Some patients are hypochondriacs. They see problems that do not exist and envision doom around every corner. Other patients take their concerns to their physician and are happy to hear that their symptoms are not so serious and can be treated. But many patients avoid the symptoms and reality of their health for as long as possible. They know they have a problem, but deny it. They wait until it is almost too late, and in some instances it is too late. They hide, deny, avoid, and rationalize.
As a provider of services to hundreds of physicians across the country, I have observed that many physicians are much like their patients — many deny and avoid the obvious symptoms of illness within their practices. Most physicians can see the business future of their profession, but still procrastinate. Many others wait as long as possible to react or do something about it, to the point they are desperate and make impulsive choices, like retiring before they are ready or selling their practice. But there is no sense in denying it: The changes in healthcare are occurring rapidly, and physicians are feeling the squeeze.
The changes in healthcare that push cost containment while also demanding high-quality care are reducing practice income in a very significant way. Physicians need to stop hiding from this reality and adapt with appropriate solutions that will "cure" their revenue crisis. Waiting will only exacerbate their situation.
For over a decade, membership approaches to healthcare — models built on payments from patients as opposed to indirect payments from third parties — have been growing slowly. As best we can determine, less than 1 percent of all physicians practice in "concierge care" models. While this represents thousands of physicians in concierge care, it is sometimes surprising that this model has not caught on more quickly. Even physicians have asked that question.
As noted, the primary reason for the slower-than-expected growth curve is that many physicians resist change. Convincing them to act while they still can is a huge challenge. The second reason is that developing a membership-based practice has an element of risk. And risk can be scary.
Most people easily understand how a full-model concierge program can be a risky endeavor for a physician. A practice must be positioned "just right" to succeed. A full model requires a certain style of physician, enough patients who are willing and able to pay an additional fee for services, and an understanding and willingness of the physician to deliver those personal services. There are also ethical and legal issues that accompany downsizing and reducing access to broad bases of patients and compatibility with payers. Without an in-depth practice analysis from an experienced professional, there are not many physicians who have the confidence to take on that kind of risk.
However, in hybrid-concierge programs, the market for success is greatly expanded and risk is nearly eliminated. There are not the same ethical and compatibility issues that exist with full-model programs. While a hybrid program still requires certain characteristics to be successful in a significant way, with the right partnership, it carries almost no risk to the practice. For years I have been surprised that despite the elimination of risk, it can still take a physician group or institution months or even years to make a decision regarding implementation of a basic hybrid program. But the resistance to even positive, no-risk changes can be fierce, with physicians and their practice entities making decisions slowly, even while their practices suffer.
We are heading to the point in healthcare where the "patients" will not be able to deny the symptoms any longer. They will either die or adapt. Physicians who can act quickly, treating the symptoms that plague their practices with low-risk treatment options like a hybrid concierge program, or — if they are properly positioned — take the extra steps to manage their risk with a full-model program, will find themselves on the path to a much healthier business future.