NEW YORK (MainStreet) — Once reserved for the wealthy and upper middle class, a small but growing number of primary care concierge doctors are filling the gap for the uninsured and the underinsured while providing many of the bells and whistles that go along with these types of practices.

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AtlasMD Family Medicine Clinic in Wichita charges a modest monthly fee of between $50 to $100 for adults, depending on age, and $10 per month for children up to age 19 years. They do not bill insurance in addition for appointments. (The doctors do, however, advise patients to carry major medical insurance to cover hospitalizations and other medical necessities.) The practice also buys medications wholesale and pays a monthly fee in cash to a local lab to reduce lab fees, saving their patients additional money. By leaving insurance out, the practice is able to lower overhead costs by saving money on coders, says Michael A. Palomino, one of the physicians in the practice, and he says routine tasks and communications are streamlined through proprietary software.

This structure allows the AtlasMD doctors to allot 30 minutes per patient and cap their practice at 500 to 600 patients compared with non-concierge practices, which have several thousand patients.

Missing is the battery of examinations and tests that higher-end concierge practices sometimes require. This is where they make a considerable amount of their money. But it could cost patients in terms of false positive test results and unnecessary anxiety.

However, the other bells and whistles typical of concierge care are there – 24/7 access, expanded and on-time appointments, direct phone and email access to your doctor, and house calls, when necessary, and an annual executive physical.

In Washington state, Qliance fees run from $59 to $99 per month, depending on age plus a one-time $99 registration fee. Although it offers fewer concierge perks, Qliance is another direct pay primary care model that may fill the gap for the insured or make it possible for people to afford high-deductible health care plans under the ACA and have affordable access to primary care where patients think twice about whether or not to visit a doctor due to excessive costs.

In 2013, concierge or cash-only practices grew a modest 2% over the previous year, according to Medscape. Research by Accenture in 2012 shows that the number of independent physicians dropped from 57% in 2000 to 39% in 2012. Accenture estimated that a third of these doctor's practices that remained in 2013 will become subscription based and that number will continue to rise.

With the Affordable Care Act now in place, it remains to be seen if the concierge model for more modest incomes will continue to grow.

--Written by S.Z. Berg for MainStreet

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