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

Neil Chesanow


January 09, 2014

In This Article

Revenues and Fees in a Hybrid Practice

Ficarola earns the same in a hybrid concierge practice as he did in a conventional practice. "If I were age 32 and not 62, my focus might be more on building the practice or increasing revenue," he says. "I was more than content with maintaining revenues and doing a better job in a more relaxed environment."

"This is not the model to choose if you want to get rich," concedes CCP's Wayne Lipton. A full concierge practice has more revenue potential -- although it also incurs more risk. Hybrid programs can increase practice revenue from 5% to 50%, he says, "although most practices will see an increase of 15% to 25%."

"The nice part about it is that it doesn't add any expenses," he says. "So there's an opportunity for a doctor to make $50,000, $75,000, even $100,000 or more a year, over and above revenues earned from the clinical side of the practice. In some instances, it will be less," he adds. "They could make $25,000 or $30,000 more."

"In a hybrid model, you can only win," Lipton insists. "If you get 1 member, you're ahead of the game. If you get 10 members, you're 10 times more ahead of the game. There's no downside. There's only an upside."

CCP, which transitions conventional practices to both full and hybrid concierge models, charges no retainer fee. New clients sign a 5-year contract "with discounts along the way based on the number of patients who start in a program," Lipton says. A transition takes about 6 months. Clients then pay a flat fee of $500 per patient per year, minus discounts for meeting enrollment targets. After 5 years, clients have the option to renew. Most do, Lipton says.

The Future of Medicine?

Are doctors like Tom LaGrelius and Mario Ficarola -- and their practice models -- the future of medicine? Many observers think so. LaGrelius, who chairs the steering committee of a new concierge organization, the American College of Private Physicians, which launches in January, gives talks at medical schools in his area. To students who initially are turned off by a career in primary care, his recounting of what's possible in a concierge practice is a revelation.

"My gosh, you can do this?" they respond incredulously when he tells them about his practice and lifestyle: the visits ample enough to treat complex patients, the relaxed pace, the civilized ambience, the time for jaunts to Catalina. "They become enthusiastic about primary care again," he says.

LaGrelius disagrees that concierge medicine poses a threat to the supply of primary doctors nationwide. Its impact will be just the opposite, he contends. "If anything, concierge medicine is going to grow the number of primary care doctors," he believes.

"We're going to eventually develop a cadre of young doctors who want to go back to primary care because they can do what my doctor did when I was a kid: have a great practice, really take care of sick people, and not just turn a crank on CPT codes," he asserts.

The ability to start a concierge practice will also lure many specialists back to primary care, he's convinced.

"I have a good friend, a cardiologist, who's about to convert to concierge medicine," LaGrelius offers by way of example. "He currently does about 10 echocardiograms a day in his office. He's in the cath lab all day long, and he's burning out. He says, 'Why don't I just convert to concierge medicine, take 600 of my sickest cardiology patients, and care for all their problems?'"

CCP's client roster includes a growing number of cardiologists, gynecologists, gastroenterologists, and rheumatologists, who typically serve as primary doctors for patients with certain chronic conditions, in addition to the majority of doctors who practice concierge medicine: internists and family physicians.

"A lot of subspecialty internists are getting ready to say, 'I'm going back to my first love -- primary care -- and care for the sickest diabetes or cardiology or rheumatology patients, do fabulous work with them, keep them out of the hospital 60%-70% of the time, and do wonderful preventive care,'" LaGrelius predicts.

"This," he concludes, "is what the whole country needs to move to."


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