The one-to-one relationship between physician and patient often takes a back seat in today’s demanding healthcare environment, in which administrative burdens, efficiency and volume can take precedence over individual care. Fortunately for practices, there are alternatives to consider. In exploring long-term patient care strategies, one option is hybrid concierge medicine.
The hybrid concierge model offers services, such as comprehensive preventative care and wellness visits, beyond what is covered in a standard visit and outside of what insurance typically covers. Many of these services are provided during an annual checkup. Patients pay a flat fee to receive greater access to their physician through consultation, discussion and medical records review. As Wayne Lipton, founder and managing partner, Concierge Choice Physicians, LLC, Rockville Centre, N.Y., notes, “In a hybrid model, [for patients] it’s not about access; it’s about the value of enhancing the connectivity and having more time with the doctor to have a sense of comfort about what’s going on with their healthcare.”
Focusing on the doctor-patient relationship
The emphasis on the doctor-patient relationship is the basis of concierge medicine. As Lipton conveys, this relationship often is deemphasized as practices strive for efficiencies. “One of the hallmarks of this type of practice is that a patient chooses a particular physician to have a stronger relationship with,” Lipton says. “Membership is not on a practice basis, but on a one-to-one relationship … what it does by its sheer design is enhance that relationship.”
Patients who long for an old-fashioned relationship with their physician find comfort and security in having 24-hour access to them. One of the perks is that physicians provide their cell number to their patients. However, as Lipton asserts, few patients take advantage of that privilege. “The time someone calls is when they are in desperate need of you, not because they are abusive,” Lipton says. “Doctors have the right to drop any abusive patients.”
In fact, since he founded Concierge Choice Physicians in 2005, Lipton has only heard about abuse a handful of times. This is largely because physicians meet with patients to discuss their expectations and establish boundaries before accepting a new hybrid concierge patient.
Benefits for physicians and practices
For physicians and practices, hybrid concierge medicine can be a practical long-term solution for several reasons:
- Participation is solely up to individual patients, and practices don’t have to give up patients to participate. In addition, not every practice physician must participate.
- Participation by a small percentage of the patient population (in most cases less than 10%) is necessary to make it worthwhile for practices.
- By continuing to accept insurance, practices have a continuous source of revenue and preserve crucial relationships with hospitals and specialist referrals. However, hybrid concierge medicine provides another revenue source that practices directly control — one that’s not affected by reimbursement rates and coding.
- For an hour or two a day, physicians can practice medicine the way they prefer, providing individual attention to their patients.
- The model can be used as a test case for transitioning to full concierge medicine, though Lipton cautions that practices rarely do so.
By integrating hybrid concierge medicine into their practice, physicians can offset some of the issues that can arise in a traditional model. “When you are concerned about quality of care and productivity being features of what your practice strives for, there’s a bit of a problem with time,” Lipton says. “It creates issues with burnout; it also creates issues of concern on the part of physicians that they’ve done everything they can. It also affects how much is referred out versus performed at the site during a particular visit.”
When physicians can introduce a respite into their day, they can help alleviate some of these concerns. As Lipton notes, “It’s a small portion of time in each practice’s day where the pace is slowed down dramatically, and time is no longer the major motivating limiter.” This also benefits the practice as a whole because patient volume is reduced during these windows.
In turn, hybrid concierge medicine can help reduce physician burnout. In primary care, physicians can often see four patients an hour, but in the hybrid concierge model, that number may be cut in half, while not adversely affecting income. The model also makes it easier for physicians to transition into retirement and extend their careers. As Lipton mentions, some physicians he works with are practicing medicine into their mid-80s in the hybrid concierge model.
On the economic side, hybrid concierge medicine can generate higher levels of compensation per hour. As mentioned, it is not affected by coding or reimbursement rates and does not require additional capitalization.
Hybrid concierge is not for every practice
Despite the benefits, hybrid concierge medicine may not be a good fit for some practices. “It will vary on the economics of the community,” Lipton emphasizes. “Interestingly, we’ve found that the model works in middle-income and lower-middle income areas, but not in an area that’s Medicaid population.” That said, there aren’t many barriers to participation. As noted, it’s not a requirement for the majority of a practice’s patient population to participate. In addition, if the annual fee is affordable — for example, less than $2,000 a year — many patients may find it beneficial.
Hybrid concierge medicine also doesn’t work well in places where there’s high patient turnover, such as resort areas, for example. In stable patient populations, the re-sign up rates are typically higher than 90%, Lipton says.
Who is participating?
There’s no single approach for setting up a hybrid concierge model. For practices, the biggest obstacle is marketing it to patients; for patients, the primary obstacle is financial, because they are participating directly rather than going through a third party.
With larger groups, Lipton says that it doesn’t matter whether physicians have five or 100 patients participating, marketing is the same for every physician. This makes the program less exclusive and not just available to “superstars.”
Although the hybrid concierge model is most often seen in primary practice, Lipton says some specialties — cardiology, endocrinology and rheumatology, for example — have patients who desire enhanced connectivity, a stronger relationship with their physician and a more comprehensive review of their health.
For some of these specialties, such as cardiology, practices are looking for methods to earn back lost revenue. “Oftentimes, there’s more of an incentive to think about ways to bring back some of that revenue that’s lost from the changing of the reimbursement rates that occurred for certain procedures and testing,” Lipton maintains.
Although hybrid concierge medicine is still a small niche (approximately 3,000 to 5,000 physicians utilize it in the United States, according to Lipton), there is opportunity for growth without significant investment, as compensation is tied to practice success.
For some practices, hybrid concierge medicine could be the solution they are looking for. “The hybrid model itself is really a wonderful approach for practices to tap into other revenue sources where they have control of private pay in an environment where they’re not giving up their relationships,” Lipton affirms.
Hybrid concierge medicine in action: Arroyo Medical Group
Arroyo Medical Group, Pismo Beach, Calif., is a primary care practice with six full-time-equivalent (FTE) physicians and one part-time PA, located in what practice administrator Sherry DiDomenico calls a “doctor desert.” The practice has approximately 6,000 patients, and half the payer mix is Medicare.
According to DiDomenico, Arroyo Medical Group adopted the hybrid concierge model five years ago to help combat shrinking revenues from traditional insurance. The desire to remain self-sufficient was also a strong motivation. “The physicians talked with local health systems about being acquired, but they didn’t want to do it because they value their independence,” DiDomenico says. “So they decided to look for other ways to stay alive. Concierge turned out to be part of that strategy.”
Currently, the practice has about 500 patients — around 8.33% of its patient population — participating in the program. The national average for hybrid concierge medicine is between 3%-10%.
DiDomenico echoes what Wayne Lipton expresses about the hybrid concierge model emphasizing a one-to-one relationship. “The physician/patient relationship is much more personal,” she says. “They are getting something they would never get in traditional insurance — a really comprehensive physical once a year — which would be expensive for them to pay for if they had to pay for all the labs separately and all the testing that gets done as part of that physical.”
DiDomenico recognizes how much the model can benefit physicians, particularly when it comes to lessening the burden on them. “They know that with a traditional patient, if they don’t jump through all those hoops and justify every last thing they do for a patient, they are not going to get paid for anything,” she says. “With a concierge patient, that is not an issue. It makes it less of a volume game; it gives them a little breathing space.”