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Practice Transformations: How to Set Up a Concierge Practice

Practice Transformations: How to Set Up a Concierge Practice

Internist Floyd Russak is not so different from most of you. He practiced in the fee-for-service reimbursement environment for nearly three decades, and over that time he saw the duration of patient visits dwindle — and along with it, the relationships he felt he could build with patients and the quality of care he felt he could provide them.

"It seemed like over the years the insurance companies were really pushing us to see more and more patients, reimbursements had gone down a little bit, and in fact they were auditing us all the time for if we spent more than 15 minutes with a patient ... I just didn't feel like I could do good internal medicine with patients who were fairly sick in 10 to 15 minutes," says Russak.

He thought about changing careers, even retiring. Then he thought about concierge medicine. But like many of you, he had serious concerns. "At first I really didn't want to do this to be honest, this concierge thing," he says. "I felt it was elitist, I felt I'd be abandoning some patients, I felt really bad about it."

Still, in July 2011, after four years of careful consideration, Russak flipped the switch. "I realized that it was really the only way I could afford, with declining reimbursements, to provide good care for several hundred people rather than providing just moderately mildly good care for 2,000 people like most doctors are doing now, and like I felt I was doing," he says.

Whether you're on the brink of going concierge or you haven't even considered it, understanding the many different and developing practice models is crucial in this changing healthcare environment. Here's a closer look at concierge medicine and how the shift to it influenced Russak, his patients, and his revenue.

Broaching the subject

Switching to concierge doesn't necessarily mean opening a completely different practice. In fact, Russak remains in his old Highlands Ranch, Colo.-based practice with his three partners (one of whom he hired just prior to transitioning). He's just reimbursed differently than them and he sees fewer patients. "It's actually very hard to start a concierge practice 'de novo;' you really need to be practicing for many years and have a significant following," says Russak, noting that he had about 1,700 patients and a long waiting list for appointments prior to transitioning.

To create a financially viable concierge practice, he knew about 200 to 300 of his patients would need to make the switch with him. "I think the biggest fear is, 'What if I start this party and nobody comes?'" says Russak. He says a big help in easing those fears — and getting patients on board — was SignatureMD, one of many companies that helps physicians transition to concierge practice. Before the shift, it conducted an "extensive survey" of Russak's patients to determine if enough would be likely to join a concierge practice. In addition, it placed a SignatureMD staff member in his practice during the five months prior to the switch who spoke to each of his patients about concierge and whether it was right for them.

Mixed reactions

Ultimately, nearly 300 of Russak's patients decided to make the transition (many of his remaining patients chose to be followed by his two partners, who were eager for new patients). "I really thought I'd get a lot of kickback from patients saying, 'Oh, Russak, you're only doing this for the money and you're abandoning me,'" he says. "I think out of 1,700 patients ... I only had one patient that was a little bit offended that I was doing this."

In exchange for expanded access to care — including faster appointment bookings, house calls, and longer visits — Russak's concierge patients pay a $1,500 annual fee. They also have regular insurance and use it to pay for services the same way they would in a typical fee-for-service practice.

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