Specialty care physicians have recently begun experiencing the same pressure on reimbursements that primary care physicians have been struggling with for years. Across the board, procedural and ancillary service revenues have been slashed or are at risk for reduction. Rheumatologists, in particular, are seeing overhead escalate and income stagnate, with a growing percentage earning less than in previous years.1
Over the past few years, some specialists have discovered that a hybrid model of concierge medicine gives them the opportunity to provide a stable source of revenue, while offering a practice option many patients today desire. In a hybrid program, physicians continue spending the majority of their time in a traditional relationship with their patients and a smaller portion of their time delivering the personalized services of concierge care.
Below are some questions and answers about how this new approach works for rheumatologists and other specialists, as well:
Q. What’s the difference between a full model & a hybrid model of concierge care?
A. In a full-model concierge care program, the entire patient panel pays a membership fee in order to see their physician. The patient panel size is kept small so the physician can offer extra time and personalized concierge services. Therefore, when a practice converts to a full concierge model, the physician must dismiss a large portion of their patients, including those on Medicare, who either can’t or don’t wish to pay the membership fee. This can prove ethically and personally challenging for specialists who would have to dismiss patients who in turn may find it difficult to find specialized care.
In a hybrid program, the physician offers an optional concierge care program for those patients who are seeking extra time, service and enhanced advocacy from their physician. Typically, only a small percentage of the practice joins the concierge program. The majority of the patients remain in the physician’s traditional practice. Physicians can maintain their full patient panel and don’t have to dismiss patients who cannot participate.
In a hybrid program, physicians continue spending the majority of their time in a traditional relationship with their patients & a smaller portion of their time delivering the
Q. Can a hybrid work for any specialist?
A. We’ve found the concierge model doesn’t work well for specialists providing predominantly episodic care. It does work well for rheumatologists whose patients see them on an ongoing, recurring basis and whose medical needs strongly relate to their rheumatologic health needs. Many of these patients typically consider their rheumatologist their go-to doctor, sometimes spending more time with their specialist than their primary care physician. Note: This is not about transforming a specialist into a primary care physician. It is about providing a greater consultative and advocacy role for specialists who seek this opportunity.
Q. What do patients receive for their membership fee?
A. The membership fee typically covers services that are not covered by insurance, such as an annual comprehensive screening exam. For rheumatologists, this means a 60- to 90-minute exam that includes a comprehensive patient and family history, and a collection of screenings customized to each particular patient. It often includes a discussion about nutrition, exercise and mobility planning, as well as lifestyle issues. The actual elements are tailored to the practice and the patients. The fee also includes enhanced services not available in the traditional practice. These may include off-hour emergency access via cell phone, dedicated office staff and phone numbers, relaxed office visits, advocacy and coordination with other healthcare professionals and transferable electronic medical records.
Q. Will my concierge patients be overly demanding?
A. Hybrid programs tend to be limited in nature, with most practices consisting of 25–100 members. This represents a small percentage of time each day dedicated to the concierge program. Physicians have reported that because patients know they can reach their physician whenever needed, they are much less likely to be overly demanding or make unnecessary calls or request after-hours visits.
Q. What does a program like this cost for the patient?
A. The annual fee to join a concierge program varies, but generally the range is between $1,600 and $3,000 per year.
Q. Does the hybrid concierge model work in group practices?
A. Hybrid concierge programs work well in group practices in which some or all of the physicians can choose to offer the program. The practice’s traditional program remains intact and continues to accept insurance plans as before, allowing for flexibility among the participating physicians.
Q. How does this affect my relationship with payers?
A. The concierge membership fee is only for non-covered services. Insurance plans continue to pay for procedures and covered services as before.
Q. What is the best way to start a hybrid concierge program?
A. There are many important issues to explore. To be successful, a practice must analyze patient interest and demographics. You will need to look carefully at the regulatory and insurance environment in your state. The program must be strategically marketed and introduced to patients. Once launched, the concierge program, including scheduling and billing, will need to be managed. To ensure ease of launch and implementation, look for resources with experience and a solid track record in this practice format.
Q. How much will it cost? What is the potential ROI?
A. Some firms will assume the cost of market research and marketing and in return, will charge a percentage of the patient fee.
Do Your Homework
The current marketplace continues to bring uncertainty and challenges for many rheumatologists. The key is to study your own needs and those of your patients before deciding whether you should consider making changes to your practice model.
Wayne Lipton is president and CEO of Concierge Choice Physicians, which he founded in 2005. He was one of the first consultants to develop concierge programs for specialists.
