With a physician shortage looming and patients seeking more access to caregivers and a higher level of service, is a hybrid concierge model the answer?
With the ongoing uncertainty in the medical community over healthcare reform and reimbursement methodologies, many physicians are exploring other practice models, including a return to cash-only (in-part or in-whole), a full-service concierge model, and the increasingly popluar hybrid model of concierge care.
These models are alternatives to generating revenue from third-party payers or volume-based care. Each is distinct in its approach and each utilizes technology to a different extent to enhance practice management and patient communication.
In addition to analyzing the pros and cons of new practice models, physicians must also examine their current approach and the technology requirements for practice alternatives. Many new models emphasize a more patient-centric approach to care. In these models, the technology needs to go beyond practice management systems designed to manage billing, electronic health records, scheduling, and reports to payers. In order for physicians to be successful under a patient-centric model of care, technology must help to better connect patients to physicians through channels such as e-mail and cell phone communications.
When considering new practice models, physicians must bear in mind several key issues:
• How much time will I need to allocate to communicate with patients under a new practice model? How will that impact other areas of the practice?
• How will technology help me deliver a better level of service to my patients?
• Will I need to invest money for new technologies?
• Will my patients utilize new technologies I offer, or are they more comfortable with traditional forms of communication?
An overview of practice models
Over the past decade, full concierge practices — in which physicians charge patients a fee in exchange for greater access and convenience — have become both popular and controversial. Full-model concierge practices require physicians to limit practice size to a few hundred patients who desire and can afford concierge medical care. Typical costs to patients range from $1,500 to more than $10,000 annually. Such practices provide benefits to physicians and participating patients. For physicians, they offer the revenue needed to survive, as well as a more manageable and enjoyable practice. For patients, concierge practices
offer convenience, and the chance for a more meaningful relationship with a trusted physician.
Technology plays an important role in full-model concierge practices. Patients want to be able to communicate with physicians by phone or e-mail, and they want that connection to be direct and almost instantaneous. Because of the limited number of patients
(or in some cases, the limited number of patients who utilize these technologies), cell phone and Internet communications are manageable for physicians, and often help facilitate a more meaningful dialogue. Conversely, most traditional physician practices, with thousands of patients on their roster, often do not have the time for this level of direct connectivity.
The full concierge model works well for physicians and for patients who are willing and able to invest more money in their health. Yet this model has raised considerable concern among many physicians, patients, and even legislators. Downsizing practices can result in thousands of disenfranchised patients. While such models do have a place in an open market, they limit the number of physicians available to care for patients who can’t afford treatment.
Traditional and cash-only practices
A number of traditional practices are using information technology to more effectively share and manage information. There are obvious benefits to having readily available, shareable, and accurate information; however, employing technology to manage data can build a barrier between the patient and physician. To that end, many traditional practices do not employ advanced communication strategies to enhance physician-patient contact, as despite the potential gains, the use of e-mail and cell phone communication with patients can interfere with handling large numbers of visits, some have found.
Cash-only primary care practices that do not participate in government and private plans are very few in number, but interest is growing. Although they often are more easily able to afford and implement electronic medical records (EMRs) and enhanced communications, they also have fewer active patients than regular practices and are not compelled to employ information management solutions. In this type of environment, the use of technology is a decision made purely on what works best for the practice.
The hybrid concierge model
A rapidly growing model, hybrid concierge, offers the benefits of a privately funded practice model with the ability to provide patients with choices regarding the style of care they wish to receive. Under this model, for an annual fee, concierge patients receive comprehensive preventive care and an annual physical, 24/7 availability to their physicians, and little or no waiting time for same or next-day appointments. Many physicians also provide cell phone numbers and make occasional house calls.
Physicians note that they appreciate the hybrid model because it addresses their professional and personal needs while keeping their patient panels and payor relationships intact. The balance of traditional volume care with a portion of the day at a much less hurried pace allows the physician an opportunity to deliver care in a more ideal environment, while still treating a wide variety of patients.
The most important difference between hybrid and full-model concierge practices is that the hybrid model enables physicians to continue to see all of their patients. Unlike full concierge and cash-only practices, the hybrid model does not detract volume from the physician. It encourages the continuation of participation in plans and the continuation of a relationship with traditional patients. Physicians remain in the system, accessible to all their patients, and patients are able to choose the model that best meets their needs.
As with the full concierge models, a hybrid practice features a membership structure where patients pay an annual fee for defined services and are part of a smaller pool of the physician’s total practice. Hybrid programs are typically a non-covered benefit under most traditional health plans and Medicare. However, many patients with flexible spending accounts and health savings accounts use that portion of their benefit to cover the fees as, with proper structuring, it is a qualifying expense. Concierge programs are attractive to Medicare patients or those with chronic and or complex illnesses, as the advocacy, advice, and enhanced services are often worth the out-of-pocket expense.
The hybrid model
In a hybrid model, technology can be used both to enhance communication between the patient and physician, and to manage the huge volume of information efficiently through the use of EMRs. The primary role of technology is to properly manage the connectivity to allow physicians sufficient time to care for a reasonable number of patients. Concierge members in a hybrid program are generally given the physician’s cell phone numbers, a dedicated phone line at the office, and often, the email address of the physician, to enhance individual communication and service levels at the practice.
Physicians are encouraged to use smart phones that are updated with basic patient demographic information and connected to their EMR. When patients call, physicians can readily access their basic information, and make entries into the patient’s record if needed. In the hybrid program, patients average less than one cell phone call per day; which is manageable for most physicians.
The hybrid model also enables patients to utilize a portable device that houses their health information. While many patients are concerned about having their medical history on the Internet, most recognize that the ability to access basic information — particularly when traveling or in the event of an emergency — is an important benefit. It contains information such as name, age, health insurance, current medications, allergies, copies of the annual physical report, etc. Practices can add to or update their personal medical stick as needed when patients visit; it can become as robust as the physician and the patients desire.
Questions to ask
Physicians considering adopting new practice models need to identify the goals for their practice and evaluate their own comfort level with technology and the needs of their patients. The key questions facing physicians considering new practice models are which one is best for their practice and their patients, and what role technology should play. Specific issues to examine include the following:
• What are my practice goals? (To see more patients; limit my practice patient load; spend more time with family; gradually transition to retirement; better manage current patients, etc.)
• Which of the practice models currently available help me reach my goals? A hybrid model could help a physician better manage existing patients and could also be used as a strategy to either grow or slowly decrease practice size over time.
• What technologies does our office currently use? If the practice has a practice management and EMR system, explore carefully the impact a new practice model will have on existing technologies. If not, look to see what new technologies would need to be acquired — from smart phones to software — to meet the model’s basic design.
• What do my patients want/need? Some older patients may have no interest in e-mail or Internet connectivity. If so, bringing on a program that forces them into that model could be detrimental. Look for programs that meet both your needs and the needs of your patients.
The goal for any medical practice today is to provide quality care to patients and maintain a financially stable practice. In today’s market, with reimbursements declining, overhead increasing and uncertainty over reform, reaching this goal seems elusive for many dedicated physicians. Looking at available successful practice model options — especially those that provide a private source of funding — and ensuring that technologies meet the needs of the practice and patients, will help physicians meet their goals and build a successful and enjoyable practice.