Concierge Practices Even for Doctors Who Don't Like the Idea

Neil Chesanow


January 09, 2014

In This Article

Can Any Practice Become a Concierge Practice?

"I had gotten acquainted with Garrison Bliss in Seattle, who was one of the first concierge doctors in the country, running Seattle Medical Associates [now Qliance], because my father needed care," LaGrelius says.

"My father lived in Seattle and wasn't getting optimum care. As things deteriorated, as the HMOs got going and doctors got busier, there just wasn't enough time. He had trouble getting ahold of his doctor. He had trouble having adequate time with him. I asked Garrison if he would take on my father. He did, and the care was incredible. He convinced me that a limited-panel practice was the optimal way to go."

LaGrelius had conferred with other thought leaders in the concierge movement as well, among them Edward Goldman, MD, Founder and now Chairman of MDVIP, a nationwide franchise of doctors in full concierge practices, and John Blanchard, MD, Founder of the American Society of Concierge Physicians (now the American Academy of Private Physicians), a trade group. When he was ready to make the move, he sought professional help.

"I realize that the vast majority of doctors have pretty much done it on their own or just ask their local attorney for advice with legal issues," he concedes. "But a lot of them have failed. And a lot of them have struggled, even the ones who have ultimately succeeded."

The Transition Process

Not every conventional practice is a candidate for a concierge conversion. Concierge medicine is an option for conventional practices that are already successful, not a lifeline for traditional practices that are underperforming, employed doctors who are striking out on their own without a substantial number of committed patients, or hospital-based physicians hoping to build a concierge practice from scratch with no established patient base from which to recruit.

"We probably turn away 60%-70% of the doctors who approach us," says Roberta Greenspan, Founder of Specialdocs Consultants, based in Chicago, the concierge marketing firm that LaGrelius hired to help him make the switch.

Specialdocs has transitioned over 100 conventional practices into full concierge practices in 28 states. Most take Medicare and commercial insurance.

The firm has 2 key questions for prospective clients: "How long have you been in the community where you are currently practicing, and how many patients have you seen in the past 2 years?" Greenspan says. "These are so important because the loyalty factor trumps everything."

"It's not how much money the patient has in their bank account; it's how loyal they are, how strong their feelings are for the physician," she explains. "Patients will say, 'I didn't really want to pay $1800 a year for a membership fee. That's a lot of extra money when I'm already paying so much for health insurance. But I'll do it because I don't want to leave Dr. Smith. He means the world to me.'"

As an indicator of patient loyalty, Specialdocs considers whether prospective clients have been in practice in the same community for a minimum of 8 years, but preferably 10 years or longer. If the doctor is a primary care physician, a panel of about 1600 patients over a 2-year period is also desirable.

That's because, even with long-time patients, only a fraction will opt to pay an annual fee -- which, among Specialdocs clients, averages about $1800 per year.

Standard offerings in concierge practices include same- or next-day appointments; visits with the doctor that last 30 minutes to an hour or longer, depending on a patient's needs; and the doctor's cell phone number for direct access 24/7.

"The only time my patients can't reach me is when I'm under general anesthesia," LaGrelius likes to joke.

In addition, concierge practices commonly offer lectures, workshops, and clinics as part of the annual fee. Depending on doctor and patient interests, these may include diet, nutrition, yoga, and cosmetics classes; acupuncture; ultrasonography; physical therapy; sports medicine testing; group counseling for patients with chronic diseases; and wellness seminars.

The amount of time the doctor plans to spend with patients and the extensiveness of other offerings must be weighed against a doctor's ability to deliver a concierge level of service without burning out. For LaGrelius (and many other concierge doctors), this meant capping his new practice at 600 patients; in the previous year in his conventional practice, he saw 1500 patients.

"If you're going to do a comprehensive wellness exam on everyone once a year, it takes an hour or two," LaGrelius says. "You can only do about 3 a day and take care of everyone else's medical problems. That limits you to a membership base of about 600 patients -- maybe 800 if they're younger, healthier people."

A consultant establishes the legal basis for offering noncovered services by a concierge practice, recruits patients, trains doctor and staff in how to deliver patient-friendly service, if necessary, and handles billing and collections for the annual membership fees that patients pay to belong. Concierge consultants do not generally get involved in the clinical side of a client practice.

Before deciding to transition, LaGrelius had his expert perform a demographic analysis of his conventional panel to see whether there was likely to be enough patients to support a full concierge practice. Surveys were conducted to gauge the level of patient interest. Patients received announcement letters, brochures, and other promotional materials created by the marketing firm.

The firm also trained LaGrelius and his staff in the niceties of concierge service, stationed a representative in the old practice to explain the benefits of the new practice to patients after their visits with the doctor, and installed a direct phone line to the firm's headquarters in Chicago, enabling patients to call Specialdocs for answers to their questions while they were still in the office.

"Every patient whom I talked to, I would get on the phone or refer them to that line and the consultant would describe to them what the practice was going to be like and sell it to them," LaGrelius says. "She actually explained it and sold it and was incredibly effective at that. It was very labor-intensive."

A transition lasts about 6 months. Then the new concierge practice "goes live."


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