Full-model and hybrid-model concierge practices require changes in how care is delivered. It may also require changes in who delivers that care.
Historically, nurse practitioners have been employed as traditional care providers by concierge practices to expand capacity and maintain non-concierge patients. NPs were not directly involved in the concierge part of the practice, except perhaps in a limited support role. However, like all things in the current healthcare marketplace, things change.
Part of the reason for change is simple supply and demand — we need more caregivers — there are more patients. Part of the reason for change is that as NPs expand their roles in practices, patient loyalty and attachment to the NPs is often comparable to that of the physicians. Yet another factor contributing to change is that physicians and patients are becoming comfortable with NPs providing more patient care. In fact, the trend today is toward independence for NPs, with some states (albeit with caveats) even allowing them to act independently from physicians.
A change in thinking
I'll confess that early on, I didn't think the NP concierge model would work. What changed my mind was simply a growing understanding about the strong relationship and bond many NPs have with their patients — and that kind of bond is crucial to any kind of concierge program. Patients don't invest in concierge for the "perks" — they do it because they want more time with a provider they like, trust, and don't want to lose. NPs are often that trusted provider.
What further changed my mind on the issue of NPs and concierge was a well-liked NP at a medical practice with two equally popular physicians who were offering a hybrid concierge program. The physicians in the practice regarded the NP as a partner and colleague, and her patients were deeply attached to her as their chosen provider. Our research uncovered that, not only did patients want to sign on to the practice's physician concierge programs, but that they also wanted to be able to participate in a concierge program for the NP.
However, that doesn't mean that incorporation of a concierge program for an NP is a "push the button and it's done" kind of step. There are a few important issues that can pose challenges when offering this program via a NP versus a physician. For example, NPs are usually employees of a physician-owned or based practice — they are generally not shareholders. Job responsibilities, compensation, insurance, allocated time, etc., all must be discussed and determined in coordination with the NP to ensure it is a step she wants to take.
Concierge programs for NPs — issues to consider
However, just as some physicians are not well suited for a concierge program, not all NPs can be concierge providers either. It takes the right blend of factors to make such a program work.
If you have or are considering a concierge program, and if you want to explore adding an NP, here are some important issues to consider:
• Check your state regulations. Every state has unique requirements regarding physician supervision and how the program is being offered.
• Do your homework. Conduct a demographic analysis and a patient survey to make sure there are the patients to support the concierge program.
• Work with experts. I realize it's tempting to build a concierge program on your own —especially if you have one — but there are a number of critical issues to consider (regulatory and especially Medicare) and steps to take (market research) and you'll want to make sure you have done your due diligence.
• Plan carefully. In many practices, the NP will still need to support the concierge physicians by caring for traditional patients in the practice. Therefore he may not be able to support the same number of concierge patients as a physician.
Look carefully at practice needs and caseloads to ensure proper concierge patient and traditional patient ratios. An experienced consultant can help you with this determination. Remember that the incorporation of a hybrid concierge option is a good strategy to balance the needs of traditional and concierge patients.
The healthcare market continues to grow and evolve. There was a time when the market didn't consider concierge as an option for specialists, now it does. The popularity of NPs in many practices combined with the increasing demand for concierge programs, means that NPs too can become important members of concierge medicine teams.