Maintain Practice Independence Via Concierge Medicine Model

With last year’s election firmly cementing the Patient Protection & Affordable Care Act (“ObamaCare”) into the American healthcare system, physicians wanting to maintain practice independence are looking for different economic models that would offer them the necessary revenue stream without joining a large healthcare system to ensure adequate patient flow.

I had the opportunity to interview Wayne Lipton, founder of Concierge Choice Physicians, for an article published in the May 2012 issue of Medical Liability Monitor. Lipton’s company is one of many that provide marketing and support services to independent practices that want to design and implement a concierge-model for their medical practice. Lipton’s hybrid concierge model maintains the individual integrity of independent private practices, offers physicians a new subscription-based revenue stream and carries medical professional liability benefits.

“There has been a push toward what I call ‘big box’ or ‘factory medicine,’ which is unfortunate because I think it takes a lot away from the art of medicine and leaves little room for the strengths of the individual provider,” Lipton told me. “The larger the group, the less physician autonomy there is. A hybrid concierge model enables small groups, middle-sized groups and individual physicians to keep practicing without succumbing to the economic pressure to aggregate into mega units. It also emphasizes the one-to-one relationship, establishing value between the patient and doctor rather than the patient and an entity.”

The Benefits of a Hybrid Concierge Model

• New Revenue Stream. Under the hybrid concierge model, a physician offers his or her patients the option to participate in enhanced, subscription-based care. Those that choose to pay the subscription fee (usually between $100 and $150 per month) will receive extra attention under the new model. Hybrid concierge patients will receive preferential scheduling of appointments, enjoy longer visits with their doctor during the appointment, be given a separate contact telephone number for expedited telemedicine consultations and receive the doctors cell phone number for after-hours emergency cases. Medical tests and appointment charges are still billed to the patient’s health insurance provider or Centers for Medicare & Medicaid Services (CMS).

Not every patient will want to subscribe to the hybrid concierge model. Under the hybrid concierge model, physicians still continue to maintain their traditional practice while devoting a portion of their daily hours to members of the concierge program (total membership generally consists of 50 to 200 patients). During program hours, only one or two patients are scheduled per hour. This allows the physician the time to offer an expanded set of services as well as additional time to coordinate their care, stay in contact with patients, encourage compliance, return phone calls and understand their patients.

Most physicians operating a hybrid concierge model not only find the subscription income a beneficial new revenue stream, they also enjoy increased professional satisfaction from the added attention that they are able to give their patients who choose to participate.

• Independence. The Affordable Care Act encourages many physicians to align themselves with large health systems. Physicians who are participating in the concierge model are doing so because they want to maintain the independence of their practice. These doctors are looking for ways to survive without joining the mega healthcare systems that will soon dominate healthcare delivery.

“The hybrid concierge model is a tremendous opportunity as physician groups and entities realize not everybody is going to want to fit into the box that [large healthcare systems] require,” Lipton said. “A hybrid concierge model enables group practices and individual physicians to offer a variety of choices in the way they offer care.”

• Personalized Care Reduces Liability Exposure. As the healthcare delivery system moves toward what Lipton refers to as “factory medicine,” doctors will have less time than they currently do to spend with each individual patient. This will lead to a further breakdown of communication between a physician and his or her patients, and numerous studies have indicated there is a close correlation between physician-patient communication and patient satisfaction, healthcare outcomes and malpractice litigation. One high-profile study concluded:

“risk appears related to patients’ dissatisfaction with their physician’s ability to establish rapport, provide access, administer care and treatment consistent with expectations, and communicate effectively.”

“[Mega healthcare systems] encourage a depersonalization of medicine,” Lipton explained. “The group model emphasizes the use of lower-level providers, like nurse practitioners and physician assistants. It doesn’t emphasize the physician-patient relationship, where the doctor knows the ‘wellness state’ of the patient and his or her medical history.

“Hybrid concierge care emphasizes personalization, the personal relationship between physician and patient. It enables the doctor’s value to be based on how they perform. This is a patient-driven, consumer-driven approach that rewards excellence in relationships and the comfort level the patient has with their physician.

“Physicians who work under a concierge model are those most appreciated by their patient base and have the greatest relationships with their patients, so they have remarkably low liability exposure. These doctors are a much [less expensive] group to cover than a broader, less select group of doctors.”

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