The TV show "Royal Pains" on the USA network, depicts concierge physician Hank Lawson treating his
wealthy/crazy clients in The Hamptons on Long Island. Obviously, the show uses literary license to the
extreme in order to keep your attention. Just recently, there was an article in the Syracuse Post recently
about a local internist who had opened up a concierge practice. The reporter called me to ask what I knew
about it. I had to admit that beyond what I knew from "Royal Pains", I really knew very little about these
practices. After reading his article I had more questions which prompted me to make some calls and do some
research.
This type of medicine goes by several different names, including: membership, boutique, retainer, cash
only, direct care and direct purchase. According to Concierge Medicine Today, a sort of trade association
and advocacy web site, there are about 5,000 physicians in the US who practice this type of medicine. Two
thirds of the concierge physicians are internists with about 300 to 600 patients. The typical internist has
about 2,500 patients.
A concierge company will first come to your practice and analyze your patient demographics to determine
whether or not there is a sufficient base for concierge medicine. I erroneously thought that concierge
patients were mostly Medicare recipients. To the contrary, most concierge patients are under 65 and
commercially insured. They have the discretionary income for the retainer fee while most seniors are on
fixed incomes. Once it is determined that the physician has the right patient mix to succeed, and the
physician is game, the company begins to notify patients of the change in the practice.
You cannot operate your concierge practice simultaneously with your traditional practice. There is a
drop dead date when your traditional practice ends and your concierge practice begins. There is no gradual
transition period from one to the other. In this way, you aren't caught in the trap or dilemma of providing
two levels of care at the same time. If one physician in a group practice decides to give concierge medicine
a go, and wants to remain a partner in the group, that physician will operate in a totally separate space
with totally separate staff, so there is no confusion or chance of two levels of care. To avoid abandonment
issues, you must find alternate care arrangements for those patients who do not elect to remain with you.
In a group practice setting, patients are usually transferred to the other partners.
The main selling point is patients get immediate access to, and undivided attention from, their physician.
The amenities include: nicer and less crowded reception area; guaranteed same/next day appointments;
evening and weekend appointment; 24 hour cell physician cell phone access; house calls; preventive/wellness/weight
loss programs; email access; free annual physicals; spa services; etc. The company you are working with
will make it clear to all what the concierge service covers above and beyond what the patients insurance covers.
It should be made clear to patients that the immediate access and increased attention does not apply to
the specialists you will be refereed to. The patient signs a retainer agreement. The agreement should
never guarantee better diagnostic or therapeutic services as clinical judgment should never be compromised
by a patient's financial status or insurance policy.
Retainers can run from $1,500 to $20,000 per year depending on whether or not the physician participates
with third party payers. Since the vast majority of concierge physicians do participate, a typical
retainer of $1,500 would provide $750,000 of income to a physician with 500 patients or $900,000 for
600 patients. According to the practices I spoke to, the physician keeps two thirds for personal income
and office overhead. The remaining third goes to the concierge company for marketing, billing, insurance
enrollment, patient notifications, etc.
Most practices continue to par with third party payers and bill for services rendered as usual. A
"full" concierge practice or cash practice does not participate in third party plans and this is
where retainers can reach $20,000. CMS is monitoring their participating physicians and will determine
the propriety of charging a retainer before delivering services. The expensive "cash only" practices
are very risky. Critics say the physician is acting, in a sense, as an unlicensed insurance company.
Concierge medicine is not for every physician and just as well as the critical shortage of primary
care physicians would be further exacerbated. The managers I spoke to said that the doctor that is
best suited for this practice style is extremely empathetic and ALREADY provides immediate care, 24
hour access by phone and extended time during office visits. Physicians that are impatient and don't
want to be bothered 24/7 are not good fits. For more information on concierge medicine, check out
MDVIP.com.
