Tackling the Assumptions about Concierge Medicine

Concierge medicine means more money and fewer worries – right?

For the basic question of, "With concierge will I generate enough revenue to keep the wolves from the door; to keep me from worrying; to sustain my practice. . . .?" the answer is: It depends.

I’ve seen countless physicians over the past decade dive into concierge medicine without doing their homework first. Some try to develop programs on their own - others work with outside companies or consultants - some of whom do not fully understand the market, the physician/s in the practice, and patients. I’ve seen some heartbreaking failures where physicians put their faith in a concierge program, say goodbye to the majority of their patients, drop their insurance contracts, put up their shingle, and within a few months, fail or find themselves struggling.

There are many reasons why. First, it’s important to recognize there is no standard concierge model, just as there is no "standard" physician practice - all are unique. Applying what works to one practice arbitrarily to another may not work.

There are also important facts all physicians must understand. A critical one is that some concierge models may increase costs. For example, an established and popular physician may offer the concierge program to some of her patients, but turn the remainder of patients over to a new younger physician, or physician extenders such as physician assistants or nurse practitioners who cost money and take time to train. (By the way, this approach may also alienate some patients leading some to leave the practice.)

Full model concierge programs may also impact the number of full-time equivalent (FTEs) required to deliver services to the members. However, it is often the case existing office staff does not have the background or training to deliver the service level needed in a concierge program, thus impacting productivity, patient satisfaction, and ultimately the program’s potential for success.

What’s more, some concierge practices try to differentiate their programs by spending on high-end separate facilities and/or separate waiting rooms or entrances to create an image of exclusive service…again, increasing costs.

Here are some additional factors that must be considered when adding a concierge program:

1. In a full-model program, you will be reducing your total number of patients by more than one half. If your current practice relies on income that is generated by either ancillary services or additional medical services (e.g., nutrition counseling) that are provided as a result of your patient volume -  and if there is a significant fixed cost associated with these services - then you must be very careful about reducing your patient volume and consider the negative impact that downsizing has on your bottom line. Also keep in mind that if you have equipment with lease costs that are covered by your current utilization of that equipment, then volume is important.

2. If you have a large office space with many exam rooms and you are committed for a long term, then you have to consider the impact of downsizing.

3. If you lease to associated physicians who perform services for the patients associated with your practice, or if you are in a multispecialty practice, then once again, downsizing has an impact.

4. The demands on your existing staff also change with full model concierge and may necessitate bringing on new personnel. Your staff may be in "volume mode" not "service mode" and may need to be retrained to move to a higher level of service. You may also need to bring on additional staff trained in providing higher levels of care, and who may require additional compensation. In addition, many physicians resist downsizing staff when they move to a concierge program. The intent is admirable, but the result is high overhead.

All of this is most definitely not meant to dissuade physicians from considering concierge, hybrid, or any other of the options available today. It’s meant to remind you to consider all facets of your decision.

There are a number of highly successful full model and hybrid concierge programs today - ask successful physicians and they will tell you they are well worth it - many noting it’s one of the best decisions they ever made. But don’t make assumptions. Do your homework,  crunch the numbers, and work with experts who can provide the advice and counsel you need to launch a successful program.