BUSINESS PRIMARY CARE

WORDS BY TIMOTHY S MESCON, Ph.D

CONCIERGE MEDICINE

Why customized primary care is the next big trend for medical practices.

Change is the norm, not the exception. Globally, this mantra  has become a rallying cry in many industries and has impacted many a vertical line of business in dramatic fashion. Perhaps no business sector is experiencing as dramatic and revolutionary a change as the medical arena. According to the Journal of the American Medical Association, medical school enrollment in the US has remained stagnant for over a decade. With major metropolitan areas seeing significant population growth, insurance reimbursements on the decline and hours of practice rising in concert with litigation, the medical profession has become complicated, and perceptions of quality of care have suffered.

In today’s world, where physicians’ incomes are being threatened in man y ways (lower reimbursements from payers, higher costs—particularly in the area of malpractice premiums, greater administrative burdens, delayed payments, claims proce ssing hassles, etc), many physicians are frantically searching for ways to maintain their income lev els. Numerous physicians have felt compelled to put in even mo re hours and see even more patients in an attempt to “maintain” their practices’ economics. Unfortunately, many of them find that there are not enough hours in the day to do that and that their economic condition is worsening. In many internal medicine practices in the US, it is not at all unusual for a physician to have 2,000-5,000 active patients.

A small but growing percentage of physicians have responded in a unique manner. In what many doctors would consider to be a drastic and risky move, hundreds of phy sicians have decided to offer a limited number of patients the opportunity to pay a fixed annual fee in exchange for “premium services and amenities.”

The philosophy argues that the best time to see a physician is before you really need one.

Those who have done this have generally limited—by a drastic amount—the number of patients that they will service. Internal medicine and primary care practices drop patients from the thousands to the hundreds. The physicians pursuing this type of practice advocate for quality (not quantity) of care and insist that by restricting practices to 600 or so patients, all can receive more personalized care. It comes with many names. The most prevalent today is “concierge medicine.” Others call it “retainer medicine,” “boutique medicine,” “executive health programs” or “platinum practices.” Whatever name is given to the concept, it is something being considered by increasing numbers of physicians. What the concept basically entails is a situation whereby patients pay a set annual fee for special services that are not now provided by most medical practices.

Concierge medical practices were the brainchild of a former team doctor for the NBA’s Seattle Supersonics. After seeing firsthand the remarkable level of service provided to professional athletes, the doctor founded MDVIP in 1996, in Seattle, to provide the same kind of services to non-athletes. The idea underlying MDVIP resonated with overworked, understaffed physicians who found themselves being stretched to breaking point by the rigors, quotas and financial limitations of managed care.

What began as a solitary, platinum-plated, Ritz Carlton-like medical practice in Seattle has now moved into the limelight—and, increasingly, more into the mainstream. Following on the heels of MDVIP, a small number of doctors began concierge practices. Today concierge practices are operating in nearly half of America’s 50 states.

One of the fastest-growing practices of this kind in the nation is MDVIP, which was founded in November 2000 as a model for concierge medicine, with its first office opening in Boca Raton, Florida, the following year. Edward Goldman MD is President and CEO of MDVIP. According to the South Florida Business Journal, MDVIP has now expanded to over 90 physicians in 14 states, serving more than 27,000 patients.

Goldman believes that in a practice of no more than 600 patients, MDVIP-affiliated physicians have the time to provide both extensive preventive care and treatment of acute and chronic illness, with a new focus on individualized attention and lifestyle planning. Same day or next day appointments, an annual physical and a host of other customized services characterize the MDVIP delivery model. The philosophy argues that the best time to see a physician is before you really need one.

Concierge medicine has emerged from an industry in chaos as a customer-focused alternative. Meeting customer needs drives great business ideas. Fast, focused, flexible delivery systems always beat slow, bureaucratic processes. Where are you and your business on this continuum?