While the fee is "nothing to sneeze at," Russak says it was affordable for most of his patients. He also provided scholarships to those who couldn't afford it but whom he felt would benefit greatly from it. "The ideal patient, I think, and the one who signed up the most was someone ... [aged] 50 and above — who has several medical problems and needs to come in multiple times a year, often on short notice," he says.
The ability to spend more time with patients is leading to a number of improvements at Russak's practice. To name a few:
It's led to more personal care. "I'm able to provide a level of care for patients that you can't provide in a busy office," says Erica Panter, Russak's personal assistant and front-desk manager, who formerly worked on the fee-for-service side of the practice. "I can tell you about their dogs and grandchildren and everything in between, and the patients really, really appreciate it."
It's led to more "thorough" care. "I feel as though we can be extraordinarily thorough with testing, with conversation, and with just getting to a conclusion a lot more specific to the patients," says Camille Kaminga, Russak's nurse.
It's led to higher-quality care. Since patients receive 24/7 access to Russak, he's able to coordinate their care much more effectively. For example, an elderly patient recently called him one evening because she had a fever and a bad cough. In the past, he would have sent her to the emergency room, she would likely have been treated by someone she did not know, and she may have been admitted. Instead, Russak sent a nurse to her home, arranged for a mobile X-ray, and checked-up on her later that evening. It turned out the patient had a small pneumonia, which could be managed at home. The patient "can say, 'Yes, I'd rather stay home,' and I can say, 'OK, I'm going to arrange to have a nurse from your Medicare, or even my own nurse, come out and see you every day until you're better,'" says Russak. "I think that ends up being actually better care."
Give and take
While it's clear patient care has improved, Russak says "it's a mixed bag" when it comes to the transition's effect on revenue. "If anyone goes into this thinking, 'I'm going to make three times as much money and my life's going to be easy,' I think they'll be a little bit disappointed," he says.
While Russak receives an additional $1,500 per patient, one-third of that goes to SignatureMD annually, 20 percent goes to the practice as additional contribution to overhead, and some is lost through scholarships. He's also treating fewer patients, so his payer-based revenue has declined. Overall, however, he says his income from his patients is up 20 percent.
The shift has also had a mixed influence on his work-life balance. As mentioned, since he sees fewer patients, he works fewer hours each week (about 40 hours instead of 50 hours). But at the same time, since he is always accessible to his patients after hours, he no longer splits call with his partners. "Except for the two weeks I'm on vacation, I take call 365 days a year 24/7," he says. "You're always on call and have to be available, so that's a little bit harder."
New model, different patients
For internist Floyd Russak, who recently transitioned to concierge practice, the new model of care has led to some interesting side effects. Since patients most attracted to concierge tend to have complicated medical conditions, the typical patient he sees has changed. "I'm really doing what I was trained to do," says Russak. "I'm seeing the sickest internal-medicine patients with interesting major problems and people who really appreciate what I'm doing — and I'm really helping them. Whereas before, I was just trying to get through the day and at the end of the day I'd feel exhausted … and wasn't sure I was really getting to the bottom of everything and getting to know everyone."
The new model is also bringing Russak back to the roots of primary care. "Before I was booked up six weeks in advance because I had such a full practice, so if someone had a bad cold or a cough or even pneumonia — almost anything that was acute — they would see one of our [nonphysician providers] or one of my partners," he says. "Now, I've almost had to [have] a little bit of retraining because ... [patients] can get in to see me the same day, or the next day."
Aubrey Westgate is an associate editor at Physicians Practice. She can be reached at [email protected].
This article originally appeared in the March 2013 issue of Physicians Practice.