Understanding the Ins and Outs of Concierge Medicine Today

By Wayne Lipton

Physicians today are faced with many options when it comes to decisions related to their practice; from selling it, to adding new products or services to increase revenue, to retiring.  While many physicians today are aware of concierge, and even newer options now available, many have not fully considered all their options due to misperceptions or perhaps even fear.

With the changes taking place in the healthcare marketplace today, all physicians owe it to themselves to fully understand all practice models; to consider how and if they’d work for their patients; and to ask themselves an even tougher question: what do I really want from medicine today.

What is concierge care?

The term “concierge medicine” has been lost on many in the population due to stereotypical images in the media and emerging watered down programs that claim the title but offer few of the benefits.

True concierge care is a practice model that incorporates a membership approach where patients pay a fee for participation. Patient-members may be paying for some specific services or not. The provider of the services, generally a primary care physician or specialist with some continuing services to a large portion of their practice, may be doing the model entirely (full concierge) or in part ( hybrid concierge). In most cases the resulting style of care delivery is one that has more interpersonal time between the physician and the patient; easier direct availability; an emphasis on preventive care; and more interpersonal time. The result is that fewer patients are seen per hour than in a standard practice. In addition, often the direct revenue for the physician is increased.

The full vs. the hybrid

A full concierge model – where physicians close their practice to only the select few that can pay for the option – is not always an ideal choice for many physicians, or one that is even possible.  In most cases, there are not enough patients who are willing to pay a fee that often is $2,000 or more per year on top of their regular medical insurances and other costs.

While it is a desirable model for many physicians, it can be difficult in a multiple physician environment that is dependent on volume and a width of available services. In addition, it may not increase revenue and could often decrease overall group revenue.   It is, however, an excellent model for physicians near retirement, or those with physical limitations, as well as those wishing to pursue other interests.

Conversely, a hybrid model, when designed and implemented properly, addresses many of the concerns some physicians have with full model programs, including:

• Typically increases practice revenue
• Is compatible with health insurance plans
• Works well in a multi-physician and multi-specialty environment
• Integrates easily into the existing practice (the amount of time needed to deliver the services is dependent on the membership population)

What characteristics work best in concierge care?

Concierge programs are not yet a “build it and they will come” model.  Simply offering a concierge program to the public won’t necessarily end in success.  Therefore, it is most appropriate to consider it a transitional model; requiring established patients who are attracted to the benefits of the model and are economically capable and inclined to pay for the service. Here are other important features necessary to achieve a successful concierge program:

1. Physicians and patients who want more face-time, and more time to discuss, prevention, wellness and other health concerns during visits.  Strong, existing relationships are also important as is the “bedside manner” of the physician.

2.  A well-designed benefit package for the concierge program that is both attractive, meets regulatory compliance, and is not in conflict with other plans and coverages. In a full model, the number of members needed to match or exceed the current practice revenue may be a very large hurdle. In a hybrid model, any number of members is a success; however, it needs a base membership to make scheduling comfortable and effective.

3. A fee that is affordable for many of the practices’ patients.  Balancing the price point of the program to the ability of the community to pay for it is important as is properly valuing the program to make it a benefit to the practice.  Concierge programs are successful in middle income areas or higher. In some cases where incomes vary, a hybrid program can be highly successful even if a full model concierge program might fail.

How does the model work and what is delivered?

Often a concierge program is built around non-covered services (often an expanded indepth physical examination) that are packaged along with commitments of fewer appointments per hour (more potential time with the physician) and expanded availability necessary to increase the advocacy that accompanies the care.   This may mean direct access via a cell phone or email system and dedicated phone lines in the office.  It also means fewer patients in a full model than in a standard practice and fewer patients per hour during hybrid concierge time.

In a hybrid practice, a few hours each day are dedicated to delivering the concierge main services and follow up care.  Members can come to the office during non-concierge time as well.  Since the concierge service represents from 10% to 25% of the practice time, the impact on the overall volume of the practice is very small.  Often, traditional productivity increases, but sometimes the overflow is moved to another provider.  During concierge hours, physicians see one to two patients an hour and there are many hours that remain open intentionally to allow for proactive contact by the physician to both patients and other physicians and specialists for coordination of care.

What do patients expect?

Whether offering full-model or hybrid, concierge patients expect more direct contact with their physician, as well as an opportunity to go over the entire picture of their care needs, including the emotional and family components of their care. They expect more time spent on “quarterbacking” the process and helping them to understand what is happening in a more engaged and compassionate fashion.  Time allows for not only more information exchange, but also for the encouragement of greater compliance and participation on the part of the patient.

Patients also expect a high level of service that includes minimal waiting time and same day or next day appointments.  While they understand that their physician cannot be available by phone 24 x7, they expect that the physician will make an effort to cover their calls as often as is possible.  The practical experience with this expectation is that members rarely call as they have all the availability that they need during the day. With a small number of members, hybrid physicians get on the average one call every 15 to 20 days.

How does it work with other parts of the practice?

While full models by their nature tend to separate the physician from a multiple physician environment, the hybrid does not.  The hybrid concierge physician uses the same facilities, is still involved in high productivity in a traditional practice and still is valuable to the other physicians and services in the practice.  Generally they see fewer new patients to adjust for the concierge time but continue to be open on a limited basis.  Full model physicians dismiss large number of patients to other providers which may be helpful in a growing practice environment, while hybrid physicians do not dismiss patients.  There may be some migration but it is limited and varies from practice to practice.

While one can attempt to introduce a hybrid model without assistance, using a company that can help practices avoid the marketing, regulatory and strategic landmines is extremely valuable.  In addition companies often cover all of the costs associated with the implementation and can ensure the overall risk to the practice is minimized.

Exploring Choices

There remains much uncertainty for physicians today.  But there are also many choices. Physicians who believe in primary care, and who want to build relationships with patients focused on prevention, wellness and meaningful relationships, owe it to themselves to consider a range of options, including full-model and hybrid concierge.

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Wayne Lipton is Managing Partner of Concierge Choice Physicians (www.choice.md).