‘Hybrid’ concierge model lets docs keep old patients, give others more time

By Dr. Cynthia Williams 
Dr. Cynthia Williams is a board-certified internal medicine physician practicing in Houston. Before becoming a physician and completing her residency in 2003, she was a researcher specializing in neurology for 15 years.

Dr. Cynthia Williams is a board-certified internal medicine physician practicing in Houston. Before becoming a physician and completing her residency in 2003, she was a researcher specializing in neurology for 15 years.

January 17, 2015 – Can a private source of revenue—provided through concierge medicine—help our nation’s struggling healthcare system? It’s a tough question for many physicians today, but one we must honestly explore.

The average physician visit has grown shorter and shorter. Physicians can discuss the illness of the day, but not much more. And, of course, there is only limited, if any, reimbursement for getting to know or educate patients, answering family members’ questions, or even researching care options or fighting with a payer for coverage of needed care.

For those reasons, I reluctantly started exploring concierge medicine. I didn’t want to have to say goodbye to all but a few hundred patients, but I started thinking it was my only choice. Then I heard about “hybrid concierge,” a model that can provide a solution for many of the issues affecting our current healthcare system, primarily: adequate reimbursement; recognition of the important role doctors play in patients’ health; and giving patients choices in the types of healthcare services they receive.


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Under a hybrid concierge program, the choice of whether to join is left entirely with the patient. And it’s a much more affordable option. In traditional full-model concierge programs, physicians typically downsize their patient panels to between 300 to 600 patients, shifting those who don’t join the program to other providers.

In a hybrid model, I am able to continue caring for all my patients and simply offer the chance to participate in the hybrid program to the small percentage—by design under about 10% of the patient panel—who want that option.

DPC Consumer Guide cover_20152I work in a large medical group in Houston, with about 40 other physicians. Six of our physicians already offer full-model concierge medicine programs. These physicians offer the traditional services of a concierge program, including less-hurried appointment times, more hands-on care coordination, hospital and perhaps home visits, and direct phone lines. Prices for full-model programs vary by additional services offered, location and other factors. Some programs are up to $25,000 a year, while some average as low as $1,800 annually.

I’m the first in our practice to offer the hybrid. The program is similar in some ways to a traditional or full-model concierge program. For example, it also features an executive-style physical, which includes extensive lab testing, tailored to the patient’s specific needs, as well as some other services not covered by insurance. The fee for the program is about $160 a month.

While patients like the perks, most told me they primarily joined to expand and build on their relationship with me—that’s what was worth the investment to them. In fact, internal surveys show that the primary reason patients join concierge programs is because they value and want more of a personalized relationship with their chosen physician. They want to be able to spend more time with their doctors.

This isn’t a disruptive model. I continue to take insurance and patients don’t have to look for another provider. I still see my existing Medicare patients. I still admit to hospitals and refer to specialists.

Most importantly, my patient caseload has gone from 28 to 30 a day to 20 to 22 a day, about what it was for doctors before the era of managed care.

Typically, concierge patients make up a few patient visits a week. Because I no longer feel economically stressed, I’m not taking on new patients I don’t really have the time to see and can dedicate myself to all the patients I do have while bringing on new patients through normal practice attrition when it makes sense.

We face a lot of tough questions and issues in our nation’s healthcare system. There are limited dollars and considerable needs. A private practice model that isn’t supported by taxpayers, such as concierge or hybrid programs, can be good for all patients and even for our healthcare system as a whole. It helps to offset the higher overhead and lower the uncertain reimbursements many doctors face today. It makes the workday less stressful and more enjoyable, which is good for physicians, patients and staff.

The bottom line message for our industry is that there’s room in our healthcare system for a broad range of choices and practice models. We can ensure access and give physicians and patients’ real choices.

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