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

Neil Chesanow


January 09, 2014

In This Article

How a Hybrid Model Works

Ficarola didn't switch to concierge medicine for the money. He figures that his revenues before and after are about the same. It was his working conditions that he sought to improve.

"That's what I'm getting from this hybrid practice," he reflects. "I feel much less stressed. I enjoy my encounters with patients because of that extra time. We can get involved more in personal things. They feel free to talk about other family members, which I don't mind them doing because it affects them emotionally. I'm able to educate them better, discuss side effects of medication that they didn't even know they were having because they never told me, and they reveal things that a lot of patients don't want to waste the doctor's time on because they see we're pressured. When they don't see the pressure, they reveal more, and then they learn more too."

Like Tom LaGrelius, Ficarola sought professional help to make the transition: Concierge Choice Physicians (CCP), a concierge marketing firm in Rockville Centre, New York. It specializes in establishing hybrid practices. CCP has transitioned 250 doctors in 23 states to concierge practices. Ninety percent are hybrid practices and 10% are full concierge practices. Most take commercial insurance and Medicare.

"For a startup, you can estimate what your patient demographics are, but someone actually needs to analyze your practice and do a risk assessment to see whether you'll lose patients by making a change," Ficarola observes. "All of that is very labor-intensive. I'm not a do-it-yourselfer, so I Ieft the marketing and demographic studies to professionals. Plus I'm not very good at billing, collecting, marketing, and a lot of the business aspects of things."

A hybrid model offers 2 benefits over transitioning to a full concierge practice, according to Wayne Lipton, CCP's Managing Partner: You don't need a minimum number of concierge patients -- who can be challenging to recruit, particularly in a slow-growing economy -- for the model to produce significant revenue gains, and your other patients aren't priced out of the practice.

"The hybrid model is a reaction to the fact that not every doctor can get 600 patients who are willing to pay for a concierge program," Lipton says. In addition, "it's terrible -- it's literally heartbreaking -- to have to say to a group of people, 'You have to pay or else you have to leave the practice.'"

"The hybrid approach affords many doctors an opportunity to enhance their revenue, still participate in insurance plans, not disenfranchise people, and create greater satisfaction for themselves and their patients," says Lipton.

If a doctor in a hybrid practice is seeing the same number of patients as before, but now some patients are seen for at least twice as long per visit, won't the doctor be bucking for burnout, rather than working at a more relaxed pace?

Not necessarily, Lipton maintains. "The solution that has worked time and again is to limit the number of new patients allowed into the practice for a short period of time," he says. "There is natural attrition in every practice -- about 5% a year -- so by not adding in new patients, who take up a large amount of time for some time, it equalizes out nicely."


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