In recent years, a concierge model of practice has gained popularity in the primary care world. Also called direct primary care, this model is set up so that patients pay a set amount, much like a membership, on a monthly or annual basis. In exchange they get comprehensive care from their physician. Doctors using this model are able to eliminate third party payers from their practice and focus on providing more personalized care to their member patients.

As a neurologist, your patients may benefit even more from this model than primary care patients do. Because your patients often face chronic pain and degenerative disorders, a plan that allows them more time and access to you is particularly valuable.

However, many neurologists don’t think of this model as viable for their practice. Your patients need specialty care, and you don’t want to leave any of them out because they can’t afford the membership. Or you may just feel that the risk of transitioning to this type of practice is too great.

But, incorporating the concierge model into your practice doesn’t have to be an all-or-nothing proposition. It is possible to offer it as an option to those patients who want additional services, while keeping your standard model for those who don’t.

At the 2017 Annual Meeting of the American Academy of Neurology, Daryl Story, MD shared his experience incorporating a concierge model as part of his practice.  He gives some advice on deciding whether this model is right for you.

First, Dr. Story suggests examining what you value in patient care. He points out, “The system that is paying us does not always value what we think is valuable and what our patients think is valuable.“

Your concierge patients, whom he calls clients, will expect more access to you. Some ways you may provide this include:

  • direct phone calls and email without the middleman of your front desk or EHR portal,
  • more time with you during their appointments, and
  • house calls for those patients who need them.

If this model resonates with you, a concierge option in your practice may be the right fit.

It is important to note that billing is a bit more complicated if you continue to contract with third party payers. You must only charge your concierge patients for items not reimbursed by those entities. For example, you can charge for travel to house calls, but not for the house call itself which is covered by Medicare when need is demonstrated. As a perk of membership, you can offer your concierge patients a direct line to you, or make non-urgent appointment available to concierge patients within one or two days. Any service that isn’t typically covered by your third party payers can find a spot in your concierge services.

This model may not be a road to riches, so if your goal is wealth, this may not be the path to get you there. It does have the potential to increase your job satisfaction by allowing you to offer concierge patients the time and focus that standard insurance models simply won’t permit.

If you think you would like to offer a concierge option in your practice, it is best to take your time and work through all the logistics. Here are some questions to consider:

When will you see these patients so they get the time they need without disrupting your daily schedule?

Dr. Story sets aside early morning and end of day appointments and sometimes lunch to see these patients.He also offers them non-urgent appointments within two days.

How will you manage the technology?

There are HIPAA requirements you need to consider, and you may want to have a phone number and email address that are only used by your concierge patients.

How much will you charge?

This depends on how many services you want to offer your concierge patients. A lower price may mean more patients are interested, so you will have to limit what you offer accordingly. A higher price will limit the number who enroll, but you will be able to offer those patients more services.

With diminishing reimbursements and the race to see more and more patients just to make ends meet, many neurologists are becoming disillusioned with the practice of medicine. A concierge option in your practice may be the first step in transitioning to an all concierge practice. Or it may help you restore the love for medicine and your patients that led you to your career in the first place.