Hybrid Concierge Medicine: A New Model for the Concierge Brand

Concierge medicine, a practice of medicine in which patients pay an annual retainer fee on top of any procedure costs in order to receive more personal care and quicker access to their primary care physicians, has been a growing trend over the past several years. In 2010, there were roughly 756 concierge physicians in the United States, up from 610 in 2006.

However, the growth of this fixed-fee service has also caused some doubt within the healthcare system. While proponents emphasize the round-the-clock treatment and personalized care from a physician, critics say concierge medicine could create a type of "insurance caste system" in which lower-income patients and many Medicare beneficiaries could see their choices of physicians wane due to their inability to pay the high retainer fees.

Wayne Lipton, founder of Concierge Choice Physicians, says a "hybrid" concierge medicine model looks at the strengths and weaknesses of the full concierge model — and presents a new, attractive business plan for both independent and hospital-based physicians.

What the hybrid concierge medicine model is — and isn't

Conventional concierge medicine, what Mr. Lipton calls the membership model, has several shortcomings. The most obvious one is that it disenfranchises current patients who cannot or choose not to pay the annual fee — which could vary from an average of $1,500 to $2,500 per year, some much higher — thus reducing a primary care physician's patient population from thousands to hundreds. For some physicians, this decreased workload is ideal and sought, but Mr. Lipton says orthodox concierge medicine could contribute to a physician shortage. "In a world of declining primary care physicians, the best and brightest could say goodbye to large portions of practice," he says.

However, the hybrid model of concierge medicine makes one simple, but rather large, tweak to the conventional model. Instead of a primary care physician completely transitioning to a concierge practice, the physician could just make it an option for any patient within the practice who wants those one-on-one specialized services. "By offering that as a choice, it is not mandatory or a requirement," Mr. Lipton says. "By making it an option, it meant people who were interested could pay out-of-pocket for enhanced services."

Hybrid concierge practices also allow physicians to continue participating in different health plans, Mr. Lipton says. Some health plans dismiss full concierge models in their coverage determinations, but the hybrid model still allows the primary care physician to work with insurance-based patients. This especially matters for hospital- and health-system-based physician practices. Mr. Lipton says those larger healthcare institutions could still continue on with normal operations because the hybrid model will not alter the cultural underpinning. "Ninety-five percent of what hybrid concierge medicine is doing is still the same as [a physician's] colleagues," Mr. Lipton says. "In the context of a large entity, it doesn't create an island, but rather physicians continue to interact in the same fashion."

Responses to the hybrid model
Although the hybrid concierge medicine model carries the "concierge" name, Mr. Lipton says the approach has provided benefits. For example, hospitals are increasingly becoming employers of different physician practices, primary care and specialists alike. Similar to the general U.S. population, there are many physicians getting close to retirement age. One survey estimated that up to 70 percent of physicians plan to work longer than expected due to the economic downturn. For physicians who are entering the last stages of their careers, Mr. Lipton says the hybrid model can give those physicians a small outlet for more personalized care. "If a physician reaches a certain age where they want to retire or can't produce, hybrid concierge medicine can extend the professional life," Mr. Lipton says. "It's appealing to employers of physicians to keep them productive and extend their professional life."

However, before any practice makes the jump into any concierge medicine format, it must consider the cultural implications. The positives (e.g., personalized patient care and steady revenue) and the negatives (e.g., restrictive parameters for many patients) must be weighed against each other. "Anything that introduces a revenue stream is an appealing approach as long as it does not interfere with the mission of the institution," Mr. Lipton says. "The hybrid model doesn't really interfere with [the mission], but a full model often times does. A full model can have a negative impact because it pulls the top-notch physicians away from general care, and sometimes that's a mission-breaker."

Related Articles on Concierge Medicine:

More Physicians Pursue Concierge Model, Stop Accepting Insurance

5 Questions to Ask When Considering Concierge Medicine

"Members Only" Medicine Increases Across the United States

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