The concierge practice emerged more than 10 years ago and centered on family practice and internal medicine. Since then, practices have adapted the model to suit their preferences and styles, and the concierge approach has even moved beyond primary care as private practice physicians of different specialties search for a more profitable and fulfilling career path.

The concierge approach aims to improve patient care while collecting all or most of the practice’s revenue directly from the patient.  Patients are attracted to more personalized service and less harried exams. Patients and physicians both feel better care is given and physicians find more satisfaction in their chosen career.

Another practice model that evolved from the concierge approach is direct pay primary care (sometimes also called ‘direct primary care’). In this model, physicians collect all their fees directly from the patient Patients pay a subscription fee that covers most primary care services.  For the practice, by eliminating the costs of dealing with private insurers such as complying insurance regulations, claims submission and managing the accounts receivable costs can be significantly reduced and services enhanced. This approach generally offers fewer frills than a true concierge practice, and so the monthly subscription fee is lower, too – usually $100 or less.

The appeal of direct pay primary care is that many patients have high deductible plans and seldom, if ever, reach the threshold level where insurance kicks in each year. In effect their insurance is more like catastrophic coverage — they pay for their doctor visits and diagnostic studies as part of their deductible. For these patients, a direct primary care subscription can offer greater access and better care for the same or even lower out-of-pocket expense.

For physicians, having more time to spend with their patients allows them to develop strong bonds with them, improving communication and patient compliance with their treatment plan. It’s a win-win proposition for doctors, patients and caregivers.

There are attractive benefits to alternate practice models, but converting an existing practice requires careful planning. If you are considering an alternative practice style that is not reliant on insurance payment, there are some important considerations.

Start with a thorough understanding

It is critical to understand yourself and your motivations. How important is it for you to develop a more personal relationship with your patients and dedicate more time with each one of them. Can you accomplish this and still have a financially viable practice?  How much attrition is likely to occur during the transition?  A practice assessment – conducted either in partnership with your practice administrator, or with the help of a consultant – can be an indispensable starting point to answering these questions.
Exploring options

There are firms that are in the business of helping physicians build concierge practices, and evaluating their offerings can be a good first exploratory step.  The firms differ greatly in their approaches, business models, and support. Appreciate that you will need to clearly understand how they work, what type of help they provide during conversion, and how much support you get on a regular basis afterwards.  For example, do they provide marketing campaigns, reporting tools, benchmarking services and outcomes measures?  What would you get, how much would you pay and would it really be worth it?

It’s almost impossible to overstate the value of talking with other physicians who have worked with any company you are considering and to physicians that have taken a similar practice conversion path. Find out if they have any regrets and what they would differently if they were doing it all over again.  Getting feedback of this sort is very easy using a service like sermo.com, where physicians can comfortably share their views in a physician-only environment.

Be especially cautious around long term agreements as there are many currently unknown factors that might affect how you want to practice medicine.  Just as in any other collaborative business agreement, seeking legal counsel before you sign a contract will be critical before you make a final decision.

We’re excited to see increased creativity in the business models of medical practices and expect many physicians to benefit from them. Perhaps you will be one of them!

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