It's not easy to open a new practice, but opening one that appeals to a smaller group of patients, such as a concierge practice, is even more difficult. Harder still, is opening a concierge practice with no patient base on which to build.
In March 2003, that's exactly what emergency medicine and ambulatory internal medicine physicians Jordan Lipton and his colleague Linda Perry, attempted to do. They opened Signature Healthcare, a Charlotte, N.C.-based concierge practice, in which patients pay an additional fee for extra perks, such as more time with the physicians and guaranteed same-day and next-day appointments.
Though Lipton and Perry had more than a decade of experience in emergency medicine and urgent care between them, the transient nature of those practice environments meant they had very few loyal patients to bring with them to the new practice. In fact, when they first opened their doors to Signature Healthcare, just two patients had signed on.
Today, their practice is thriving with approximately 1,100 patients, five physicians, and two practice locations. Here, Lipton shares more about why they opened the practice, how they did it, and the biggest lessons they learned.
Several factors drove Lipton's desire to go concierge, including dissatisfaction with the hospital system with which he was employed (the hospital was pressuring him to bill higher for services than he felt was warranted), and his belief that care could be provided a better way. Still, it wasn't clear what way would be better for patients — and for him — until a conversation he had with one of his ER patients.
"That night in the emergency department, [my patient] said, 'You know, you should think about doing something that my father-in-law is a patient of, it just started in Florida,'" says Lipton. The patient, of course, was referring to a concierge practice, and Lipton found the idea appealing. "I thought about it, I sort of put together some numbers in my head, and I thought this could probably work, and I could probably take great care of patients without having to be dictated to about how I should bill, and how I should code, and what's necessary to the bottom line, as opposed to what's necessary to the patient," says Lipton.
He brought the idea up to Perry, who was working with him at the time, but neither physician was sure they were ready to take on the risks of opening a concierge practice. Still, when their hospital system employer decided to outsource its emergency service contract to a private group, which would require renegotiating employment contracts, Perry and Lipton decided it was time to move on.
An uphill battle
To get started with their new venture, Lipton and Perry hired a consultant with previous experience helping physicians open private practices. "He was a great resource for the first year as we got all of our licensing and accreditation … for the practice," says Lipton. "Also, my partner's husband is a business person. He did the business stuff, crunched the numbers, and told us what we needed to be doing, just so we didn't go completely broke."
Still, opening the concierge practice, and keeping it open, was not easy. "The biggest struggle, of course, was financial because we didn't have a patient base that we could draw from," says Lipton, "... We generally worked five days a week in the office and then every other weekend we worked three eight-to-12 hour shifts in the emergency department to pay the bills."