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Analysis

5 Best Practices for Concierge Medicine

By Christopher Cheney  
   June 26, 2018

Successful concierge medicine practices have a patient-centered philosophy, small scale, financial strength, strong care coordination, and focus on prevention, a concierge physician and author says.

Embracing patient-centered care is an essential ingredient for success at concierge medicine practices.

"We are focused on doing everything we can do to exceed the expectations of the patient," says David Winter, MD, a concierge medicine physician in Dallas and chairman and president of HealthTexas Provider Network, a physician group affiliated with Baylor Scott & White Health.

Concierge medicine is based on a membership model, where the concierge physician receives a monthly or annual fee to subsidize amenities not offered in most primary care offices. Those amenities include 24/7 access to a physician, same-day appointments, and the ability to have lengthy office visits if necessary.

There are five best practices to operate a successful concierge medicine practice, says Winter, who recently published a book, Service Extraordinaire: Unlocking the Value of Concierge Medicine.

1. Primacy of Patient Experience

Well-run concierge medicine practices provide an excellent patient experience, he says.

"You have prompt access, 24/7; phone, text, or email communication at the patient's choice; and our office visits are unrushed and lengthier than standard clinics."

Concierge medicine is the antithesis of the past's practice of medicine, Winter says. "In many of the old practices, it was built for the physician—the schedule was set for the physician, the parking places were closer for the physician. We've switched all of that. Our patients get valet parking, and we pay."

At Winter's practice, BSW Signature Medicine - Tom Landry, efforts to enhance the patient experience start the moment a patient comes through the door, he says.

"We'll serve them water, coffee, or soft drinks. We'll update their records. They don't have any idle time. We don't want them to wait. In fact, we don't call our entry room a waiting room, we call it a greeting room."

2. Less is More in Scale

The optimal scale for a concierge practice is a single physician, Winter says. "The ideal way to run a concierge practice is with a physician who has been in practice [for a] while and has a relationship with patients."

Establishing relationships with patients enhances care, he says. "It's about a one-on-one relationship between a patient and a physician—a trusting relationship. That augments the care of the patient."

3. Retainer Fee Financing Model

Monthly and annual patient retainer fees help finance concierge practices. There are two approaches, Winter says.

"You can charge a retainer fee and bill people for billable events, which is the way we do it. If you come in with bronchitis, we will send a bill to the insurance company or Medicare. The other way is to have a higher retainer fee, with no billing for anything."

For Winter's practice in the Dallas market, the blended approach made more sense. "People have the insurance anyway. Patients need it in any concierge practice for specialty care and hospitalization. They had the insurance anyway, so we felt that was the easier way to go."

In North Texas, retainer fees range from $1,800 to $18,000. Winter says his practice's retainer fee is at the low end of that scale.

The retainer fee financial model helps concierge practices generate more income than many standard primary care practices. "If the patients are paying annual retainer fees, then the physician does not have to see 20 or 25 patients per day to pay overhead and generate income," Winter says.

Time is a precious commodity at a physician practice, he says.

"I was in practice for 20 years, had a very busy practice, and I went from one patient to the next. I would focus very intently on my patients; but once a patient was out of the exam room, you forgot about them and were on to the next one. With concierge medicine, you can think about patients, do research, and call them back to see how they are doing."

4. Care quarterbacks

Most concierge practices offer primary care, and the best ones prioritize care coordination, he says.

"They are the quarterback of a patient's medical team. They will get the specialists they need to take care of the patient, but the care all runs through one physician," Winter says. "How you coordinate care is a key factor in concierge medicine—you want to make sure you are doing all you can do for the patient. You use specialists as necessary to augment the care."

5. Promoting preventive care

The best concierge practices also focus on preventive care, he says.

"Every afternoon when I am working in my administrative role, my nurse goes through our patients to see who is behind on colonoscopies, mammograms, and vaccinations," he says. "My nurse calls patients to get them into the office, so our quality scores are very high."

In quality scores, Winter's concierge practice consistently ranks in the top of Baylor Scott & White Health's 340 primary care practices, he says.

The luxury of time is critical in preventive care, Winter says. "When we were working together in my standard practice, we didn't have the time to do preventative services work. … When you do all of these things properly, you can save lives. People who get colonoscopies get less cancer."

Winter is trying to bring elements of concierge medicine to the physician practices in the HealthTexas Provider Network. "We're working on access, consumerism, same-day scheduling, and online scheduling—all things that I have been doing for a long time in concierge medicine."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

Concierge physicians may help boost preventive services.

Small-scale practices foster trusting relationships between doctors and patients.

Amenities include 24/7 access to a physician and same-day appointments.


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