Everything you ever wanted to know about CONCIERGE MODELS
but were too afraid to ask!
Concierge medicine has come a long way since its inception more than 20 years ago. In fact, because there are so many different models, concierge medicine is now often referred to as “membership medicine.”
Today, we sit down with Keith Elgart, Chief Operating Officer from Concierge Choice Physicians, a leading provider of the full spectrum of concierge models, to discuss the different models, and why choices are so important.
So, what was the very first model of “concierge medicine?”
Concierge medicine began on the West Coast over 20 years ago. It began as a way for patients to secure more time and one-on-one attention from physicians. The first model was known simply as “concierge medicine” but today we refer to it as a “full-model” concierge program, because there are quite a few models.
It’s “full model” because the doctor converts the entire practice to a concierge practice. All patients become members, or they must find a new health care provider. Most doctors take pro-bono cases for select patients who cannot afford the fee, or for personal reasons, but otherwise, every patient is a paying member.
Typically, a full model concierge practice, or a “FullFlex” model as CCP calls it, has between 400-600 patients, so it is significantly smaller than an average practice. The revenue from membership fees more than makes up for the smaller patient panel.
How did concierge medicine evolve from the full-model program?
We noticed that, because of the nature of full model practices, some highly regarded physicians with patients who really wanted the opportunity to secure this one-to one relationship, were unable to make a full transition to a concierge model. Perhaps because the patient panel was small, or because the demographics of the area wouldn’t support a membership model, they were passed over. There were also some providers who simply weren’t comfortable
dismissing patients who weren’t interested in joining or couldn’t afford to join.
This seemed like an opportunity for us. What if we could develop a model that allowed physicians to continue to serve patients in a traditional way, and simply offer patients the option to join a concierge program, if they wanted to? Same
doctor, same practice, different service/support level. That’s how the Hybrid Choice™ was born.
So, there is a full model, and a hybrid model. What else?
Flexibility is what CCP is known for. So, our models continue to evolve as the nature of medical practices evolve. For example, we also offer what we refer to as a “Hybrid XT” model that essentially allows a physician to practice as a full
model concierge physician, but keep their complete patient panel with the support of a physician extender, like a nurse practitioner, physician assistant or junior level physician.
Many physicians who are transitioning to retirement and looking to sell their practice have had great success with this type of model, for example. The lead physician sees the concierge patients, while the junior physician treats the
traditional patients, getting to know them and establishing good connections so that, when the time comes, they can take over the practice and maintain the concierge program too. The concierge program adds tremendous value to a
practice and keeps the practice serving all patients as before.
What about a Direct-Pay model? How does this type of model factor in?
A Direct-Pay model is a bit different from concierge models because the physician is paid directly from the patients. Unlike concierge medicine, physicians who operate under a direct-pay model don’t accept any insurance—no Medicare or third-party insurance. At base, that’s what direct pay is all about.
How the direct pay practice is structured can vary. Some physicians have patients pay a membership fee that covers visits to a certain extent, some are fee-for-service practices, and some offer the choice—you can join the
practice a member, paying monthly, or you can be a fee-for-service paying patient.
Because some direct-pay physicians have membership programs, it does fall under the membership model umbrella.
So, what kind of physician is best suited for which kind of program?
That’s not an easy question to answer! The nature of thepractice, the goals of the physician, the relationship with the patients and the demographics of the area all combine to inform that choice. We conduct an extensive analysis to predict the level of success a physician would have with each approach and let the physician decide what they feel most comfortable with.
For example, our analytics may reveal that a physician would be extremely successful in our full model FullFlex program, but perhaps they are risk-averse, and want to start slow and safe with a Hybrid Choice. From there, they can transition to a FullFlex model when they feel ready. The important thing is that the doctor knows their options and has confidence moving forward. That’s what we strive for. It’s not one-size-fits-all anymore.
THE BASIC MODELS OF MEMBERSHIP MEDICINE:
The practice converts entirely from traditional to concierge care. Patients pay an annual fee for membership and in exchange receive more time, personalized service, convenience and support. If they choose not to join, their care can be transferred to another available provider either within or outside the practice. Physicians typically continue to accept Medicare and insurance plans for customary office visits. This model is a good choice for physicians, especially solo practitioners, in select markets or physicians
looking to reduce the pace and pressure on their practice.
A flexible model that allows a physician to offer a full model concierge program while continuing to oversee the care of all patients. Physician extenders like nurse practitioners, physician assistants or junior level physicians usually see non-member patients, while member patients are seen exclusively by the concierge physician. This is a great option for a physician with a strong support staff who wants to move to a full model program with minimal disruptions to the patient base or business structure.
A unique model that blends concierge care with a physician’s traditional practice. Concierge service is an option patients may choose to purchase through an annual fee. Because a physician never needs to dismiss patients and maintains referral networks, this low-risk model is an
excellent choice for a wide array of physicians, including primary care physicians, specialists and even physicians employed by large groups or delivery systems. Physicians continue to accept Medicare and insurance payments for customary services.
This term refers to an arrangement where the patient pays the doctor for services directly—bypassing all traditional insurance and government programs. A direct-pay model may include a membership model or it could be fee-for-service. Because doctors rely entirely on income paid
directly from patients, it is widely considered the most risky approach.
Physicians can get started by contacting CCP directly, or by visiting our website at: www.choice.md/PVR and answering a few simple questions.
We will then provide you with an introductory analysis that can explain some initial options.