Concierge Models Fit Needs of Patients and Pediatricians
The concept of a concierge pediatric practice embodies a variety of models that span from the retainer-based internal medicine model to providing valued services that go beyond the traditional office-based model of care. For some, the term concierge is objectionable; they conceptualize it as an elitist and exclusionary practice, but it often also represents a much more patient-friendly, accommodating, and medically appropriate service. It is market driven and can be an important part of the Patient-Centered Medical Home, especially relevant to the evolving payment paradigms associated with health care reform.
The usual concierge practice is one that will, for a retainer fee, provide 24/7 access, coordinate hospital and specialty care, have untimed visits/consultations, and may include house calls. These services may be performed for a flat fee, not taking insurance (direct care), or as a supplement to insurance reimbursements. Usually this arrangement allows for a smaller and more personalized practice.
Dr. Russell Libby
There are many situations where a concierge practice makes tremendous sense for a patient, the family, and the pediatrician. Consider the child with special health care needs who may be technology dependent and/or difficult to transport to the office; 24/7 access and occasional house calls by a primary or subspecialty pediatrician can be of significant benefit to the child and family. For the healthy child, a house calls practice can provide a desired service and enhance the family-physician relationship. The medical benefits of home visits are numerous and can provide many insights.
The typical pediatric practice has taken on many expensive and nonreimbursed tasks over the past several years – converting to EMRs, insurance authorizations, electronic prescribing, forms, and more forms. Ever increasing overhead and flat or declining fee schedules have turned many practices into impersonal visit mills just trying to survive. There is less time and little incentive to provide the time and expertise many patients and families need. One option some have undertaken is to develop a hybrid concierge model where, instead of charging piecemeal for some of these services, the practice charges a small annual fee that may cover these elements. Some may charge a bit more to include a certain number of untimed visits or behavioral consultations, extended hours, or phone and electronic visits. This fee does not have to be very large to make a huge difference in practice cash flow and financial viability. Even more gratifying is the pleasure of providing more responsive and personal service that can enhance your professional satisfaction and, ultimately, your practice’s reputation.
In the context of health care reform, one might consider the Patient Centered Medical Home as a form of concierge care, dangling payments for certain quality and patient satisfaction indicators. If the pilots provide adequate revenues, that may be the future of this hybrid concept. In the meantime, pediatricians deserve the opportunity to experiment in their own settings. This is not an elitist trend that will disenfranchise large numbers of children. The fees can be low enough that even families receiving benefits through Medicaid could afford it. This is simply an alternative to the traditional practice model. Rather than criticism, the variety of concierge models warrant endorsement as an opportunity to provide better care for patients and improve the professional and personal life of the pediatrician.
Dr. Libby is chief of general pediatrics at Inova Fairfax (Va.) Hospital for Children, President of Virginia Pediatric Group, and the cofounder of American Pediatric Consultants, a pediatric home care company. He is also the medical director for Lipton Health Pediatrics, a Washington, D.C.–based company that helps pediatricians move their practices to a concierge model.
Focus on Medical Homes for All Children
The concierge concept is a good idea wrongly applied. What I like about the concierge medicine practice model is that it is a business model that supports spending more time with patients. It enables pediatricians to focus on key tenants of comprehensive care: access and availability. I empathize with pediatricians who want to get off the treadmill of the practice built around high volume and "what gets paid." It is exhausting and leaves both patients and providers feeling dissatisfied.
But while the concierge model may be a good concept in theory, in practice this approach is only viable in communities where families are educated and affluent enough to pay out of pocket for this improved care and access. That’s troubling when you consider that in 2010 nearly a quarter of U.S. children were living in poverty. That number was as high as 38% among African-American children.