Practice Burden or Stepping Stone?

By Kihm, John T. | Medical Economics, August 1, 2011 | Go to article overview

Practice Burden or Stepping Stone?


Kihm, John T., Medical Economics


THE HYBRID CONCIERGE MODEL IS WORTH A LOOK

Hybrid concierge medical practices add concierge medicine aspects to traditional practices. The lately extolled virtues of concierge medicine hybrid models sing praise to its advantages. But what verses intone its disadvantages? Every coin has two sides, and you need to see both.

I deliberately designed and implemented a steppingstone hybrid model against the behest of sage advisers, and I share with you my bittersweet experience. For me it was worth it But for you, well, you will need to decide. First, we view the warts, then the splendor of hybrids.

"That sounds like too much work, having two practices," counseled my father, a semi-retired orthopedic surgeon, on hearing about my hybrid practice plans.

"Why buy the cow when you can get the milk for free?" opined John Blanchard, MD, father of the now American Academy of Private Physicians, regarding whether my patients would sign up. I had flown to Detroit from North Carolina to talk with John about my concept.

TRUCKLOAD OF WORK

Guess what? Both my father and John were right. Among other things, the hybrid practice is a truckload of work that offers limited value to patients. In the hybrid practice, one offers on-time, more-time appointments to "special" patients while simultaneously trying to catch up with one's hamster treadmill traditional-practice patients- forcing a double life for both office staff and physician. Hybrids offer "two practices within a practice." Personally, I barely could keep up with my old singleton practice let alone two parallel practices. The stress was bad enough in my old practice. With my elegant hybrid, I had more stress and more work.

Next, could I actually succeed in simultaneously offering dueling levels of care within my office confines? The answer: "No!" I only wanted to offer the best to both patient classes. Most hybrid-practicing doctors will admit as much. Increasing quality across your practice without reducing patient numbers equals hard work.

Patients ask, "Why sign up if I can still see you?" Why indeed? With free milk, what's the value proposition for buying the cow? Why should patients join?

After converting my hybrid to filli concierge, I surveyed my patients, finding that 96% of them joined simply to remain as my patients. If patients are allowed to stay in your practice without paying extra, why join the "special practice component?" The hybrid is a hard sell, except to patients afraid of later being shed for not signing. With little incentive to join, most patients will not see value.

The hybrid can lead to the full concierge medicine conversion. In business, you should test before leaping. Do low risk before high risk. A hybrid model is essentially low risk- you will not lose patients- possibly just the capital spent on sales and marketing. …

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