When I heard about a different kind of concierge medicine, known as the Hybrid, I decided to find out more. I was skeptical and firmly against any model that made me say goodbye to the majority of patients that I'd known for years.
After a thorough review, I decided the Hybrid Concierge model would work for me because it isn't an "either/or" proposition. By design, less than 10% of my patient panel participate in the program. I set aside some time every day for my concierge patients, and see the rest of my patients as before.
Unlike the direct pay or cash-only options now emerging, this option also keeps insurers in the picture and yet gives patients - especially those with strong ties to me as their physician - the choice of more personalized care.
Patients and their families benefit from this approach by receiving services not covered by traditional insurance including:
- an enhanced in-depth/executive-style physical tailored to their needs with the lab tests included
- personalized care coordination from me
- same or next-day appointments
- a dedicated "Concierge Coordinator" to personally handle their phone calls
- a dedicated, private concierge phone line
- my direct personal phone line for after-hours emergencies.
I benefit from the program because it is a simple, risk-free model to integrate into my practice. It provides a private, stable source of revenue and it allows me to practice medicine the way I think is best for my patients.
Nationally, patient membership fees for Hybrid programs are about $160 per month, about what many people spend on cell phone fees or a gym membership.
Patients with insurance simply continue to use it as they always would for their routine visits. Patients are not paying "extra" - the membership fee is for those enhanced non-covered services. And again, no patient has to join. Those who don't need a concierge program keep seeing me as before.
Other physicians often ask me what's different about providing concierge care. The big difference is that the office visit isn't the average 15-minute chat about the illness of the day. We can have a more in-depth and meaningful conversation about a patient's health, questions and concerns. I am actively involved in all aspects of care, remaining the trusted advocate and resource for patients, as well as family.
Plus, our relationship is built around an in-depth, personalized physical - something I believe is an important foundation for quality care and the physician/patient relationship. This enables me to ask in-depth questions, to find out what else is going on in a patient's life, and to jointly discuss and explore healthcare goals. My rediscovery of how enjoyable and fulfilling truly patient-centered medicine can be carries through to all my patients and to my staff as well.
With so many physicians struggling to make ends meet today, a question I'm often asked is, "how much more money can you make?"
While each physician's experience will vary based on the size of the program and other factors (e.g., if you increase/decrease the overall patient panel), on average, practice revenue increases 10 to 25% according to Concierge Choice Physicians, the company that manages my program. My income increased about 30% in the first year and has continued to increase. I am spending fewer clinical hours than I used to.
It's also important to note that I've achieved a more stable practice at no financial risk to me. There was a small upfront investment. I maintain insurance and referral relationships. Plus, with little effort, I was able to start and maintain the program. I also work in a large group, with 45 other physicians, and this model works well within our group practice. In fact, several other physicians in our group also offer either a hybrid or full-model concierge program, giving choices not only to physicians, but also to our patients.
What is good about the option we chose is the management company does nearly all of the work. For example, they provide initial market research, survey patients to determine interest, market the program for retention and new patients, train staff, provide billing support, including credit card services, coordinate with insurance if needed, as well as provide monthly newsletters and communications with patients, and provide us with the tools to build a personalized secure portable health record for patients.
Doctors also want to know what portion of the membership fee goes to the practice management firm, consultant, etc. helping to set up the program. That's an important question. It's important to shop around and ask the vendor up front for what they charge; at least two-third of the membership fee should go back to you - not someone else's pocket. Compare and see for yourself what makes sense. If the company or consultant doesn't provide you a clear answer or asks for money upfront - go somewhere else. One other piece of advice, look very carefully at the contract. Make sure you aren't locked in for the long-term, with no freedom and heavy penalties to get out when you want. Make sure your patients can opt out with no penalties or extra costs as well.
Keep in mind, the Hybrid Concierge model might not work for every physician in every community. You have to have a patient base that can afford the modest monthly fee. You must have a strong relationship with your current patients - to the extent they want to join the concierge program. You have to maintain a very high level of patient satisfaction. If you don't, patients will leave or go back to the traditional practice.
The good news with this model is you continue to see all your patients. The choice to join is with them. Those who do join, love the program. Retention for my program and most others in Hybrids is high, averaging over 90 percent, which represents routine practice attrition. Those who haven't joined the program report little to no changes in our relationship. (Remember your best source of future patients will be your current ones and their friends/family so your service must always remain stellar).
For my colleagues who are struggling to determine how to remain independent, or who want to strengthen their group practice, and who want to practice medicine the way they envisioned as a young medical student, this is one path I suggest they research and consider.
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About the Author: Anand Lothe, MD, F.ACP, is an internist and director with Virginia Physicians, Inc. of Glen Allen, VA. The hybrid concierge program he adopted is provided by Concierge Choice Physicians, which pioneered the model in 2005. For more information go to www.choice.md or call 877-777-6625.
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