By Michael Tetreault, Editor-In-Chief
JULY 19, 2017 – The two business models, now distinguished by their engagement with patients through transparent pricing and their disconnection or loose connection with insurance, are increasingly gaining the attention of consumers, employers and the media. At Concierge Medicine Today and our sister publications, The Direct Primary Care Journal (The DPC Journal), Concierge Medicine CANADA and the American Journal of Retail Medicine, our mission is to communicate news and relevant educational information about the growing industry’s of concierge medicine and direct-pay, primary care.
We serve as a public relations advocate and educational resource for the media, consumers (i.e. patients/prospective patients), curious physicians and industry practitioners. As we continue our public relations endeavors, promoting good news [and bad, at times …], we will keep developing more and more educational resources for these markets. At this time, we are blessed and grateful to have such great friends and colleagues in these evolving healthcare industry’s that work with us each day to help us educate, influence and guide outsiders about what these two very different healthcare delivery models are all about. At this time, we’d like to say ‘thank you’ to many of these industry-influencers and innovative physicians by highlighting some of their most popular quotes that have educate, persuade and guide others to a more satisfying career in medicine and helped thousands of our readers better understand how-to achieve better patient-physician outcomes in a difficult and at times, political economy.
Let’s Begin …
“I am amazed we have received so much recognition that within a few years an entire field of “concierge” practices emerged nationally. Our Practice was designed around this ideology: provide the convenience, accommodation, and best-of-class service you expect from every service provider in your life. The very nature of these relationships necessitates we limit our practice to so few.” ~Dr. Howard Maron; MD² founder Dr. Howard Maron
“In some respects, our well-heeled patient population and their inherent and unique needs is our specialty. We are fortunate to have interesting and distinguished patients; I cherish the relationships deeply,” said MD² founder Dr. Howard Maron
“In my old waiting room in Seattle, the C.E.O. of a company might be sitting next to a custodian from that company,” he recalled. “While I admired that egalitarian aspect of medicine, it started to appear somewhat odd. Why would people who have all their other affairs in order — legal, financial, even groundskeepers — settle for a 15-minute slot?” ~New York Times; June 3, 2017; MD² founder Dr. Howard Maron
“The bottom line is it’s not for free,” she said. “You can’t do this for $25 [per person] per month. If we start doing it for $50 to $100 per month then we can start doing serious primary care.” ~Article: Despite A Growing Appetite, Buffet-Style Flat-Fee Clinics Shutter In Seattle; By Michelle Andrews; Kaiser Health News; June 20, 2017
“The existing system is built around diagnosing and treating complex cases. It rewards expensive, invasive and complicated solutions. But patients don’t want to be complex cases,” Bliss says. She cites a famous study by the Institute of Medicine that estimated that 30% of each health care dollar is wasted in the U.S. While reformers struggle to “bend the curve” of rising costs by squeezing out the waste, “we just lop it off,” says Dr. Erika Bliss of Qliance.
The News Tribune (May 27) | “Despite all our efforts, we have found that the more we grew and proved that this really works, the more the system resisted us and made it harder and harder to survive,” said Dr. Erika Bliss, Qliance’s chief executive.
“Do not be afraid to try something new. If we do not try to do things differently, primary care will continue to languish and we will have a harder and harder time attracting people into the field and ensuring that primary care survives for us, our children, and our grandchildren. You do not have to do it all at once, though – a lot of practices are trying to develop a hybrid model, gradually moving more and more of their Patients to the DPC model. It is challenging to do this if you are caring for large numbers of Patients, but practices are finding ways to do it.” ~Dr. Erika Bliss of Qliance.
“Data supporting the cost-effectiveness and affordability of Concierge Medicine and other free market healthcare delivery models is intriguing,” said Michael Tetreault, Editor of the independent industry trade publication, Concierge Medicine Today. “Long-term data on these particular subscription-based Patients is still being compiled. Further analysis is encouraged and supported by marketplace consultants and physicians. More data to support these common observations should be analyzed and published. What we do know today is that Concierge Medicine, retainer medicine and boutique physicians that have a long, relational history with their Patients often have high annual retention rates. Based upon observation of these trends year after year, these [Concierge] practices are reporting levels or percentages at or exceeding traditional primary care and family practice patient retention and care expectations.”
“As an industry,” said Tetreault in a July 2017 interview with a prominent New York City lifestyle magazine, “we still need more patient outcome data to be published to further unpack these trend lines and observations. What we do know for certain is that inside each and every Concierge Medicine office is opportunity to connect a patient with a physician who desires to have a relationship with his community.”
MD² CEO, Peter Hoedemaker says “Time is just so critical. By limiting their total number of families they have the ability to accompany patients to specialist visits, navigate their care through hospital stays and truly research every ache and pain. It’s like having a physician as part of your inner circle, as if they’re a member of your own family.”
“I really have time to think about my patients when they’re not in front of me,” said Dr. Greene, a pediatrician who joined the company’s Los Angeles practice in October. “I may spend a morning researching and emailing specialists for one patient. Before, I had to see 10 patients in a morning, and could never spend that kind of time on one case.” ~New York Times; June 3, 2017
“We all say we should get the same care, but I got sick and tired of waiting for that to happen,” he added. “I decided to go for quality, not quantity.” ~New York Times; June 3, 2017; Rex Chiu, an internist with Private Medical in Menlo Park, spent more than a decade as a doctor on Stanford’s faculty.
Roy Ramthun of HSA Consulting Services based in Washington, DC, says “The IRS does not generally consider the monthly payment a ‘qualified medical expense.’ However, we do believe that they will accept reimbursements from an HSA for actual services provided by your practice physicians if you can produce something for the patient that they can use to document the services they received (including any procedure/treatment codes), the date they were provided (and by whom), and the amount you would charge the patient for the services provided. I know your practice is not set up that way, but the patient needs something that tells them the fair market value of the services they received for tax-free reimbursement from their HSA.”
“In selecting only a small population of clients and providing dedicated counseling sessions, sometimes as often as weekly, allows clients to actively participate in their care plan and to move goals forward at a real-time pace. This enables all of us to realize that healthcare can be a positive experience.” ~Dr. Carrie Bordinko of Consolaré Primary Care in Paradise Valley, AZ
“There is a big difference between being expected to do something and being invited to try something,” said Michael Tetreault, Editor of Concierge Medicine Today. “Inside traditional medicine, patients expect to wait. They expect insurance to cover their visit. When it is not, they expect to fight. Consumers of healthcare today say they expect a disengaged staff and an unpleasant visit when at their doctor’s office. We can do better. Concierge Medicine Patients are Invited rather than Expected. This counter-intuitive approach exceeds expectations, thereby creating a massively loyal and engaged audience which, in turn, is producing some amazing patient outcome data as released and seen by some organizations in the space.”
“The distinctions between concierge medicine, private medicine, and direct primary care may be ultimately meaningless, since some doctors call themselves whatever they feel sounds better, and there are so many practice variations, many overlapping, that it often isn’t clear which is which.” ~Neil Chesanow, Medscape/WebMD, May 2014
“It’s a different type of busy … My day is just as long now, if not longer. But, I’m spending a lot more time with all of my patients. In between visits, I’m on the phone checking on people at home.” ~MDVIP-Affiliated Physician in FL
“I became a concierge physician for the same reason I became a doctor – I want to help people. With this model, I can continue to help people even when traditional medicine changes significantly. When a patient has a “one more thing, Doctor…,” the last thing I want to do is to cut the patient off. Patients deserve to be involved in their care and receive the valuable service of planning for optimal health with the guidance of a family physician who is dedicated to the care of the patient.” ~Dr. Brian Nadolne, MD, Marietta, GA
“It’s about believability. Would it work for me? Could it work for me?” says Richard Doughty, CEO of Cypress Concierge Medicine, a Louisiana-based company helping doctors move into this industry. “Where physicians have taken an early leap of faith, if you build it they will come, overwhelmingly they have been satisfied. As a result, physicians now have many examples of colleagues experiencing the benefits of concierge medicine for themselves and their patients. In those areas, we see momentum continuing to build.”
“With concierge medicine, the impact for patients and physicians is phenomenal,” says Richard Doughty, CEO in a recent article on Baton Rouge’s The Advocate. The article states … ‘In a typical concierge practice, the management firm gets one-third of the membership fees patients pay, Doughty said. Most contracts are for five years, and the fee structure remains the same over the life of the contract. If a practice has 600 members and the members pay $1,500 a year, the management firm’s share is $300,000 a year. Over a five-year contract, that adds up to $1.5 million. But most of the heavy lifting is done during the first 18 months of moving the practice to the concierge model, Doughty said. After that, if the management firm has done a good job, there’s not nearly as much work required.In a typical concierge practice, the management firm gets one-third of the membership fees patients pay, Doughty said. Most contracts are for five years, and the fee structure remains the same over the life of the contract. If a practice has 600 members and the members pay $1,500 a year, the management firm’s share is $300,000 a year. Over a five-year contract, that adds up to $1.5 million. But most of the heavy lifting is done during the first 18 months of moving the practice to the concierge model, Doughty said. After that, if the management firm has done a good job, there’s not nearly as much work required.’
“Patients are educated, possibly more than ever, as a result of the changes to our healthcare system,” adds Richard Doughty, CEO of Cypress Concierge Medicine based in Louisiana. “Patients are looking for answers and options and taking more initiative in their overall health. Following their doctor into concierge medicine for many patients is exactly the vehicle that meets their needs. In addition, knowing others who have benefitted from that relationship with their concierge doctor confirms the value as their doctor makes this change.”
“Instead of just looking at blood, I’m looking at blood, urine, stool and saliva. Instead of just chemistry markers, I’m looking at chemistry, metabolomics (chemical fingerprints of cellular processes), genomics, microbiome (microorganisms), hormone tests, and I’m starting to look at immunology markers. That’s a very different experience. In a perfect world, your body is like the airplane and I’m the co-pilot and we’re using all these tools to identify if there are issues going wrong with the engine.” ~Dr. Molly Maloof runs a Concierge Medicine practice in San Francisco which serves a small number of patients for anywhere from $5,000 for an initial assessment to upwards of $40,000 per year for comprehensive care. Her clients are often engineers and executives looking to hit peak performance, or recover from an over-stressed work-life. Maloof, who earned her medical degree from the University in Illinois in 2011, sees part of her work as ensuring they they are doing it safely, backed up by the maximum amount of evidence.
C.J. Miles, MBAHCM, MSA Research Analyst at the AMAC Foundation writes ... ‘Any type of healthcare and health insurance-related issue is going to have legal and ethical issues that everyone will not agree on. The bottom line with concierge medicine is that it is quickly growing, presumably due to physicians and patients fed up with the current state of America’s healthcare system and where it could be going due to The Affordable Care Act. In fact, even with the growing number of concierge physicians, “the number of patients who are seeking concierge medical care in the past 24 months is far greater than the actual number of primary care and family practice concierge physicians available to service them” (CMT, 2014b, para. 22). Only time will tell how this will pan out, but for now, it looks like this is where our country is heading.’
“Although there are differences in the models for DPC and concierge care, there are similarities as well…most notably, the ultimate benefit for both patients and physicians: having quality time for offering consistent care and developing strong relationships with patients that are at the heart of these primary care delivery models.” ~Rob Lewis Specialdocs Consultants, Inc.
“I believe that is the way medical care is supposed to be. This kind of unfettered direct engagement between doctor and Patient can never be achieved in a system of third-party networks where the doctor is a “provider” of services paid by someone else and the Patient is relegated to a passive ‘network subscriber’.” ~Direct-Pay Physician, Dr. Robert Nelson of Cumming, GA. “Primary Care needs to become relevant again by servicing patients directly and being available and offering the kinds of broad services that family doctors used to offer. Only returning to broad-based primary care that is affordable (DPC and similar), getting back in the hospitals and being available to keep our patients out of the ER and urgent care will solve this supply-demand imbalance. This kind of approach will also drive more medical students back into primary care and restore the balance back to the ratios before managed care.”
“… a 2013 JP Morgan white paper, Key Trends in Healthcare Patient Payments, showed that 74% of insured consumers are both able and willing to pay their out-of-pocket medical expenses up to $1,000 per year, and 90% would pay for medical expenses up to $500 per year.”
“The past year has been one of big changes. We are continuing to grow the practice in numbers, but we are also working to improve our quality. There’s a lot to be done still! We added immunizations. At the present time we are doing adult immunizations, but are soon to move fully into pediatric immunizations. We continue to work on improving our quality, collecting information and reaching out to people who are needing care. Our goal is to continue to improve the quality of care from where we are now.” ~Rob Lamberts, MD, Augusta, GA
“The road was much more difficult than I expected, but also much more satisfying. I spent much of my time learning what doesn’t work, but in the end learned that most good ideas grow out of the remains of a hundred bad ones that didn’t survive.” ~Rob Lamberts, MD, Augusta, GA
“Care is about access and communication, not doing stuff necessarily. I am not sure if there is any way to change this, but it seems that any visits my patients have (or communication with me) is something they get in exchange for my monthly fee.” ~Dr. Robert Lamberts, Augusta, GA
“There are no insurance codes for ‘cure,’” says Dr. Garrison Bliss of Qliance, based in Seattle, WA.
“The people who can pull this off are often people who already have long-term existing practices,” says Internist Garrison Bliss, MD, a movement pioneer, sits on the board of the Direct Primary Care Coalition and is Founder and Chief Medical Officer of Seattle-based Qliance Medical Management, the nation’s first direct primary care practice. “You need to have 10-15 years in practice, so you have an established base of patients who trust and like you. It also matters if you have people with chronic illnesses, or who are older, who just don’t want to go through the heartbreak and complexity of finding another doctor,” he continues. “And it depends on whether you really do provide extraordinary service already. The practices that do great work, have large patient populations, have been around for a long time, and have great reputations can often make this transition without difficulty.”
“If you are thinking about staying in your fee-for-service practice because DPC is shrinking, I suggest that you rethink that decision,” concludes Garrison. “This movement is gathering steam and you may not want to wait until everyone else makes the transition. All you have to lose is that massive headache from fee-for-service insurance billing with its inevitable corruption and destruction of the American health care system.” ~Internist Garrison Bliss, MD, a movement pioneer, sits on the board of the Direct Primary Care Coalition and is Founder and Chief Medical Officer of Seattle-based Qliance Medical Management
“Some have said, ‘We’re in the Golden Age of technology but Dark Ages of delivery.’ We have resources but no time to utilize them to their highest & best use.” ~Dr Andrea Klemes, physician and MDVIP Medical Director, says to Medical Economics.
“To be able to practice in this fashion, the patient roster is limited to a maximum of 600 patients. Each patient enjoys a 90- to 120-minute annual wellness visit similar to an executive style physical. This includes an exam, review and coaching for every patient. Follow up visits last 30 minutes. Under this calculation, doctors see eight to 12 patients a day. Physicians benefit on multiple fronts. We enjoy financial stability in this uncertain time. We regain the freedom to practice the way we were trained. Our time, tools and technology improve our abilities and make us even more valuable to our patients than we were before. Partnering with a consultant or an organization who provides the resources to transition successfully to this model is critical particularly to ensure that your practice is compliant with all federal and state laws. The model even improves national outcomes. Hospitalizations are down – by 79% in Medicare patients in one year and 72% in commercial patients. Readmission rates for common problems (Acute MI, CHF and pneumonia) are all under 2%, as compared to the national averages that range from 15% to 21%. Control of chronic conditions is better against all benchmarks and together, these saved the healthcare system over $300 million a year. The patient benefits of a smaller size practice include same-day appointments, 24-hour availability, no waiting and a higher level of coordination of care. As a result, patient satisfaction tops 94%, with nine in 10 patients renewing annually. Moreover, physician satisfaction is over 95%. With the right tools and model, we get to practice medicine the way we had been trained. We find the time to talk. We tease out buried details, identify issues, and become the hands-on healers we once were. For their part, patients become more accountable and see real results.” ~Dr. Andrea Klemes is the Chief Medical Officer of MDVIP.
“Being a good physician is not just about knowing how to diagnose and treat disease. Honestly…that’s what books and studying is for. Being a good doctor entails earning the trust of your patients by being honest and forthcoming. It means knowing how to communicate effectively while still remaining sympathetic. It requires you, first and foremost, to be a human being. It honestly bothers me that young doctors feel like they have to “know everything” to be a great physician. Put down the damn book and go talk to your patient. Be a friggin human being. Be a friend. Its really that simple.” ~ Tiffany Sizemore-Ruiz, D.O. of Choice Physicians of South Florida.
“I received a phone call the other day from a physician in Winter Park Florida,” says Tiffany Sizemore-Ruiz, D.O. of Choice Physicians of South Florida. “She was calling just to thank me for answering her questions about [this industry] a few months ago, and encouraging her to start her own practice. Today, her practice is thriving and she said that ‘she is happy with her schedule, her life, and being able to practice medicine that way it is meant to be practiced.’ I was so happy to hear that I helped a fellow physician and colleague, and even more happy to hear that she was doing so well!”
“I have negotiated lower prices for certain tests and one-third of the cost for lab values from what they charge when they go through insurance companies. People will be spending less, and what they do spend will be spent on their own care instead of the care for two other people,” ~Dr. Donald F. Condon, a Spokane, WA-based direct primary care physician
Concierge Medicine Inside Hospitals
“The challenges of medical center concierge-style programs are very different than those experienced by concierge physicians in private practice. All hospitals/medical centers have special perks and usually enhanced access to specialists for their donors and patrons, often a special number they can call. Most have an informal “private banking” approach where there is no established fee, just an expected level of donation. Despite the proliferation of individual concierge practices and now organized networks, concierge medicine programs INSIDE medical centers are quite unusual – there may be only 20-25 in the entire country.” ~ John Kirkpatrick, MD Seattle, WA
“Some hospitals are investing considerable amounts of money into making their Emergency Rooms into more patient-friendly environments,” adds Tetreault. “Others are redesigning pediatric wings to accommodate for extended family stays.”
“Today, even inside hospitals, its [Concierge Medicine’s] historical fingerprints are centered around access, transparency and relationship. It is these types of new delivery programs and free market healthcare business models that are rescuing the careers of some of America’s greatest physicians and healthcare professionals. Concierge Medicine Programs and Executive Healthcare Memberships inside Medical Centers and Hospital environments have been happening for over a decade. There are a number of reasons why hospital executives and physicians do this. In today’s healthcare culture advertising aimed at the 55-plus audience is simply aimed at maintaining brand loyalty and establishing that the products they love are still good, still function and are most likely being improved. These are powerful programs which help maintain brand loyalty and provide care to a population in need of multiple chronic care visits with their doctor.” ~Michael Tetreault, Editor of Concierge Medicine Today
More About Subscription-Based Healthcare Delivery Models
“DPC allows me to have the time to care for patients rather than third party payers,” writes Dr. Eric Potter to The DPC Journal. Dr. Potter is a DPC physician at Sanctuary Medical Care which services the Middle Tennessee-Nashville region and Northeast Tennessee/Southwest Virginia. “Many more doctors turn over a new leaf with DPC.”
“We are all used to subscriptions. We all have Amazon Prime and Netflix, and like Netflix or Amazon subscriptions,” he said, “you’ll find doctors out there with monthly subscriptions that seem incredibly affordable or geared for a certain audience. The more you pay, the more your get.” ~LLNYC Magazine; Article: The doctor will see you immediately; July/Aug 2017 Edition
“In both Concierge Care and DPC, people have inherent, not ascribed value. There’s no class order … no first class or second class, just people for whom doctors serve each day. They’ve built clinics for children, families and people who are sick … and it is these visioneering physicians who are drawing attention to the cost of healthcare across the country and designing ways for it to be available and affordable for anyone. But there are significant differences between the two categories or sectors in healthcare and it’s time we learn what they are.” ~Michael Tetreault, Editor
“This transition is getting harder and harder the closer I get [to my ‘all-in’ date],” states one DPC physician in a December 2014 interview with The DPC Journal. “There’s a lot of rejection from patients I’ve cared for and thought would join. It’s difficult to hear.”
“According to industry analysis and national data summaries to be released in early 2015 by The Direct Primary Care Journal (The DPC Journal), the independent trade journal and news reporting publication observing and reporting on the national scope of the DPC industry, 90% of the interviews, surveys and DPC physician polling indicates that these practices are doing better financially than over one year ago, whereas, only 10% said they were doing worse nationwide.” ~Michael Tetreault, Editor-In-Chief, The DPC Journal, January 2015
“This kind of innovative medicine is for C-suite executives and craft brewers. It’s for people who say, ‘I want the best healthcare in the world from one of the best doctors in the world, and there is a value to that,’ Tetreault says, with an air of triumphant make-healthcare-great-again-ism. “It’s an innovation that takes us back to how healthcare used to be delivered. You can have a family doctor again. No longer is it about what kind of insurance Opie has. It’s taking us back to an Andy Griffith style of healthcare.” ~LLNYC Magazine; Article: The doctor will see you immediately; July/Aug 2017 Edition
“The outlook for DPC is much brighter throughout the U.S. than what one report may conclude,” says Michael Tetreault, The DPC Journal’s Editor-In-Chief. “No industry is full of sunshine and roses all the time and every industry needs data to benchmark success. The mission of DPC is to reduce the healthcare expenses on the individual while improving the physician-patient care service relationship — and it’s working. Data coming forth from a wide variety of industry sources in the past several months validates that it works. WeCare Clinics, Iora Health, Qliance M ~LLNYC; July 2017edical Management, MDVIP, and OneMedical have all reported reductions for total healthcare costs for their patients of 15% or more versus population norms*. However, more [DPC] doctors need to get out in front of their local employers, media and patients and talk about their own DPC data in relevant ways in the months ahead.”
“We’ve seen a tremendous amount of growth,” said Dr. Dean McElwain, president and COO of Castle Connolly Private Health Partners, a medical consulting company founded four years ago with John Castle and Dr. John Connolly that helps physicians convert their practices to a concierge model. “Concierge medicine affords physicians the ability to return to a much more old-fashioned style of practice where you actually had generous time to communicate with your patients and to work one-on-one with them to solve their problem and get to know them as individuals and not just a diagnosis.” ~LLNYC Magazine; July/August 2017
“There is only so much they can move the dial, and I think it is going to go back toward self-determination,” McElwain said of the Republican healthcare legislation. “Certainly, with this administration, there seems to be an appreciation for the utilization of health saving accounts and the ability to engage privately with your physician … It’s very multifactorial, but I think if anything, it looks like it will have a nurturing effect on what we do.” ~LLNYC Magazine; July/August 2017
“The claim that MDs who go into concierge and become millionaires is rarely true,” says Wayne Lipton of Concierge Choice in a commentary related to a Forbes article. “As someone who has been working with MDs for more than 30 years and talks to hundreds of doctors a year, I can tell you that most improve their economic and professional situations, and many do it just to survive. The goal of nearly all concierge physicians is to keep their practices independent and viable for their staff and patients. Additionally, for a physician with an established practice and a sound plan, financing a concierge practice conversion is a non-issue. If they align with a company that has experience with practice conversions, the costs to the practice are minimal. The risks are far greater if they attempt to build a concierge program from scratch, in which case they will more likely need a bankruptcy attorney. The other benefit to aligning with an experienced concierge care company is that it handles business development, allowing the physician and his staff to focus on doing what they do best—providing superior care to their patients.”
“My overhead is a phone, an electronic medical record, internet access, rent for office space and one medical assistant. The clinic is built lean because we don’t have to deal with the insurance companies. The revenue that is generated through the monthly fee of $39 to $89 per month is where we get the money to pay our overhead and the doctor’s salary. We don’t need to make a profit on anything else.” ~Dr. Chris Larson is a family physician and can be reached at Austin Osteopathic Family Medicine.
“My vision is to cultivate a personal Patient – doctor relationship amidst a bustling urban community where impersonal professional relationships are the norm. Our practice strives to deliver quality medical care with an emphasis on evidence based medicine, open communication, easy accessibility, and a focus on customer service. These benefits can lead to an overall improvement in how healthcare is delivered and may ultimately improve outcomes.” ~Dr. Edward Espinosa Buckhead Concierge Internal Medicine, Atlanta, GA
“Determining the right price point for the monthly DPC membership, and what services would be included in said membership were both of vital importance. At first we considered charging a monthly fee accompanied by a very low fee per office visit. However, we both agreed the dual fee structure would create complexities and we were trying to simplify the delivery of primary care. Thus, we set a $99 per month individual price, $139 per month for couples, $179 per month for a four-person family, and $39 per month per child for additional dependents.” ~Dr.s Clint Flanagan and Dr. David Tusek of Nextera Healthcare based in Firestone, CO
“Running on the discount-insurance based hamster wheel is fatally destructive to doctor morale, patient care and the entire health system,” ~Dr. Thomas LaGrelius, Torrance, CALIF.
“You will never regret being a doctor IF you work only for patients. But if you don’t work only for patients, you will regret your decision in the end.” ~Dr. Thomas LaGrelius, California
“While it is true, as the AP reported, that more and more patients are joining our practices nationwide, the number of patients is not just in the thousands already but in the millions. While it is true that concierge practice is exponentially on the rise, the current number of such doctors is not just in the hundreds but in the thousands, perhaps tens of thousands. Most are below the radar. They work quietly and are never counted by bureaucrats. ” ~ Thomas W. LaGrelius, MD, Daily Breeze, Calif.
“I’m 60 years old now and I had to figure out how I could continue to practice medicine, enjoy it and enjoy my life at the same time. This is something I decided to try and see if it works, and so far, it’s working,” said Dr. Derrell W. Anglyn, Jr. of Anglyn Family Medical Center in McDonough, GA
“Direct Primary Care is a growing point of light in the darkness. I encourage those who are facing these high deductibles to look for Direct Primary Care which can save them money on doctor visits, urgent care visits, prescription costs, lab costs, and help avoid some ER visits. People will be surprised at the value they get for their healthcare dollar.” ~Dr. Eric Potter is a DPC physician at Sanctuary Medical Care
“Many of my patients, including those with insurance, save more money on these ancillary services (versus traditional prices) than they pay for their membership each month. And they get unlimited visits with their personal physician without copays. With improving technology, scalable models and use of physician extenders, I believe DPC membership prices can and will continue to trend even lower. What level of DPC pricing would be low enough to deem it universally affordable? I rarely hear critics give an acceptable dollar figure. I recognize some people may struggle to afford even $10 per month, but does this sad reality invalidate the entire concept of DPC?” ~Dr. W. Ryan Neuhofel is a family physician and owner, NeuCare Family Medicine
“In terms of Patient discounts, I try to negotiate discounted cash pricing for my Patients whenever possible. Whether it is for blood testing, radiology, or supplements/medications – I would rather they keep their money for my know-how/concierge fees. And a lot of times cash-pricing makes their life easier, because they do not have to wonder or worry about whether or not insurance will cover, etc.,” said Shira Miller, MD of Sherman Oaks, CA.
“My focus is on being a trusted advisor and I don’t want to have any potential conflict of interests,” said Shira Miller, MD of Sherman Oaks, CA. “For example, a lot of doctors make money on supplements, for me I take that out of the equation. In terms of my practice, I just want to focus on providing the best advice I can give my patients, not worrying about making money off retail.”
“I suspect that employers will be the major reason for direct primary care membership/retainer-based practice growth in the coming years as they will essentially demand that level of service for their employees — and in so doing they will be reducing their company health care costs as a result of high quality primary care. The exact number of physicians in DPC practices is unclear but an estimate by Concierge Medicine Today in early 2014 pegs the known number at about 4,000 with about 8,000 others doing so but without fanfare [so in total, approximately 12,000]. More doctors will convert once the general population understands the advantages and begins to ask for it. There are many good reasons for an individual to connect with a direct primary care physician: better quality care, a return to relationship medicine and often a significant cost savings despite the fee.” ~Dr. Stephen C. Schimpff is a quasi-retired internist, professor of medicine and public policy, former CEO of the University of Maryland Medical Center, senior advisor to Sage Growth Partners and is the author of The Future of Health-Care Delivery: Why It Must Change and How It Will Affect You
“Not all direct primary care practices are concierge practices, and not all concierge practices are direct primary care practices. The terms are not synonymous, and even the basic fundamentals of either model do not overlap. The key to differentiation is whether or not a third party payer is involved. If not, then the model is a direct pay, or direct primary care model, no matter what the fees.” ~Samir Qamar is CEO, MedLion
“Direct Primary Care can complement High Deductible Health Plans (HDHPs), taking care of the primary care component of health care,” adds Dr. Samir Qamar, CEO and Founder of MedLion. “HDHPs, or major medical plans, can take care of catastrophes. This combination can result in significant savings overall. Health Savings Accounts (HSAs), when structured properly with Direct Primary Care plans, can also be used. The key is working with a Direct Primary Care company, like MedLion, that has unquestionable legal and insurance knowledge.”
“Insurance is the business of risk management via coverage for rare, expensive events. Nearly every industry in this country uses insurance in this manner — except health care. In health care, in addition to covering for rare events like surgeries and accidents, insurance is also used to cover common medical events as routinely encountered in primary care. Whenever insurance is used to cover common events, premiums go up due to claims being filed more frequently. Unfortunately, routine primary care is expensive in the current state, and society is forced to seek health insurance for this as well. This drives up health care costs across the board. Direct Primary Care is able to make primary care relatively affordable, and thus eliminate the need for costly insurance. Health insurance is reserved for rare, expensive events, like in all other industries. By removing the need for insurance from primary care, which is a significant portion of health care, costs are driven down.” ~Samir Qamar, MD, MedLion, Founder
“For the past 2 1/2 years, Dr. Rob Marsh, 58, [Middlebrook, VA] also has reached out to another medically neglected population: the truck drivers who spend their days on the interstate, many never home long enough to find a primary-care physician. At the TA Petro truck stop here, where Marsh opened his clinic in July 2012, drivers wander the stores killing time, looking at chrome for their trucks, hunting gear and fried strawberry-rhubarb pies in wax-paper packets. They can get an oil change, work out, take a shower. And now they can get a U.S. Department of Transportation-mandated physical, a flu shot or treatment for a sore back.” ~Written by Susan Svrluga, Jan. 19, 2015
Dr. Carrie Bordinko states “Gain some customer service experience– try a service industry job as these skills are not taught in med school. Moving into Concierge Medicine is not solely about providing excellent medical care without the restraints of insurance industry mandates. You have to also appreciate the lost art of customer service so long ago forgotten when visiting a healthcare institution. Many times my clients (notice I do not use the word “Patients”) have noted why they refer their friends to my practice. It is the attention to detail, always delivering exactly what is promised and then some, and keeping their unique needs positioned first with a flexibility to offer new programs or meet needs as quickly as they are identified. This is the cornerstone of customer service.”
“I believe one of the keys to the continuing growth of Direct Primary Care (DPC) is integrating it within the employer sponsored health plans,” says Mason Reiner, CEO of R-Health, “which remain the primary means for paying for healthcare for the majority of Americans. However, for DPC to be a viable option for employers, there needs to be a critical mass of physicians offering it as an option in the employer’s geographic area. That is why we have focused over the past year on expanding our panel of affiliated physicians offering DPC in the Philadelphia region to nearly 100 (and growing), including Family Physicians, Internal Medicine Physicians and Pediatricians. The strong geographic coverage we have in the region has been a critical factor for the employer groups we have added as clients.”
“The “don’ts” can be just as important as the “dos” when it comes to financing your concierge medicine practice or direct primary care clinic. Here are three pieces of advice on the subject. First, don’t invest all your time in trying to raise money. There have been so many good business concepts that go south because the person has committed everything to raising money and puts the concept on hold. Second, ideas are great but execution is everything. Don’t pursue financing if you don’t have a working concept. Lastly, don’t get hung up on the interest rate. If someone is offering you $50,000 at 12 percent and someone else is offering you $30,000 at 8 percent, the loan with the higher interest rate may be the way to go if that is the capital you need and this may prevent you from spending more than you need.” ~Michael Tetreault, Editor, Concierge Medicine Today
“I didn’t become a doctor to bankrupt my patients …” ~Dr. Jordan Grumet
“Business is tough,” says Dr. Chris Ewin of 121MD in Fort Worth, TX. “If you are doing something just for the money, you are never going to enjoy it. You will be the hardest boss you have ever had. So, find something you love and pursue it. Follow this advice and you will set yourself up for an enjoyable future in medicine.”
“It’s notable that growth in the DPC industry according to physician interviews across the U.S. throughout the past 12-24-months is largely supported by consumers motivated by price and transparency,” says Catherine Sykes, Publisher and Managing Director of The DPC Journal. “We also find that most DPC patients have [and pay for] insurance and they want to use it. The questions consumers have most when approached with the value proposition of DPC is how does it work with my insurance? and how much does this cost? It is important to communicate that DPC is not insurance. If a doctors program is not properly paired with high-deductible health plan policy or a wrap-around insurance product of some kind, those low price points [and monthly premiums] compete with a lot of other expenses — which we [The DPC Journal] have found represents 14% of patients throughout the country who use DPC earn less than $49,000 per year [combined annual HH income].”
“Instead of viewing the status quo PCP model as the center of the universe. Maybe we should take some plays from the Retail Clinic playbook before we become obsolete.” ~Direct-Pay Physician, Dr. Robert Nelson of Cumming, GA.
CAP has been working in the concierge physician space for quite some time. For the last 10 years CAP has been tracking the benefits, losses and business practices of concierge [and direct primary care] physicians. Starting in 2013, CAP started offering discounts to concierge physicians. CAP reviewed records of concierge physicians over the past 10 years and concierge physicians have fewer claims than regular physicians – they can get up to a 45% discount. “When they become concierge physicians their loss experience improves [by losses, CAP means medical liability claims],” says Cindy Belcher, Senior Vice President of Corporate Strategy and Business Development at CAP. “When one becomes a concierge physicians they [most likely] go from high volume practice to a low volume practice [have fewer patients]. We are aware that concierge physicians really do understand that their staff is vital to having satisfied patients. What makes us different from other carriers is our longevity in the marketplace and our Risk Management Institute — educational modules designed specifically for solo and small group office staff that provide a lot of information in a short period of time to help office staff/office management processes and reduce risk.”
“I made the switch many years ago into concierge medicine, or at least a form of it, and I couldn’t be happier. I can provide better care and build a strong relationship with my patients. It definitely can be challenging since I make myself available 24/7, however if you can develop a good support structure of other like-minded MDs you can maintain a successful business with less stress than a traditional practice.” ~Las Vegas Urgent Care Doctor, Facebook.com/24HourVegasDoctor
Here is what Dr. Timothy J. Murray of Solstice Health [Wisconsin] says about his private practice philosophy: “I believe every individual is unique and deserves the best, most affordable personal care possible.”
“It’s common for physicians, particularly those with long-standing patients, to significantly underestimate ‘ramp-up time’ – how long it takes to get new people enrolled,” said Helen Hadley, Founder and CEO of VantagePoint Healthcare Advisors in Hamden, CT.
“Why does a successful transition need outside funding at all?” asks N. Scott Borden of www.DirectPayConsulting.com. “With the new wave of affordable DPC practices that almost anyone can afford, patients are not expecting first class facilities. They value physician access above scenic views. By educating patients about DPC friendly health insurance plans, more patients will join the new practice. Our goal is to make DPC affordable for both physicians and patients.”
According to The DPC Journal analysis and national data summaries to be released in January 2015, on average, 68% of fees inside most DPC practices cost between $25 to $85 a month. Approximately 45% of DPC Medical Offices average between $51-$85 per month. (Source: DPC Journal Industry Summary to be released in January 2015)
“I have decided to adopt a blended model of concierge medicine. My current patients may continue their medical care at our clinic, and a well-trained and capable nurse practitioner under my supervision will be seeing them. When necessary, I will be brought in with the nurse practitioner to discuss and formulate the medical management plan. Those patients who sign up for the concierge service be seen by me and get to enjoy extended appointment time during their visits, have access to me via telephone 24 hour/7 days a week, same day appointments, and get detailed in-depth yearly physical that focuses on disease prevention and wellness. My motto is “Preventive Healthcare, A Smart Approach to Healthy Life”. I believe that a healthy body and stable mind gives the opportunity to live an enjoyable and rewarding life.” ~Dr. Mary Thomas, Baton Rouge, LA
A little advice from DPC Patients …
A large number of Consumers (I.e. current patients and prospective patients) who read our DPC Journal and books have some advice for DPC doctors … “If I’m paying any amount of a monthly subscription to see my doctor, you better know my name when I arrive and I sure shouldn’t have to tap on the glass when I walk-in. And please, move the phone to the back of the office so I don’t have to hear your staff calling in prescriptions or making specialist referral calls.”
“We recognized back in 2000 that health care was moving from personal to a more institutionalized form, and it wasn’t what we wanted to do,” said Dr. John Blanchard of Premier Private Physicians, a concierge medicine practice with offices in Troy and Clarkston. “We felt we needed to have time with our patients, to have the excellence to have the time with patients. Health care has been cutting reimbursement to doctors, which has forced doctors to see more patients, so the time doctors have with their patients have declined. The average time today with patients for most doctors is only 10 minutes.”
“Don’t apologize to your patients for the business changes you’re making. This new process will help them. Inform them that this is a positive change and will help you maintain more secure patient-physician communication on a timely basis and offers them a much more affordable payment system with routine and convenient access to their doctor.” ~Mike Permenter
“We ask people to do really hard things: gluten and dairy free diets, mold remediation, massive amounts of targeted vitamin and mineral supplementation based on labs, calorie counting and exercise logs, meditation. When they are willing to do these things they usually get better. When they don’t, they are wasting our time and their money. We coach them with a lifestyle coach included in their membership, we follow up with them via snail mail cards, phone and email, and we do everything to give them tools for success but if they are not willing to make the changes, we tell them that the relationship is not working and they need to seek another doctor.” ~Dr. Ellie Campbell of Campbell Family Medicine in Cumming, GA
“Today, everyone has to have health insurance and for all of us, it’s now the law of the land under Affordable Care Act (ACA). The $100 or less price point is very important to DPC moving forward, a line in the sand. Anything more than that [$100/mo.] you’re probably not going to get federal subsidies, managed care operations and other people that would provide wrap-around insurance to pay much more than that, particularly because they’re probably not paying more than $40 for primary care right now.” says Jay Keese, DPCC (Direct Primary Care Coalition) lobbyist. “As we move forward into the employer and individual responsibility of the ACA kicking in, people will have to have insurance. You can’t simply say ‘I don’t need to be insured because I have a DPC doctor.’ That is not a viable policy option under the ACA moving forward. What is a viable option is to have a low-cost, DPC plan [i.e. less than $100/mo] with a high-deductible insurance or a wrap around plan that could make that level of insurance fit under confines of Section 1301 A3 under the ACA a viable product. This could work with employers, Medicaid, Medicare Advantage and private insurance. I think that’s where the model makes a lot of sense.”
“Concierge medicine is, at its most basic, a return to the age when doctors made house calls and were paid directly by the patients they treated.”~Paul Sisson, UT San Diego
“When doctors talk about concierge medicine being “the oldest, new form of medicine,” they’re not speaking figuratively—they are trying to reframe the identity of their practice and an over-worked industry.” ~Catherine Sykes, Author, Publisher, Speaker
“The concierge model is a great option for physicians seeking more control over their time, their professional lives, and their ability to care for patients. But it is by no means a financial cure-all. My life is so much better now. It’s a big improvement. I’m enjoying the benefit of more time for my family and my kids, more time to do administrative stuff during the workday rather than after-hours. But it’s not like my financial woes suddenly disappeared, especially during the first year.” ~Marcela Dominquez, MD, family physician in Mission Vejo, CA
“Happier doctors usually have happier patients and tend to be more successful by many measures including reputation and patient retention, which leads usually to better financial reward in the end,” says Dr. Robert Nelson, MD, a Direct Primary Care Physician and Advocate for free-market healthcare. “If focus is on good care and good business practices, reward will follow.”
“This primary care business model [direct primary care] gives these type of providers the time to deliver more personalized care to their patients and pursue a comprehensive medical home approach,” said Norm Wu, CEO of Qliance Medical Management based in Seattle, Washington. “One in which the provider’s incentives are fully aligned with the patient’s incentives.”
“This primary care business model [DPC] gives these types of providers the time to deliver more personalized care to their patients and pursue a comprehensive medical home approach,” said a spokesperson at Qliance Medical Management based in Seattle, Washington. “… In which the provider’s incentives are fully aligned with the patient’s incentives.”
“Direct Primary Care (DPC) is not insurance, does not strive to replace health insurance, nor is it adversarial to it. On the contrary, many DPC practices are eager to work with insurance carriers to co-create blended plans which integrate DPC with high-deductible insurance and ultimately correct the perverse incentives which are rife in the traditional fee-for-service system.” ~Dr. David Z. Tusek, Nextera Healthcare, Colorado
“I love my job! Unfortunately, very few family physicians and internists can say that. To save our profession from extinction given the exodus of medical students to subspecialties, we must offer a physician in a primary care specialty the ability to love their job.” ~Charles Whitney, M.D. Washington Crossing, PA | Revolutionary Health Services
“Every visit is on time; you are not waiting. If you are ill and come in the morning, you are always able to be seen the same day. And I don’t mean ‘squeezed in.’ I mean seen in a relaxing comfortable visit. You are not seen for five minutes with a practitioner saying, ‘Tell me your problem,’” but is rushed because five more people are waiting. When patients call at 10 o’clock on a Saturday night, they get their doctor on his cell phone — not an answering service, not a doctor who is covering for the weekend. It is their own doctor. He knows them. He doesn’t have to go back to a computer and say, ‘I see here that three years ago, you had pneumonia and we prescribed Cipro.’ When you have that number of patients,” says Roberta Greenspan of Specialdocs. ”You know your patients.”
“The biggest reason he was able to transition so quickly is because he is a very popular physician with a large number of loyal Patients.” ~Scott Borden, Consultant, HSA Advisor, Consultant
“The anti-aging and medical home delivery model fits well inside a concierge medicine [and direct care] practice. The nutritional component, the wellness solutions, the anti-aging and team-focused health care delivery professionals led by a concierge [or direct care] doctor are providing comprehensive and continuous health care services to patients year after year that they simply can’t find elsewhere. This combination is increasing patient retention and patient interest in the concept. The goal here is healthy outcomes for patients followed by increased patient retention outcomes for the physician year after year.” ~Michael Tetreault, Editor
“Direct practices should be successful in most cities and states where there is an inadequate supply of primary care physicians,” says Dr. Chris Ewin, Founder and physician at 121MD in Fort Worth, TX. “This may be true in the country with the correct practice model. Most important, a physician needs to have social skills to sell him/herself and there new practice model to their patients and their community.”
“With the right planning, a hybrid can be converted to a Direct Primary Care model,” says Mike Permenter, industry expert and consultant to physicians. “I predict there will be many hybrids converting to a Direct [Primary] Care model in the future.”
“Because this is such an innovative model, and because of the high level of disruption that DPC entails, we would expect the first practices out there to have the hardest time as they get a feel for the new landscape and encounter the first, big problems. What we are seeing now is that our customers who are the second and third waves of DPC practices are becoming more comfortable with the model and also more savvy partnering with employers to secure large groups of patients with longer contracts. This makes them less susceptible to consumer whims. Finally, I do not know the politics of the situation, but you always have to understand the motives of the government agency putting these reports out. There are a lot of stakeholders who are very comfortable with the status quo. And those people likely have a lot more money and influence than individual DPC doctors.” ~ Blaine W. Lindsey, JD, MPH, CEO of GetHealthy, Inc., a technology operator in the DPC industry providing an evidence-based health and wellness platform that develops unique solutions and services to the DPC marketplace.
“There is no substitute for a doctor who one knows and trusts, and who acts exclusively on behalf of one’s own needs and interests. Fortunately, many people can have this type of care. For people who are enrolled in high deductible insurance plans, they can apply their annual retainer fee toward their deductible. For people who have flexible spending accounts, they can use the money from that account toward the annual retainer fee. My fee is less than the cost of a daily sandwich lunch or a monthly cable contract. I think if more of the public were aware of how affordable this care can be, more people would be clamoring for it. Access 24/7, prompt appointments, same or next day sick visits, unhurried visits, health care coaching, continuity and advocacy. What is there not to recommend this model of care?” ~Alexa Faraday, M.D., Greater Baltimore Medical Center, Baltimore, MD
“What I found interesting was that when I left my old practice — I had a 10% Medicare population. That fraction has grown to almost half, suggesting to me that some of the folks most interested in this model are older patients.” ~Dr. Alexa Faraday
“I had to do this to be able to do my job,” says Dr. Marcy Zwelling, who has been an concierge internist since 1987. “I get to practice the way I think I can practice best. It’s capitalism at its best.”
“The first thing to decide is whether you want to continue billing insurance,” says Mike Permenter, long-time industry consultant and physician advisor. “If so, then there are specific legal issues to address with regards to the structure. If you are opting out of insurance there are a number of options. The biggest mistake in my opinion is charging too low. Conversions [into this private-pay marketplace] will eventually be unnecessary as the public becomes more aware of the benefits of these types of memberships. The big challenge is continuing growth after the initial conversion. Customer service, as described by some physicians, is the number one way to grow [this type of] practice. Linking the service to local self-insured employers is a good way to grow but certainly requires expertise with regards to structuring the appropriate benefit, usually a high-deductible plan with an HSA plus a membership. Most doctors currently practicing concierge medicine as a career choice fall into one of two intelligence-gathering categories when they first opened. First, they used a franchise concierge company to help them with the details or they opted to do it themselves and surround themselves with a local team that would provide counsel in starting this practice model. I perform a thorough analysis of the practice and determine areas where expenses will be reduced. After a survey of the physicians patients, we conduct a 12-16 week conversion. Our fees are collected during the transition only. Once a successful conversion has been completed, we help train the physician staff to provide membership services. If customer service is maintained, we know the practice will continue growing without a need for further services.” ~Mike Permenter, long-time industry consultant and physician advisor.
“We keep all unearned membership fees in an escrow account, so if they have pre-paid, they are refunded for any unused days of service. If the relationship is not working, dismiss the patient. Use proper dismissal letters, adequate notice and names of other docs in the community, but don’t spin your wheels on folks who don’t value you.” ~Dr. Ellie Campbell of Campbell Family Medicine in Cumming, GA
“Until just a few years ago, people mostly based choosing a doctor on the personal recommendation of a trusted friend or relative,” says Michael Tetreault, Editor-In-Chief of Concierge Medicine Today and its healthcare trade journal companion, The Direct Primary Care Journal. “Now with the advent of social media, word of mouth marketing is changing from a spoken word referral to a social media link referral. When you think of Andy Griffith-style medicine, the doctor had a clinic in the local town. It’d be strange for him to say, ‘What kind of insurance does Opie have?’ The people you entrust to help your practice grow must be aware of how to effectively promote this new, old-fashioned message and delivery model of healthcare.”
“Industry sources from within Concierge Medicine confirm there are probably around 5,000 to 20,000 private medicine physicians nationally according to the independent industry trade publication, Concierge Medicine Today. However, since there is no federal registry or official national database of these physicians, it is difficult to accurately estimate a precise number. These figures still only represent a minute percentage of the roughly 923,308 total licensed physicians in the U.S., that actively practice medicine today. Industry experts and observers tell Concierge Medicine Today that growth in the provision of subscription private medicine services has been primarily in internal medicine and family medicine, although specialty physician participation is on the rise. Concierge Medicine Today also cautions that there is no way that Internet searches and polling on the Internet can or will result in an accurate head count of these subscription-based business model physicians. Therefore, it is left up to industry examiners, physicians and thought leaders in the space, to accurately estimate and educate others about the history and future of this private medical space.” ~ Concierge Medicine Today; July/August 2017;  Kaiser Family Foundation; April 2017; Total Professionally Active Physicians in the United States; Data includes currently active allopathic physicians (MDs) and osteopathic physicians (DOs).
Dr. James Pinckney, II of Diamond Physicians based in Dallas, TX writes … “Preventative medicine is now our top priority. The upfront costs associated with genetic testing, inflammatory testing, etc. pales in comparison to the cost of treating chronic disease. Stakeholders are realizing that it is more important to invest in technologies that detect disease at an earlier stage when it is less challenging to treat effectively. Spending capital now on tailored treatment plans for individuals will save billions in the future.”
“Young doctors are refusing to go into primary care medicine,” notes Dr. Steven Knope of Tucson, Arizona in his writings about The Myths of Concierge Medicine. “This is due to the fact that practicing primary care medicine in our current broken system, seeing 30 patients per day, making only one-third to one-fourth of what a specialist makes, have created an understandable shortage of doctors willing to practice primary care medicine. Over the long run, the only way to increase the number of qualified primary care doctors is to make the profession more attractive, both from a professional and financial perspective. It is our current broken system that has caused a shortage of primary care doctors; and if we stay on the old path, it will only get worse.”
“Doctors carrying a medical bag and coming into a patient’s home was standard into the late 1960s. Look at The Andy Griffith Show. That’s what our grandparents did. Medicine became government regulated and that started to end. It came in for a reason — there did need to be some amount of administration. But now regulation and administrative tasks have frustrated doctors. Be intentional with your excellence, don’t be normal.”~Michael Tetreault, Editor, Author, Speaker, Concierge Medicine Today
“If things are going well, not need to worry. In 18 months, I have only had one patient leave after 3 months and then she re-joined 3 months later when her finances improved. I have not even come close to firing anyone; nor have I had any card denials on recurring payments.” ~Dr. Robert Nelson, Cumming, GA
“One of the most difficult occurrences is when patients who does not understand the program or who philosophically disagrees with the membership fees (i.e. thinks this is for rich people) accuse the physician of abandoning them,” says one former Transition Manager in Arizona. “Sometimes patients can be very vocal about their opinion of this and at times, be quite rude. This is very disheartening to most doctors, at least in the early stages of the transition process. ‘Saying goodbye’ to some long-term patients is one of the reasons many Physicians are reluctant to convert [to a Hybrid model].”
“The language of strategy rather than the delivery of platitudes is more informative and effective with physicians when talking to them about how concierge medicine will benefit their practice, patients and bottom-line. For consultants to sail and compete in the concierge medicine ocean over the next two to four years, the company that will repeatedly give its physician clients something that feels refreshingly new and solves their problems in a way no existing consultant has done will exit the red ocean and begin trawling in blue waters.” ~Michael Tetreault, Editor-in-Chief, Concierge Medicine Today and The DPC Journal
“On my side, it is not really any different than terminating in an insurance environment – actually easier in that I have no contract with the insurance company which often dictate terms of dismissal. STEP ONE: The standard is a certified letter indicating the patient needs to find another doctor within a specified period (30, 60 or 90 days usually), which also outlines what services will and will not be provided during that interval of transition. STEP TWO: Make sure they have enough medication to hold them over until the end of the transition period. STEP THREE: Stop taking their money.” ~Dr. Robert Nelson, Cumming, GA
“Slow and steady growth is ideal in this type of practice because it allows you to offer patients a personalized experience,” says Joel Bessmer, MD, FACP of Omaha, Nebraska’s Members.MD. “I’ve found that the word-of-mouth aspect (vs. a billboard advertising approach) has been the most consistent factor in building my practice. I consistently have patients recommending their family members and friends. Getting word of mouth referrals based on high quality care, staff service and patient satisfaction has been a much more effective tool than traditional marketing. And the slow and steady approach ensures that staff can keep up with new patients, as opposed to getting a rush of new caseloads that would be more difficult to manage all at once.”
“In today’s healthcare culture, the 55-plus audience hasn’t been entirely abandoned, but the advertising aimed at this population segment is simply aimed at maintaining brand loyalty and establishing that the products they love are still good, still function and most likely being improved. Conversely, you can watch any prime-time television show that’s targeting the 25-54 demographic, and you will learn what those people think is cool, hip, and where our culture is trending. You will not see advertising aimed at the 55-plus demographic population that’s designed to get them to switch brands. The advertising aimed at 25-54 is all about that. And, by the way, most doctors, consultants and advertising agencies know that. This is just one of the many helpful topics you’ll learn about at this conference.” ~Michael Tetreault, Editor-In-Chief, Concierge Medicine Today and its healthcare trade journal companion, The Direct Primary Care Journal
“I remember when I started my direct-access, home-based primary care practice (www.MetroMedicalDirect.com) in 2009,” says Raymond Zakhari, NP and CEO of Metro Medical Direct. “Patients were skeptical and reluctant because of how accessible and convenient the service was. They expected to be kept waiting on hold. Some seemed puzzled by the fact that when they called I answered the phone and knew who they were. One patient even inquired as to how come they only had one form to fill out. Direct-access primary care patients who have been referred post hospital discharge, have not been readmitted to the hospital in the last 4 years because I can see them without delay or red tape. In NYC, despite the high number of physicians per patient, particularly on the upper east side of Manhattan, direct-access primary care can still be a viable practice solution for patients and providers. It helps patients cut through the red tape that has become expected in accessing health care.”
“Some doctors would say this is easy, especially the successful ones,” says Matthew Priddy, MD, who operates in a thriving concierge medicine practice based in Indianapolis, IN. “But there are also doctors who failed, gave up, and went back and worked for hospitals. Those folks are out there too, and they would probably tell you that it’s impossible. It can be a little bit of a selection bias when you talk to the doctors who are oft-quoted in the media or who are involved in national organizations. But that is more the exception than the norm.”
“There are downsides to a hybrid practice,” said Michael Tetreault in an interview with Medscape in late 2014. “Number one is that a lot of patients will get into a wait-and-see mode. They will say, ‘I can still see my doctor. I’m just going to file through insurance. I might have to wait longer to get an appointment, but that’s fine.’”
“The biggest mistake in my opinion is charging too low,” says Mike Permenter, industry consultant. “Conversions [into this private-pay marketplace] will eventually be unnecessary as the public becomes more aware of the benefits of these types of memberships. The big challenge is continuing growth after the initial conversion. Customer service, as described by some physicians, is the number one way to grow [this type of] practice. Linking the service to local self-insured employers is a good way to grow but certainly requires expertise with regards to structuring the appropriate benefit, usually a high-deductible plan with an HSA plus a membership.”
Neil Chesanow with Medscape writes … Only a fraction of your traditional patients will typically join you in a retainer medicine practice, experts caution. It’s not unusual for a traditional primary care practice with 5000 patients to have trouble attracting the 300-600 patients needed for a full concierge practice, or the 1000 or so patients needed for a full direct primary care practice. Doctors who open with half-full practices court financial collapse. “Unrealistic expectations are what I hear in many doctors’ comments,” Tetreault reports. “Doctors set themselves up for hard times over the next 12-24 months by underestimating the market. We’ve seen physicians fail because of lack of capital. They think, ‘My patients love me. There’s no way they’re not going to continue to use me after I transition. I’m affordable. How can they not choose this? This is great!’” One family doctor, who left a primary care group practice to open a solo concierge practice in 2003 — without a single patient going in (a restrictive covenant prevented him from taking practice patients with him) — told Medscape that he wiped out his entire savings keeping the practice afloat, and that he finally earned $100,000 in 2012, 9 years after he left traditional practice.
“There was a time when patients valued their family doctor, trusted our opinion and called us after hours to help decide if symptoms needed urgent attention or could wait,” says Dr. Ellie Campbell of Campbell Family Medicine in Cumming, GA in an interview with Concierge Medicine Today. “Our phone trees, answering services, and after hours call-sharing doctors make it unlikely that any given patient will actually speak to their own doctor. So they don’t bother, and they seek care wherever it is most convenient.”
“To those who say concierge doctors are hurting the system by diminishing the number of patients we can care for, my reply is: if you keep doing the same thing year after year, you are going to get the same results!” said Dr. Joel Bessmer of Members.MD based in Omaha, NE. “If we don’t focus on salvaging the doctor-patient relationship and allowing the appropriate time for each patient’s care and follow-up, patients will begin to feel their primary care is a waste of time.”
“We believe that Direct Primary Care (DPC) Models reaffirm the central role of the physician-patient relationship which lies at the heart of an effective health care delivery system,” said Laurence Bauer, MSW, Med, CEO of FMEC. “Direct Primary Care incentivizes the physician to respond effectively to the needs of his/her patients.”
“We try to make it fit into your lifestyle instead of disrupt it,” said Iowa physician, Dr. Ingram. “You call the office, you call my cellphone, you text me, email me and we set something up.”
Neil Chesanow with Medscape writes … Most concierge and some direct primary care practices promise patients 24/7 cell phone access to their physicians. Is it tantamount to being on call 24/7 as a lifestyle? “The question I’m most often asked in regard to patients is: Does private medicine attract the type of needy patients who feel like they’re paying money so they can boss you around?” says Dr. Matthew Priddy. “Will they call me in the middle of the night because they have a hangnail? Do they demand that you do unreasonable things, like get them an MRI in 5 minutes?” The answer, he says, is generally no. In fact, this was Priddy’s biggest fear before he made the transition: that patients who paid a fee to be a member of the practice would act like prima donnas. “I didn’t want to be someone’s butler,” he says. “I was worried that there would be a sense of entitlement among our patients — that we’re paying you X amount of money a year, and if I want that antibiotic, you’re going to give it to me. And if I want those pain meds, you’re going to write those scripts for me. Or I’ll quit. “We absolutely have people who sign up with that attitude, and we tell them they can quit,” he says. “I’m not going to write you a script for Vicodin® just because you write me a check. That’s not how it works.” But demanding patients have been the exception, not the rule. “Ninety-five percent of our patients are fantastic,” Priddy says. “Five percent aren’t. That’s just life.”
“The conversion process is not an easy one,” said Jeffrey S. Gorodetsky, M.D. of Stuart, FL. “My staff and I are cognizant of the fact that we must consistently communicate the benefits of this choice in care, with the challenge to increase my [memberships] numbers and convert other patients.”
“Overall, Concierge Medicine is thriving in metropolitan markets,” said Tetreault. “Concierge Medicine continues to grow at a moderate and acceptable pace each year with physician earnings increasing gradually. We concur with other outside surveys and many industry consultant observations that moderate and gradual growth will continue each year in Concierge Medicine … as industry consultants continue to field more and more physician inquiries from entrepreneurial-minded doctors (from across the U.S.) about their business model options.”
“Patients value speed and low cost most of all for most minor complaints,” notes Dr. Ellie Campbell of Cumming, GA. “Even my patients who pay a membership fee for all of their covered and non-covered services including 24-hour access to my personal email and cell phone number, and whose care for these complaints would be covered without additional cost, still use these [retail medicine style] health providers [i.e. CVS, MinuteClinic, TakeCare Clinic, etc.]. Many patients say, ‘I just did not want to bother you on the weekend, and I was near there anyhow.’ As long as we live in a world of drive-though windows, ATMs, and garage door openers, patients are going to value and pay for any service that gets them in and out quickly, on their time schedule, with their desired objective. We [Concierge Medicine and Direct-Pay Doctors] need to learn to adapt, as this delivery model of care seems here to stay. Unless we offer on site dispensaries, extended hours, and no appointment needed delivery, we will be deferring more urgent issues to these models. Perhaps then we will have more time to devote to preventing disease and reversing the burden of chronic conditions, if only we can convince third party payors that there is value in that.”
“Becoming a concierge physician is an opportunity to give my patients the special personal touch that they like, need, and desire! The concierge practice will afford me the opportunity to engage my patients about all aspects of their healthcare: preventative, social, family, fitness & wellness, as well as nutrition, and all the while spending a good deal of quality time with them. For physicians, concierge practice is our chance to practice medicine the way it was before insurance companies started dictating healthcare. I am very excited about the opportunity for my patients as well as myself.” ~Dr. Eddie Richardson, Eatonton, GA
“We also had to acknowledge that, while our services were extensive [at our physical practice], certain activities couldn’t be performed at North Vista Medical Center,” said Drs. Clint Flanagan and David Tusek of Firestone, CO. “We’ve always believed in being a patient’s ‘healthcare quarterback,’ so we negotiated highly competitive rates for lab and imaging services within our market. We determined the services most crucial to our patients, educated ourselves about available resources in our community, and created a list of options with full cost transparency.”
“Typically, there’s a period after start-up when income goes way down as patients decide whether to stay,” said Allison McCarthy, a senior consultant in the northeast office of Corporate Health Group, a national consulting firm. “It often takes a good two years to bring the patient level up to where it should be.” At that point, physicians do better financially. In the interim, they are likely to struggle, particularly with those large start-up costs, which range from $50,000 to over $300,000.
“As an integrative physician, my goal is to help people focus on health and wellness. I prefer to teach patients self-help skills and provide them tools to transform their life rather than prescribing them medication. If I could, I’d love to hand a patient a pair of running shoes and a tasty plate of vegetables instead of constantly scribbling out prescriptions. Pills are not always the answer. Your body often has the ability to heal and take care of itself if you are willing to make the lifestyle changes.” ~Dr. Jameelah Gater, MD
“Consumers buy what they understand. It has taken years for the industry to educate consumers about the basic components of concierge medicine. Build upon that existing knowledge base and take the time to further educate them on how your practice uses labs, technology and other tools that will elevate their health.” ~Sonja Horner, President at Private Medical Partners, CMT Contributor
“Becoming a concierge physician opens up that time to practice medicine this way. It truly permits me to become a partner in my patient’s lives. In the past year, I’ve started to explore the science of anti-aging medicine. I have wanted to have a better understanding of why some patients age more quickly than others. I’m excited about the cutting edge knowledge and products that I am able to bring back to my practice.” ~Dr. William Adcox, Peachtree City, GA
“When a physician is free to create pricing structures that meet their local demographic demands without the intrusion from insurance and avoid providing ‘hamster healthcare,’ which only allows doctors to spend 6 to 9 minutes with their Patients, you make a happier Patient, healthier family and less frustrated and fatigued doctor who is able to care for their Patients more thoroughly and comprehensively.
“Direct Primary Care (DPC) allows doctors to provide better care, more often, at a fraction of the cost to patients, while increasing their income and offering greater satisfaction … why would anyone stay in a broken insurance-based model?” ~Doug Nunamaker, M.D.
C.J. Miles, MBAHCM, MSA Research Analyst at the AMAC Foundation writes … ‘The four states with a very large lead in the number of concierge physicians in practices, as well as consumers seeking their care, are Florida, California, Pennsylvania, and Virginia. In these areas, the franchise concierge fees are increasing and the independent concierge doctor fees are decreasing due to competition (Tetreault, 2014). However, the number of patients seeking concierge medicine far outweigh the number of available physicians, especially in rural areas. According to Concierge Medicine Today (CMT, 2014b), states with high demand but very few concierge physicians include Hawaii, Idaho, Iowa, Mississippi, Maine, New Hampshire, South Dakota, North Dakota, Louisiana, and Alaska. The most common specialty for these types of practices is obviously primary care with family medicine a close second. The next top two specialties are cardiology and pediatrics (CMT, 2014a). In 2011, specialists were growing in numbers in concierge medicine, which include general surgery, psychiatry, spine surgery, gynecology, dentistry, addiction medicine, dermatology, oncology, and the cardiology and pediatric specialties already mentioned. Specialists offer the same increased access and patient attention as the primary care concierge doctors and tend to have patients with chronic conditions. The main difference is that the primary care concierge physicians tend to have a patient load of 300-750, whereas the specialists tend to have a patient load of 150-300 (CMT, 2014b).’
“This new practice has been truly liberating. I am working harder than ever getting it of the ground but my time with patients is wonderful. And I get to be creative again in how I develop the practice, something that was lost from my previous office.” ~Dr. Alicia Cunningham, Vermont
“Personalized medicine provides the best possible solution to navigating today’s complex healthcare landscape,” says Dr. Sandhoo. “The gift of more time to spend with patients is of incalculable value, enabling me to comprehensively address multiple, complex conditions and focus on prevention and wellness. It also allows me to be my patients’ advocate, whenever and wherever needed…at the office or hospital, during regular hours, or on my cell phone in the middle of the night.”
“Concierge medicine must be treated seriously by physicians and patients alike because it is a concept that is here to stay. Paying a set annual fee for “special services” may appear to some to focus on money and greed but to others it may be redirecting the focus of medicine back to preventing disease and seeking wellness. If concierge physicians are successful in preventing illness and keeping patients healthier then it is in the best interest of patients, physicians and society as a whole.” ~Peter A. Clark SJ, PhD Professor of Medical Ethics and Director, Institute of Catholic Bioethics, Saint Joseph’s University
“Since 2005, I have been providing comprehensive primary care to families and individuals of all ages in San Francisco. Through mutual respect, careful listening, and collaborative communication, I have built strong long-term relationships with patients and health care providers in the community,” says Dr. Bhandari.
“What physicians and healthcare professionals are learning and observing in the Concierge Medicine space is having an impact on the entire healthcare ecosystem across the U.S. and abroad. From in-depth, 90-minute intake visits with your doctor, 30 to 60-minute follow-up visits at your convenience to the use of advanced genomic testing and lifestyle coaching, Concierge Medicine physicians don’t accept the status quo.”
Related to HSAs and Membership Medicine fees … “Most of these arrangements do not meet the criteria to be considered qualified health care expenses under the Code. If you want to submit such expenses under your employer’s FSA plan, expect to be asked to back up the reimbursement claims with documentation that medical services were rendered.” ~Janet Palcko is a partner at NEO Administration Company, a benefits consulting firm that provides FSA, HRA, HSA and COBRA administration and compliance services
“I use PayPal merchant account to process cards.” ~Dr. Marina Gafanovich MD, New York, NY
“One major reason for the failure of many so-called wellness programs is that an outside company is hired instead of having a program structured with local physicians.” says Mike Permenter, industry consultant
“The #1 rule in successfully designing your new membership based practice is to start with defining the services you would like to provide to produce the patient outcomes you hope to achieve, then pick the model that best fits your “clock”, your marketplace and equally important covers your overhead.” ~Sonja Horner, Healthcare Business Innovator | Outcomes Advocate, CMT Contributor
“Direct Primary Care or even Concierge Medicine are not just for the rich any more. Economic models which cut out the administrative costs of insurance make this level of care affordable for your average American. For an investment of a few dollars per day, patients can buy a measure of security knowing that their physician can focus on their health rather than the well-being of 20 different insurance companies. One of the goals behind my practice, Sanctuary Medical Care and Consulting, is this mission to middle America. Old fashioned house calls combine with mobile technology while being enveloped in extended visits can rebuild the physician-patient relationship and restore some hope in the medical system.” ~Eric Potter MD Sanctuary Medical Care
“If you possess excellent communication skills, around the clock dedication and the desire to promote optimal health in pursuit of excellent medicine, then concierge medicine is for you. It’s the best career choice I’ve ever made.” ~Brian Thornburg, MSM, DO, PA, FAAP Innovative Pediatrics
“Be careful with those that say HIPAA does not apply to cash practices. It is really the HITECH part of HIPAA that you need to be pay attention to. There is also Federal and State aspects of HIPAA. While the insurers are not going to be breathing down your neck about compliance issues, you are still in the “supply chain” as it were when it comes to handling records. It is just as easy to be in compliance really without spending any more. There are a variety of secure and hipaa compliant apps and video platforms out there.” ~Dr. Robert Nelson, Cumming, GA
“We offer either a membership or typical fee-for-service direct payment model to our patients. All of our medical services meet the requirements of IRS Publication 502, so it is a no-brainer for our fee-for-service patients to justify the use of their HRA/HSA/FSA for our services. (We also provide a standard CPT code on our statement for them.) We then list our standard fees (used for our fee-for-service patients) as “value of service” on statements for our membership patients when they request justification for HRA/FSA purposes for the cost of their membership. It is a little tedious and frustrating, but until the IRS determines that DPC membership costs are “qualified medical expenses” in and of themselves, I see no other way to help our patients justify their medical expenses to their health plan administrators.” ~Bruce Jung, DocShoppe
“The heart of good medicine is care,” said Dr. Rebecca Plute, a concierge doctor at Paragon Personal Health Care in Canonsburg, PA. “I think the key to concierge medicine is the personal relationship between doctor and patient.”
“As the managing partner at the Surgery Center of Oklahoma we have seen a boom resulting from our online pricing. Beware, those who reject a more price transparent model..the market is beginning to judge harshly and this will only intensify as more embrace the same market discipline that every other industry must endure.” writes G. Keith Smith, M.D. to The DPC Journal at the Surgery Center of Oklahoma
“This is healthcare the way it should be, with zero compromises. It’s about being cared for in the way you would care for your own family member.” – Dr. Howard Maron
“This is a level of personal care known only in years long past, and only to a few. It is truly medicine in the ideal.” – Dr. Howard Maron
- The Physicians Foundation. A survey of America’s physicians: practice patterns and perspectives. September 2012. http://www.physiciansfoundation.org/uploads/default/Physicians_Foundation_2012_Biennial_Survey.pdf Accessed April 23, 2014.
- Association of American Medical Colleges. 2013 state physician workforce data book. November 2013. https://www.aamc.org/download/362168/data/2013statephysicianworkforcedatabook.pdf Accessed April 24, 2014.
- Medscape Business of Medicine © 2014 WebMD, LLC; http://www.medscape.com/viewarticle/824543_1
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