In this episode, Dr. Hales discusses:
*How to transition to a concierge medical practice
*Benefits of a concierge model
*Key considerations for adopting a concierge model

Key Takeaway:
“Transitioning to a concierge medical practice offers practitioners and patients a unique opportunity to redefine the healthcare experience.” – Barbara Hales, M.D.

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Dr. Barbara Hales: Welcome to another episode of Marketing Tips for Doctors.

I’m your host, Dr. Barbara Hales. Today, we will explore innovative solutions in the healthcare industry as we delve into transitioning from a traditional medical practice with third-party payers and insurance reimbursement to a concierge model. We’ll uncover the benefits, challenges, and key considerations for physicians and healthcare providers looking to adopt this patient-focused approach.

Benefits of Transitioning to a Concierge Medical Practice

Dr. Barbara Hales: Transitioning to a concierge medical practice represents a significant shift in healthcare delivery, as it emphasizes personalized care, enhanced patient experiences, and sustainable practice models. A huge benefit is not relying on insurance reimbursements, which are beyond our control and may decrease over time. I had a wall in my office where Medicare and third-party payer checks were taped. The value of the checks ranged from $1.38 to $2.50. It was more meaningful to have patients see this for visits that I had spent almost an hour on. I couldn’t believe the value, and I knew my patients couldn’t believe it either.

The shift in transitioning to a concierge model requires careful consideration of patient communication, financial structures, and navigating regulatory requirements. What are the key strategies for communicating this change to existing patients and attracting new clientele? It’s essential to establish clear communication channels to educate patients about the enhanced services and benefits offered through the concierge model. Focus on building strong patient-provider relationships, prioritizing continuity of care, and ensuring transparency throughout the transition process and transitioning to a concierge model.

Key Considerations for Transitioning

Dr. Barbara Hales: Several considerations are vital for success: tailoring patient communication and engagement strategies to convey the value of personalized care and the extended services offered, implementing a sustainable and ethical pricing structure that aligns with the practice’s value proposition and the needs of the patient population, embracing innovative technology solutions to streamline administrative tasks, enhance communication, and uphold data privacy and security standards, establishing collaborative care networks and partnerships to provide comprehensive, coordinated care for patients and meet evolving healthcare needs.

The key takeaway here is transitioning to a concierge medical practice offers practitioners and patients a unique opportunity to redefine the healthcare experience. This transformation requires careful planning, open communication, and a commitment to patient-centered care. By embracing this model, healthcare providers can strengthen their connection with patients, promote wellness-focused care, and build sustainable practice models rooted in a foundation of trust and collaboration.

Mitigating Patient Loss During Transition

Dr. Barbara Hales: How do you keep from losing patience when going to a concierge model? This is something that I think many doctors worry about. And the fear of this is what keeps them from changing over to the concierge model. Transitioning to a concierge medical practice involves a significant shift in the way healthcare services are delivered, which can understandably raise concerns about patient retention during the transition. To address this, it’s important to implement clear communication strategies and transparent processes To minimize patient attrition and strengthen trust, here are eight effective approaches to help mitigate patient loss when transitioning to a concierge model.

First, clear communication. Communicate the transition to a concierge model well in advance to provide patients with ample time to understand the changes and ask questions. Secondly, we need transparency. This is a key to addressing patient concerns and building trust during this period of transformation. The next value proposition clearly articulates the enhanced value and benefits that patients will receive through the concierge models such as extended appointment times, proactive wellness programs 24/7 access to the physician, and personalized care plans, emphasizing the added value and improved patient experience that the concierge model offers. Let’s face it, what patient doesn’t want to have a lot of time addressing their concerns with their doctor as opposed to the five minutes of face time that many patients get in their doctor’s offices now?

Next, we have education and engagement and host informal sessions, open forums, or webinars to educate patients about the concierge model and its advantages. provide a platform for patients to voice their concerns, share feedback, and engage in open dialogue regarding the transition. Customized outreach, tailor your communication to address specific patient concerns and preferences, provide personalized information, answer individual questions, and offer one one-on-one consultations to discuss how the transition will affect each patient’s care.

Options for existing patients offer flexible options for existing patients who may have concerns about the financial implications of the concierge model. Consider offering reduced rates or extended payment plans for a transitional period to ease the financial burden for loyal patients. Continuity of Care emphasizes the commitment to continuity of care and the ongoing relationship with existing patients. Assure them that their medical history, treatment plans, and ongoing care will be seamlessly transitioned to the concierge model without disruption.

transparent pricing and services clearly outline the pricing structure. Services and additional benefits associated with the concierge model provide detailed information about how the new model aligns with patient needs and contributes to improved healthcare outcomes. Finally, highlight the patient-focused nature of the concierge model underscoring the increased attention, time and personalized care their patients will receive emphasizing the provider-patient relationship at the core of the concierge model and its positive impact on overall wellness.

By implementing these structures and these strategies, healthcare providers can effectively navigate the transition to a concierge model while minimizing patient attrition. Open communication. Personalized engagement and a steadfast commitment to patient-centered care are fundamental in assuring patients of the ongoing value and benefits of their healthcare experience within the concierge model.

Insurance Acceptance for Surgery vs. Office Hours

Dr. Barbara Hales: You may be wondering now, can doctors accept insurance for surgery but not for office hours? The answer is yes. Doctors can choose to accept insurance for surgical procedures while not accepting it for office visits. This approach is commonly seen in practices that operate on a concierge or direct primary A-care model. In this scenario, the physician or practice may opt to accept insurance for specific medical sir services, such as surgeries, hospital admission or complex treatments, while providing primary care services, routine office visits, and preventive care through a membership-based or fee-for-service structure. This answers the fear that patients may have, saying: “Okay, well, I’m willing to pay for office visits, but what happens if I need an expensive surgery? I don’t want to negate my insurance and have to pay for that also out of pocket.”

The decision to segment insurance acceptance in this manner is often driven by the desire to maintain a greater degree of control over the patient care experience, optimize administrative efficiency, and enhance the quality of primary care services. By not relying on insurance for routine office visits, providers can reduce administrative burdens, streamline patient interactions, and focus on delivering personalized comprehensive care without the constraint of insurance, billing, and reimbursement complexities.

It’s important for healthcare providers considering this approach to clearly communicate to patients how their services are structured, transparent communication about insurance acceptance, out-of-pocket costs, and the scope of services covered under various payment models is essential to ensure that patients understand their healthcare options and financial responsibilities. Physicians and practices should also be aware of the regulatory and compliance considerations when structuring their practice in this manner, it’s advisable to seek legal and regulatory guidance to ensure that the practice model complies with applicable laws, regulations, and ethical guidelines.

Ultimately, the decision to accept insurance for specific medical services while not doing so for office visits is a strategic choice that should align with the practice’s overall goals, patient population, and commitment to delivering high-quality personalized care. It is important to look into what regulatory laws apply to accepting insurance for surgery but not office hours.

Regulatory Considerations for Hybrid Practice Models

Dr. Barbara Hales: The regulatory landscape surrounding the acceptance of insurance for surgical procedures, while not accepting it for office visits, is multifaceted. And it’s vital for healthcare providers to navigate this territory with a clear understanding of the relevant laws and regulations. Here are the key regulatory considerations that may apply to this practice model.

First, we have the insurance contractual obligations. Healthcare providers who choose to accept insurance for surgical procedures must understand their contractual obligations with insurance companies. Providers need to review their participating provider agreements and contracts to ensure compliance with the terms and conditions stipulated by insurers. Secondly, we have state insurance regulations. healthcare practices operating within the United States are subject to state-specific insurance regulations. It’s essential for providers to be knowledgeable about state laws governing insurance reimbursement, provider network participation, patient billing practices, and any restrictions or obligations related to the scope of covered services.

Next, we have the scope of practice regulations. state licensing boards and professional regulatory bodies define the scope of practice for healthcare providers. It’s important for physicians to ensure that their practice model aligns with relevant laws and regulations pertaining to the performance of surgical procedures, office consultations, and the delivery of medical care in various settings. Next, we have fraud and abuse laws. Providers must adhere to anti-fraud and abuse laws, such as the federal Anti-Kickback Statute and the Stark Law, which govern financial relationships and arrangements in healthcare. These laws are designed to prevent improper inducements, kickbacks, and improper financial incentives in relation to patient referrals and services reimbursed by federal health care programs. patient protection and informed consent is next. Regardless of the practices reimbursement structure, healthcare providers must uphold patient rights, confidentiality, and informed consent practices, compliance with patient private laws and regulations, as well as ethical standards for patient communication and informed decision- making remain essential in all aspects of care delivery.

Lastly, we have billing and reimbursement compliance, providers must adhere to billing and coding regulations, including accurate reporting and documentation of services provided compliant coding practices, and transparent patient billing practices. This includes adherence to coding standards set forth by the Centers for Medicare and Medicaid Services and private insurers. Given the complex regulatory landscape, healthcare providers considering this practice model should seek legal counsel and regulatory guidance to ensure compliance with applicable laws, regulations, and ethical standards. Additionally, ongoing vigilance and proactive monitoring of regulatory developments at both the state and federal law levels are essential to stay abreast of any changes that may impact the practices operational and billing practices. The thing also now is that if you are using an electronic health record system, the coding and the coding concerning your procedures are built right into the software.

Prevalence of Hybrid Practice Models

Dr. Barbara Hales: How common is a hybrid model of medical practice with accepting insurance for surgery, but not for office visits? The practice of accepting insurance for surgical procedures while not accepting it for office visits, often seen in hybrid medical models such as concierge medicine or direct primary care is a relatively uncommon, but emerging trend within the healthcare industry. So if at this point you are considering transitioning from an insurance payer model to a concierge model, you are trending.

While traditional fees for service and insurance-based models have historically been predominant. There is a growing interest among healthcare providers in exploring alternative practice models that emphasize patient-centered care, enhanced access, and personalized services. The hybrid model where insurance is accepted for specific medical services such as surgeries, hospital admissions, or complex treatments, while primary care services and routine office visits are provided through a membership-based model or fee-for-service basis, represents a departure from the traditional practice of relying solely on insurance billing for all medical services.

Although the adoption of this hybrid approach is not yet widespread, it has gained traction in certain segments of the healthcare landscape. Its appeal lies in the potential to offer a more personalized and comprehensive care experience for patients freed from the constraints of insurance-driven administrative burdens and billing complexities. An increased number of healthcare providers are exploring innovative practice models that prioritize meaningful patient-provider relationships, proactive wellness initiatives, and streamlined care deliveries by leveraging a hybrid model that combines insurance services with membership-based or direct payment options for primary care providers aiming to create a more patient-centric and sustainable practice framework.

As the medical industry continues to evolve, it is anticipated that the adoption of hybrid practice models that incorporate a blend of insurance accepted and direct payment services may become more prevalent, particularly as providers seek to address patient demands for enhanced access, continuity of care, and personalized health care experiences.


Dr. Barbara Hales: As we conclude today’s episode, we extend our gratitude to those colleagues who have shared their experiences and transitioning to a new model and guiding our audience through the transformative journey of transitioning to concierge medical practice. We hope that this episode has provided valuable insights and inspiration for healthcare providers seeking to embrace innovative care delivery models. Stay tuned and remember to prioritize wellness, innovation, and patient-centered care in your practice. This has been another episode of Marketing Tips for Doctors with your host Dr. Barbara Hales. Till next time