisers, doctors and policy experts said. Growing care backlogs, coding and documentation tasks that take doctors away from patients and seemingly ever-rising health insurance premiums are also contributing, they said.

“A year ago, I would’ve told you these care models were a slowly evolving, quiet phenomenon,” said Dr. Zirui Song, an associate professor of healthcare policy at Harvard Medical School and a primary care provider at Massachusetts General Hospital. “It is now evolving quite rapidly — it is not so quiet anymore.”

Concierge medicine has been around for decades, but only a small subset of well-off individuals has typically subscribed to the white-glove service.

Patients can get same-day appointments, around-the-clock responses from clinicians via text messages, longer visits and other perks if they pay annual fees that generally range from several thousand dollars up to $10,000. On top of the yearly fee, concierge physicians bill Medicare and other insurance for office visits and procedures. That differs from direct primary care practices, which do not accept insurance.

Physicians’ motivation to transition to concierge medicine is clear, doctors said.

Physicians — especially those in some of the lowest-paid specialties like primary care — have had to treat more patients to offset reimbursement cuts, research shows. Medicare reimbursement for doctors has declined a third over the last decade as waning Medicare Advantage rates, declining Medicare outpatient payments and inflation have squeezed physician practice margins, according to a recent report from data analytics company Omniscient Health.

“The fundamental problem is the pay-for-volume system,” said Dr. Robert Pearl, an organizational behavior lecturer at the Stanford Graduate School of Business and former CEO of the Permanente Medical Group. “The cost of operating a practice has gone up almost twice as fast as reimbursement for primary care, and how people have responded is to cut back on staff, but that increases their workload.”

The volatility of Medicare and Medicaid reimbursement, including the impending Medicaid cuts under the new tax law, could further push doctors away from traditional care models, said Bailey Walden, a healthcare attorney at law firm Quarles & Brady.

“There’s always an unknown with respect to government-funded programs that can make practitioners nervous,” she said.

Physicians also move to cash-pay models to improve their work-life balance. Concierge physicians can generally reduce the number of patients they treat from roughly 2,500 individuals to around 400 without taking a financial hit, doctors said. Their pay is not measured by procedure volume.

“When doctors get off of fee-for-service and get away from quality reporting and performance improvement, the world survives,” said Shawn Martin, CEO of the American Academy of Family Physicians. “Nothing collapses, and patient and physician satisfaction goes up.”

Switching to mostly cash pay can eliminate the many stressors involved with billing insurance, such as claim denials, prior authorization and quality reporting, as well. Concierge doctors run their practice how they want, without direction from health system- or insurer-based employment models, experts said.

These factors will fuel concierge medicine and direct primary care’s growth, said Dr. David Blumenthal, a health policy professor at Harvard University who previously had a primary care practice at Massachusetts General Hospital in Boston.

“This is what happens when you have a resource in primary care physicians that is undercompensated and undervalued,” he said. “Primary care physicians are realizing their true market value by taking themselves out of the current system and creating a side business.”

Some of the push stems from employers, said Douglas Grimm, a healthcare lawyer at law firm ArentFox Schiff. Grimm recently advised two self-insured employers considering direct primary care offerings.

Grimm said direct primary care costs tend to be less volatile than traditional insurance premiums, which are projected to grow 9% next year for employers, up from 8% in 2025, according to a report published last week from the Business Group on Health.

“Employers’ risk is reduced if they pay a flat cash fee up front, and then providers don’t have to chase payment,” he said.

Health systems are also betting on direct primary care and concierge medicine growth. Well-known organizations, including Boston-based Mass General Brigham and Rochester, Minnesota-based Mayo Clinic, have started their own concierge medicine divisions. Mass General and Mayo did not provide additional information.

More health systems will likely adopt this strategy to boost referrals from primary care doctors and accommodate patients seeking more personalized care, experts said.

“Health systems want to provide a panoply of positions and retain physicians in their system,” said Susan Feigin Harris, a healthcare attorney at law firm Norton Rose Fulbright. “It is a way to bring in referrals for subspecialty care, and keep patients and physicians happy.”

Health systems will want to partner with concierge clinicians because there is such a limited supply of primary care doctors, said Duane Fitch, a partner at consultancy Plante Moran. Concierge practices can take capacity out of an already strained system, he said.

Having a health system-affiliated concierge practice could bring in a growing number of patients as the treatment model expands, Grimm said.

“Patients may not choose to go to a particular hospital unless concierge services are available to them,” he said.

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