By Ruth Carol, contributing writer, June 02, 2014
If spending more time with your patients and less time battling insurers for increasingly shrinking reimbursement dollars sounds appealing, concierge medicine may be the answer for you. Primary care physicians and internists are the most likely converts to this model, but some specialists, including dermatologists, are converting their practices or adding concierge services. Indeed, in Medscape’s Physician Compensation Report 2014, 3 percent of dermatologists who responded to the survey said they are in concierge practice.
Concierge medicine is a business model for practicing medicine in which a patient pays the physician an annual, or monthly, fee in exchange for enhanced services. The latter could be same-day or next-day appointments, 24/7 access via cell phone or email, extended visits, and house calls. Some physicians offer tiered options with different price points; they could vary by the number of visits or tests offered within the year or by the persons covered, as in an individual or family plan. Retainer fees range from $1,200 to $1,800, according to Doug Graham, senior management consultant with DoctorsManagement, LLC. In the classic model, physicians do not accept insurance, which substantially reduces their overhead and administrative expenses, allowing them to provide services at a lower cost. It also substantially reduces the number of patients in the practice as many will not opt to join. In a hybrid model, physicians do accept insurance, even Medicare, but also establish concierge services above and beyond those covered by insurance.
Also known as “boutique medicine,” concierge medicine has been criticized for offering high quality care to only those who can afford it. Thus, critics argue, it contributes to the growing lack of access caused by looming physician shortages and more individuals joining the ranks of the insured as the Affordable Care Act rolls out.
It is the same health care environment that is leading physicians to consider the model. Based on the number of patients they must see daily to keep up with the demands of their managed care contracts, Graham explained, some physicians feel that they are unable to deliver the high quality of care they would like. To compensate for the high patient volume, they must either spend less time with patients or come in early, stay late, or skip lunch. Then there are the shrinking reimbursement, a flawed sustainable growth rate formula for Medicare payments that continues to go unfixed, and growing demands from the federal government and insurers to participate in myriad initiatives from quality reporting to electronic health records. In response, some physicians are joining forces with larger practices or hospital groups, merging with other practices, or retiring, Graham noted. Others are converting their traditional practices to concierge practices.
The primary reason that physicians are switching to the concierge model is that they can provide a higher standard of care, including disease management and wellness care, to their patients because they can spend more time with them, he said. They can do that because they are paring the number of patients they see each year.
“Right now, it’s still largely a primary care movement versus a specialty movement,” Graham noted. Although numbers are hard to come by, he estimates between 1,000 and 1,200 physicians are in concierge practices. Cardiologists and pediatricians are some of the specialists paving the way for others, including dermatologists.
There are many ways to move in the direction of concierge medicine in dermatology; below, several dermatologists discuss their approaches.[pagebreak]
Back to basics
Dermatologist Eugene Conte, DO, started his concierge practice in Prescott, Ariz., approximately 18 months ago. Cosmetic Dermatology Associates of Prescott offers medical and cosmetic dermatology care. The services do not include pathology because he is not a dermatopathologist. Dr. Conte only offers lower-end cosmetic procedures, such as injectables and fillers. If patients want to have botulinum toxin injections, he charges them his wholesale cost; injecting it is included in the annual fee. That fee is $1,188 per year per person or $2,500 per year for a family plan. Ninety percent of his patients choose the individual plan.
Dr. Conte also offers a direct-pay program, an offshoot of concierge medicine in which he doesn’t accept insurance and charges lower prices for services. “If you’re not affiliated with insurance companies, you can charge what you want,” he said. Many times, the reduced fees are equal to, or less than, the patient’s existing co-pay to see a specialist. For example, in the past, Dr. Conte would bill insurance for a consult at $85 and would be reimbursed $48.20. Now, he just charges the patient $48.20. “The patient saves money and I save time and overhead expenses by not having to deal with insurance companies,” Dr. Conte said. The direct-pay option is especially advantageous for patients who lack insurance or have high-deductible health plans.
Patients are privy to longer appointment times, same- or next-day appointments, his cell phone number, and no restrictions on the number of visits allowed per year. “Every patient gets a full half hour in my office,” he said.
Dr. Conte’s patient load has dropped from 65- 70 patients a day to 20. His rent has dropped from $5,300 a month to $1,350. His former practice office, consisting of two surgery rooms and seven exam rooms, has been replaced with a two-room office: an exam room and a waiting room. He works with one medical assistant. Not only has he reduced his administrative costs, but he has eliminated the extensive time commitment required to deal with insurance companies, staff, and billing and accounting services. “There’s no more micromanagement,” Dr. Conte said. “It’s a whole different way of thinking.”
For him, starting a concierge practice was akin to starting a new practice, he explained. Dr. Conte chose not to renew his contract with a traditional practice based in Ohio after it had expired. Instead, he moved to Arizona, where he already had a state license to practice medicine because of his work of more than 12 years treating Native Americans for unique skin diseases. “I was tired of doing it the other way,” said Dr. Conte, who still flies back to Ohio to cover for his former associates when needed. “I didn’t want to keep running from room to room until I was 70 years old.” These days, he works approximately three days a week. “I don’t come home exhausted,” Dr. Conte added.[pagebreak]
A hybrid model
In 2012, Thomas McMeekin, MD, teamed up with enhancedcareMD to offer two hybrid concierge programs at his Genesee Valley Laser Centre. EC Concierge Dermatology is for patients with recurring skin conditions or flare ups. They get same- or next-day appointments, extended appointment times, direct access to him on a designated cell phone, and an annual consult and cancer screening. Through enhancedcareMD, they also have 24/7 unlimited access to a network of registered nurses by phone or online chat, participation in a prescription drug savings program for all family members, and access to health and wellness portals. The 24/7 access to nurses is for any family member, not just the patient in the program, and for any medical problem, not just dermatology, he said. Patients pay $100 a month to participate in EC Concierge Dermatology.
This program is not just for patients with chronic conditions, such as eczema and psoriasis, but for those who want additional care. For example, patients with a family history of melanoma who get a suspicious lesion, and are understandably more anxious than the average patient, want to have it looked at immediately. “It’s a way to spend more meaningful time with a select group of patients who want more time,” Dr. McMeekin said. More time enhances the doctor-patient relationship. For him, it’s the luxury of knowing that he doesn’t have another patient for 20 or 30 minutes. “I’m not feeling the push of having to turn out so many patients to pay for overhead,” Dr. McMeekin added.
The EC CosmeDerm program Dr. McMeekin offers is designed for cosmetic dermatology patients. It includes all of the services in the basic package plus a 10 percent discount on all products and services in the aesthetic center. The program, which costs $200 a month, saves patients more than $1,300 per year versus buying these services individually. Patients can choose from a specified number of cosmetic services and products in the plan.
Both programs are reasonably priced and provide an income stream separate from normal billing as Dr. McMeekin continues to take insurance, he said. The cosmetic program, which has proven to be more popular than the medical program, keeps his aesthetician and nurses busier than before, even if the services are performed at a discounted price.[pagebreak]
Will Richardson, MD, started a cosmetic concierge program in 2010 to supplement the income from his traditional practice Natura Dermatology and Cosmetics due to declining reimbursement. The program offers three tiers because he wanted to create products that would fit many budgets. All programs offer on-demand appointments, direct access to Dr. Richardson on his private cell phone number, and a percentage discount off future services; the more expensive the package, the higher the discount. Program prices start at $3,500. Dr. Richardson also offers a direct-pay program for certain medical/surgical services. The other dermatologist who works with him continues to see patients for whom he bills insurance plans. “It’s really like having a business within the business,” Dr. Richardson said. They even have separate entries — one for the traditional practice patients and one for the concierge patients.
A more cosmetic approach
Tucson, Ariz.-based Ironwood Dermatology began offering a cosmetic concierge program in 2000 in addition to its traditional offerings. The package includes an annual skin cancer screening exam, cosmetic consultation, and personalized skin rejuvenation program in addition to a specified number of injectables, fillers, leg spider vein treatments, VBeam laser treatments for vessels and brown spots, laser treatments for hair removal, and peels. Additionally, patients who purchase the package have priority scheduling and a friends-and-family discount on products. The fee is $10,000 per year.
The patients who are approached about participating in the program are already buying many of these services, explained James Titone, PA-C, Ironwood’s aesthetics services coordinator. By participating in the program, they can choose the treatments that offer the best results for their skin and save money at the same time. “It gives me the freedom to do full corrections and touch-ups, as necessary, without the patient having to worry if it’s going to cost them extra because it’s all included,” he said. Titone acknowledges that it is a small subset of patients who would utilize this type of program, but said those who do are really pleased with it.
Whether providing medical/surgical or cosmetic services, at the end of the day, it’s about providing quality care to your patients. “It’s not that I’m a better dermatologist than my fellow dermatologists,” Dr. Conte concluded. “It’s that more time translates into better care. My mantra is the dermatologist you need giving you the time you deserve.’”