As more physicians tire of declining reimbursements and growing patient loads, concierge medicine may become more popular. According to the American Academy of Private Physicians, more than 1,000 physicians already practice concierge, boutique or "members only" medicine in which patients receive special services — such as increased access and personal attention — for a regular fee. Wayne Miller, JD, of Compliance Law Group in Thousand Oaks, Calif., says the attraction makes sense for physicians who are "just too busy, have too many patients and don't feel they can really treat patients the way they'd like to." He suggests five questions physicians should ask themselves when considering the move to concierge medicine.
1. Do your patients really want a concierge medicine service? Before you commit to starting a concierge or "boutique" practice, you need to look at your patient population to determine whether they will actually use one. "Some of the decision will be based on how committed the patients are to their doctors," Mr. Miller says. If a large number of your patients will stick with your practice because of a long history of quality care, concierge medicine might work for you. "If the patients are on a fixed income or older," that might mean they won't be able to afford a regular fee," Mr. Miller says. "You have to expect that you will lose some of your patient population who won't be willing to pay extra for your services, and you need to consider if that's a good thing for your practice and the patients," he says.
2. Will you need to terminate existing relationships with payors? Some payors may not allow physicians to collect additional payments from patients in addition to reimbursements. If you continue to participate in third-party payor plans, you will need to make sure your concierge practice does not conflict with payor contracts. "Payors may even penalize the physician for charging that extra fee, which means that some doctors who [pursue concierge medicine] have to become out-of-network doctors because it gives them more flexibility to set up this arrangement." As concierge medicine becomes more popular, it is likely that CMS will increasingly review concierge care practices to make sure concierge fees charged by the practice are for "non-covered services" under Medicare.
3. Which additional services are you going to offer? If you are charging patients an extra fee for your care, you need to consider which "above and beyond" services they will be paying for. "Can you live up to that obligation?" Mr. Miller says. "If it means longer visits or access all night and day, patients might take advantage of that [and over-burden you]. Can you hire new people or different people to help fulfill those obligations?" If you think your practice may be stretched too thin with patients demanding late-night visits or longer appointments, concierge medicine might not be a good idea.
4. How much are you going to charge? When determining what to charge patients, you need to assess whether the fee is present to lower your patient load and give you more quality time with patients, or whether you need to charge enough to staff new employees and increase your hours. "The charge can't be so large that the patient can't accommodate it," Mr. Miller says. "You also need to consider when you will collect the fee. Are you going to collect it monthly? Annually? What happens when a patient can't pay?" Though "members only" medicine may seem attractive, you absolutely need to have backup plans in place for patients who decide to discontinue membership or can't pay when their bill arrives.
5. Does your state have regulatory issues prohibiting concierge medicine? Mr. Miller, who practices law in California, says his state has some regulatory issues that might challenge concierge practices. "Some states have very strict requirements about accepting a fee in return for arranging or providing care," he says. "In some states, these arrangements might be seen as creating an HMO or pre-paid health plan, which would have to be licensed." He says physicians have to be careful about which benefits they provide to patients who pay up front. "You need to avoid allegations of an unlicensed insurance plan, and that really requires some expert involvement when setting up a practice like this," he says.
The American Medical Association has said "retainer contracts, whereby physicians offer special services and amenities (such as longer visits, guaranteed availability by phone or pager, counseling for healthier lifestyles and various other customized services) to patients who pay additional fees distinct from the cost of medical care, are consistent with pluralism in the delivery and financing of health care. However, they also raise ethical concerns that warrant careful attention, particularly if retainer practices become so widespread as to threaten access to care." This warning suggests concierge medicine may undergo increased scrutiny and that quality care — whether or not a patient is paying a "members only" fee — should still be a physician's first priority.
1. Do your patients really want a concierge medicine service? Before you commit to starting a concierge or "boutique" practice, you need to look at your patient population to determine whether they will actually use one. "Some of the decision will be based on how committed the patients are to their doctors," Mr. Miller says. If a large number of your patients will stick with your practice because of a long history of quality care, concierge medicine might work for you. "If the patients are on a fixed income or older," that might mean they won't be able to afford a regular fee," Mr. Miller says. "You have to expect that you will lose some of your patient population who won't be willing to pay extra for your services, and you need to consider if that's a good thing for your practice and the patients," he says.
2. Will you need to terminate existing relationships with payors? Some payors may not allow physicians to collect additional payments from patients in addition to reimbursements. If you continue to participate in third-party payor plans, you will need to make sure your concierge practice does not conflict with payor contracts. "Payors may even penalize the physician for charging that extra fee, which means that some doctors who [pursue concierge medicine] have to become out-of-network doctors because it gives them more flexibility to set up this arrangement." As concierge medicine becomes more popular, it is likely that CMS will increasingly review concierge care practices to make sure concierge fees charged by the practice are for "non-covered services" under Medicare.
3. Which additional services are you going to offer? If you are charging patients an extra fee for your care, you need to consider which "above and beyond" services they will be paying for. "Can you live up to that obligation?" Mr. Miller says. "If it means longer visits or access all night and day, patients might take advantage of that [and over-burden you]. Can you hire new people or different people to help fulfill those obligations?" If you think your practice may be stretched too thin with patients demanding late-night visits or longer appointments, concierge medicine might not be a good idea.
4. How much are you going to charge? When determining what to charge patients, you need to assess whether the fee is present to lower your patient load and give you more quality time with patients, or whether you need to charge enough to staff new employees and increase your hours. "The charge can't be so large that the patient can't accommodate it," Mr. Miller says. "You also need to consider when you will collect the fee. Are you going to collect it monthly? Annually? What happens when a patient can't pay?" Though "members only" medicine may seem attractive, you absolutely need to have backup plans in place for patients who decide to discontinue membership or can't pay when their bill arrives.
5. Does your state have regulatory issues prohibiting concierge medicine? Mr. Miller, who practices law in California, says his state has some regulatory issues that might challenge concierge practices. "Some states have very strict requirements about accepting a fee in return for arranging or providing care," he says. "In some states, these arrangements might be seen as creating an HMO or pre-paid health plan, which would have to be licensed." He says physicians have to be careful about which benefits they provide to patients who pay up front. "You need to avoid allegations of an unlicensed insurance plan, and that really requires some expert involvement when setting up a practice like this," he says.
The American Medical Association has said "retainer contracts, whereby physicians offer special services and amenities (such as longer visits, guaranteed availability by phone or pager, counseling for healthier lifestyles and various other customized services) to patients who pay additional fees distinct from the cost of medical care, are consistent with pluralism in the delivery and financing of health care. However, they also raise ethical concerns that warrant careful attention, particularly if retainer practices become so widespread as to threaten access to care." This warning suggests concierge medicine may undergo increased scrutiny and that quality care — whether or not a patient is paying a "members only" fee — should still be a physician's first priority.