Concierge Care: Is It Right for Your Practice?

August 25, 2015 by Antonio Arias, MBA, CHBME

Topics: Medical Billing, Revenue Cycle Management, Practice Management

Depending on who you ask, concierge medicine is one of two antithetical things: an elitist, small-minded approach to practice management and patient care; or a more egalitarian, logical solution to the problems of today’s healthcare system.

Concierge care or “retainer-based” medicine is a model in which patients pay an upfront fee to secure physician services. With estimates putting the number of concierge docs at around 5,000, the approach is far from widespread – but it is growing. The most recent survey from the Physicians Foundation found that almost seven percent of providers planned to convert their practices to concierge in the next one to three years.

The growing numbers have many healthcare observers worried, believing that the concierge model is an exclusively “boutique” approach. Negative articles on the trend typically portray the concept as “pay up or lose care,” focusing on those doctors who shift to the concierge model to cap their patient base at an appealing number and earn more money from patients with deeper pockets.

But that’s not the only way it can be utilized. Some doctors, frustrated with the inherent limitations of the the payer-provider payment model, are leveraging the concierge approach to actually broaden their patient base:Fed up with how few patients in his community could afford insurance, one San Antonio physician instituted a low-fee concierge model ($25 per month, $10 per visit) to serve low-income individuals.

Whether you’re interested in concierge medicine from a more elitist or egalitarian standpoint, you should know before diving in that the model comes with unique constraints, considerations, benefits, and challenges.

You Can Still Accept Insurance (Or Not): Every concierge practice has its own particular business model. Some charge high upfront fees and allow for unlimited care in exchange for monthly payments. Others, like our San Antonio doc, utilize both monthly fees and and per-encounter payments. Still others take a traditional-concierge-hybrid approach, charging monthly membership payments while still contracting with insurers. The bottom line: Going concierge doesn’t mean accepting a “one-size-fits-all” path. 

You Can Cut Overhead: Should you decide to forgo insurance altogether (or move to only work with a small number of payers), you can lessen your needs when it comes to medical billing and coding. This may enable you to cut staff or contract with a medical billing firm to work only with select payers, only when necessary.

You Can Customize Your Practice: Switching to concierge medicine means your practice can be more targeted to the specific needs of your community. For example, if a large number of your patients typically require follow-up visits for primary care concerns, you can utilize the model to see them more often without the drama of co-pays and reimbursements. 

You Can (And Will) Lose Patients: It’s one thing to launch a practice with a concierge model from the get-go; it’s another to start as a traditional outpost and shift to another model. No matter if you personally see the change as a good thing for your patient community, it’s still a change that many patients won’t be happy about. Expect to see your numbers dwindle and consider how the shift will impact your revenue cycle management.

You Can Provide Better Care: With fewer patients come higher expectations, but the concierge model may allow you to meet them. Patients who pay upfront for access will expect their doctor to be more reachable, but they’re also going to be more invested in their own healthcare outcomes. The approach may lead you to better patient relationships and a higher quality of care.

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