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

Neil Chesanow


January 09, 2014

In This Article

How Much Does a Consultant Cost?

The fees charged by consultants vary widely and depend on how extensive the concierge services are, as well as a consultant's reputation, longevity, and clients. However, taking a percentage of the annual fees that patients pay is standard. This is why consultants are selective in the practices they take on as clients. If membership targets aren't reached, both practice and consultant lose money.

Specialdocs clients, for example, sign a 3-year contract and pay a one-time retainer fee of $17,000. A transition usually takes about 6 months, during which patient recruitment and physician and staff training occur.

After the transition is complete, a fee structure kicks in. The fee for the first year (which is actually a year and a half into the contract) is19% of all collections (for the concierge part of the practice only), and thereafter the fees work on a sliding scale: 15% of all concierge fee collections for the second year, and then 12% of all fee collections for the remaining 7 months of the contract.

After this, clients have the option to renew on an annual basis. There's no retainer fee involved with renewal; the fee is 10.5% of all collections. For this, Specialdocs handles fee collections from patients and provides consulting support services, including marketing initiatives, physician branding, and legal services. It does not get involved in managing the clinical side of the practice.

Must All Your Patients "Go Concierge"?

Internist Mario Ficarola was facing the same dilemma as Tom LaGrelius when he decided to switch to a concierge practice in 2008. He already had a busy practice, which is a must to realistically consider a transition to concierge medicine, but was dissatisfied with how he was forced to practice due to a heavy patient load.

"I had way too many patients with complex medical problems, mostly geriatric patients, and not enough time," he recalls. "I didn't feel that I could do an adequate job in 15-minute appointments. I needed a concierge practice to free up time to be able to spend more time with patients, be more thorough, and get back to the focus on prevention and patient education. That was not tenable when having to see 20 patients or more a day."

But Ficarola, who had a panel of about 2000 patients before he transitioned, did not even consider switching to a full concierge practice with its reduced panel size. That would have meant letting many patients go. Most of his patients had been with him for decades. His goal was simply to free up enough time each day to adequately treat a core group of his sickest patients -- and still see all the others, who didn't require as much time -- without burning out.

This is the model for a mixed, or hybrid, practice: Most patients continue seeing the doctor for 15-minute visits and paying copays -- Ficarola takes both commercial insurance and Medicare; he never considered a cash-only practice -- while a relatively small number of patients pay an annual fee to receive greater access and visits that last however long is necessary.

Ficarola's patient panel is now approximately 1800 patients; only about 90 patients are members of the concierge part of the practice, for which they pay an annual fee of $1600. If a husband and wife are concierge members, their dependent children, if they have them, receive free memberships.

Time slots from 8 -9:30 AM and 1:30-2:30 PM are reserved for concierge patients, who may require a half-hour to an hour or more of the doctor's time because of multiple comorbidities and complex regimens. Sometimes the 4:30 PM time slot is available too. If all of the slots aren't needed on a given day, conventional patients are scheduled in. Otherwise they are seen at other times for the usual visits.

"I used to see 20-22 patients a day," Ficarola says. "Now I see about 14 a day. I still spend the same amount of hours in the office. But the work is less compressed and more enjoyable."


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