How one physician transitioned to hybrid concierge, and how it is affecting his practice and his patients.
For internal medicine physician David Nadolski, retiring earlier than anticipated seemed inevitable. The Midland, Mich.-based physician had been practicing independently for nearly three decades, and he just didn't see how he could keep his doors open much longer. "The biggest thing was that reimbursements were not going up, and my overhead continued to go higher - it was difficult trying to run a business in that type of scenario," says Nadolski. "Every year the reimbursement wasn't good enough to cover the changes that we had."
But a lot has changed for Nadolski over the past few years. Today, his practice is not only open, it is thriving. So what made the difference? In December 2011, he added concierge patients to his practice; patients who, in addition to holding traditional insurance, pay Nadolski an annual fee for extra services such as improved access to care and a more complex annual physical. "It's allowing me to continue to practice more easily with less financial pressure on me," he says of the change.
The model Nadolski is embracing is called hybrid concierge, and for many physicians, it provides a happy medium between a full concierge-model of care and a traditional fee-for-service practice. That's because it enables physicians to retain many or all of their current patients, while bringing in an additional source of revenue through concierge patients.
To learn more about hybrid concierge and what the transition to it entails, we asked Nadolski to weigh in. Here's how he made the transition, and how it is affecting his practice, his patients, and his revenue.
Transitioning to a hybrid concierge model is no small undertaking. It will of course, dramatically change your practice. Nadolski, who refers to the transition as a "life-changing event," didn't take it on alone. Instead, he retained Concierge Choice Physicians (CCP), a company that helps doctors transition to concierge and hybrid concierge practices.
Before jumping into the transition process, Concierge Choice assessed Nadolski's practice to determine if it would be a viable hybrid practice. For instance, it assessed whether enough of his current patients and individuals in his geographic area would be interested in paying an additional fee for concierge services.
The results were promising, so Nadolski decided to move forward. He, and Concierge Choice, embarked on a comprehensive marketing campaign to spread the word about the concierge side of his practice. The campaign included a town hall meeting, promotional mailings, and placing a Concierge Choice sales representative inside Nadolski's practice to explain to patients how concierge medicine works.
Defining the details
Ultimately, about 100 patients decided to join the concierge side of the practice, and the majority of them were already Nadolski's patients. "They wanted to retain me as their physician, and adding these extra things was a good fit," he says, noting that many of these patients were elderly with complicated healthcare needs.
In addition to holding traditional insurance, which Nadolski accepts, his concierge patients pay an $1,800 annual fee for concierge services. Those services include:
• An annual physical exam, including cognitive evaluations, depression index, sleep status, hearing tests, vision tests, smell tests, spirometry tests, and bone densitometry tests;
• Same-day or next-day appointments;
• Nadolski's cell phone number, a dedicated office number, and a secure e-mail address; and
• Access to other physicians affiliated with Concierge Choice Physicians. Nadolski says this is appealing to many of his patients who move to warmer climates during the winter.
"We have a much greater in-depth knowledge of the patient," says Nadolski, who pays Concierge Choice $500 annually for each patient that joins his program. "It's more of a holistic type of approach, something that I never would be able to do with traditional medicine."
Offering a new service
One other concierge benefit Nadolski's patients enjoy is an annual consultation with a physical therapist and a dietician. "When I knew that I was going to join Concierge Choice, I contacted the best physical therapist I had and we started talking about how we could work together to bring them into concierge choice as a paid provider," says Nadolski. "We negotiated a contract on a per-patient basis, and did the same thing for the dietician."
The consultations with the therapist and dietician provide patients with a perspective into their health that they might otherwise overlook, and make Nadolski aware of important health issues he needs to address, he says. For instance, if the physical therapist finds that a patient's core-muscle strength and balance indicate potential, larger healthcare problems, he will pass that information along to Nadolski. "It allows me to take a look and find out who's at risk of falling and fracturing things, and [at risk for] osteoporosis," he says. "We can go in like a laser to determine who's at risk and what we need to do."
Currently, about 25 percent of Nadolski's patients are part of the concierge side of his practice, and he's happy to keep it that way. "I take care of a lot of families and I view many of my patients as friends, and I hate to shut the door on my friends and say, 'Hey you can't come in to see me because you are not a concierge patient,'" he says. "It allows me the luxury to continue to treat them."
Nadolski's concierge patients do tend to receive longer appointments and faster access to care than his non-concierge patients, but most non-concierge patients don't really feel negative effects, he says. One reason: He works with two part-time nurse practitioners who help him accommodate non-concierge patients quickly, when necessary.
To better accommodate his concierge patients, Nadolski reserves his first morning and his first afternoon appointments for them, to ensure they are less disturbed by unexpected scheduling delays that tend to crop up throughout the day.
Gaining a new outlook
The additional revenue brought in through the concierge side of the practice has enabled Nadolski to keep his practice open. But, he says, that's not the only payoff he is experiencing.
One of the biggest perks is additional time - time he can spend engaging in meaningful conversations with patients, and time he can spend pursuing his personal interests. For instance, he now has time to spend half a day each week as an assistant professor at Central Michigan University School of Medicine.
Another benefit: Nadolski's now more aware of and connected to his patients' healthcare needs. "They're more apt to give me a telephone call and say, 'Hey my husband has congestive heart failure, he's a concierge patient and he is short of breath, what do I do?'" says Nadolski. "It streamlines the communication process with them so that we can take care of the patient's needs more easily."
David Nadolski, an internal medicine physician, opened a hybrid concierge medical practice a few years ago. While the transition went smoothly, there were some bumps along the way, he says. One of the biggest challenges: Educating staff and patients about what concierge medicine is and how it works. For instance, many patients were unsure if he would continue accepting insurance (he does), in addition to charging his annual fee for concierge services. "They'll call up on the telephone and staff has to be knowledgeable of the workings of it," says Nadolski.
Here are a few of the key differences between a concierge medical practice in the Concierge Choice Physicians program versus a traditional practice (information provided by Concierge Choice Physicians):
•Physical exams. The physician offers a longer, more comprehensive physical with additional wellness screenings.
•Appointments. The physician offers same day/next day appointments and longer appointments.
•Phone access. The physician provides a private dedicated office number, as well as his cell phone number.
•Emergency room. The physician facilitates admission to the ER, and may even meet the patient in the ER.
•Referrals to specialists, procedures, and tests. The physician coordinates appointments with specialists and consults with the specialist directly.
•Insurance billing. The practice acts as the patient's advocate to help resolve insurance issues, such as a coverage dispute.
•Travel referrals. The practice assists in referring the patient to other concierge physicians.
Internal medicine physician David Nadolski says the transition to hybrid concierge had many perks, including boosting practice revenue, enabling him to spend more time with patients, and providing him with more time to pursue outside interests. But there's still one more benefit Nadolski says he is experiencing:
Aubrey Westgate is senior editor for Physicians Practice. She can be reached at firstname.lastname@example.org.
This article originally appeared in the May 2014 issue of Physicians Practice.