Is Concierge Integrative Medicine a Viable Model for You?

By Glenn Sabin

After a year closely following the inexorable growth of concierge care in the U.S.—and advising several primary care integrative health-directed physicians and pediatricians regarding various modeling options—it’s very clear to me that its basic business principals are a terrific match for some integrative health practitioners.

Insurance and CMS Models Don’t Support Integrative Medicine Consults

Physicians trained in integrative medicine will spend nearly 90 minutes per new patient consult (including the review of an extensive intake form), homing in on the biography, biology and pathology of the whole person sitting before them. Additional follow up visits can easily last 30 minutes.

Losing Revenue on Patient Consults is Not Good Business

Although your integrative practice may do fairly well with ancillary cash services, i.e., supplement sales, massage, acupuncture and dietician consults, the time you spend on extensive patient consults should not be viewed as a ‘loss leader’. All aspects of your practice should be profitable at best, cost neutral at worst.

Based on current CPT codes and anemic Medicare and private payer visit reimbursements, it’s untenable in this economic environment to operate a comprehensive integrative medical delivery model requiring a hamster-wheel-like approach to maintain patient volume and sustain appropriate physician income levels.

The Exceptions

Notable exceptions to this general rule include integrative medicine pioneer Dr. Elson Haas’s Preventive Medicine Center of Marin, and Dr. Edward Levitan’s Visions Healthcare. Dr. Haas still takes insurance and happily makes his services accessible to everyone possible. Meanwhile, Visions, a greater Boston metro area multi-practitioner juggernaut, seems to grow their family practice model by offering a plethora of services while achieving critical economies of scale. They recently opened a second and even larger 21000 square foot location. Consistent with conventional practice trends, Vision’s physician assistants and nurse practitioners will regularly support the more non-complex patient visits enabling the practice to most efficiently manage its increased insurance-based patient volume.

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The Slow and Steady Exodus to Concierge Care

(The following section has been updated from FON’s article, Integrative Medicine: Solution to Primary Care Crisis?)

Driven by a confluence of unfavorable economics, personal burnout rates and intense frustration at not being able to provide quality, comprehensive care, we’ve seen primary care doctors slowly but steadily migrate toward concierge practice models.

Concierge medicine is an umbrella term that includes both direct primary care and hybrid models either eliminating third-party payers altogether, or charging customers (aka patients) a monthly or annual fee on top of their insurance reimbursements. Also referred to as retained care, numerous clinic and patient membership models have evolved, strengthening patient primary care services and practitioner business interests.

While some physicians are working with name brand concierge care consultants like MDVIP, SignatureMD and Concierge Choice Physicians, others are going it alone. Primary care physicians are moving away from the third-party payer system’s heavy paper-loads, slow and low reimbursements, and tight clinical oversight. Instead, more doctors are opting for annual membership fees thereby reducing patient panels thus allowing same day appointments, creating greater email and cell phone access, as well as, providing quality clinic time for educating patients about beneficial lifestyle changes.

Compared with pure concierge care, physicians charge smaller annual fees with a hybrid approach while continuing to take insurance. Some also continue to accept Medicare. The annual fees associated with a hybrid practice model can also allow physicians to take optional measured steps over time toward eliminating insurance altogether. Hybrid and direct pay concierge practices are run by both conventional primary care docs and physicians trained in, or leaning toward, integrative medicine. Their common interests lie in providing better care, seeing fewer patients and making decent livings while, importantly, regaining and maintaining their own personal life balance and health.

Do Your Patient Demographics Allow the Shift to a Concierge Model?

For consultative integrative health providers not doing primary care, direct pay and superbill provision is my typical recommendation. However, primary care practices should consider concierge if the demographics support it.

If your patient panel is comprised of enough folks willing and able to pay a little extra for the quality medicine, greater communication and access you provide, think about beginning a measured shift to an insurance plus membership fee model (aka Hybrid) instead of eliminating insurance altogether.

Do the Work and Lose the Fear

“A direct-pay business model requires entrepreneurial spirit, marketing know-how and willingness to take risks—three traits that many doctors lack.” ~Erik Goldman, Editor, ‘Holistic Primary Care’

If you’ve been practicing integrative and lifestyle medicine within a conventional primary care insurance model setting for years—or perhaps decades—I understand how incredibly difficult it might be to consider the move to concierge care. Realistically, not all of your patients will come along for the transition and these are folks for whom you care greatly.

That said, you cannot overlook the tremendous upside value of having a less hectic workload and, consequently, much greater and healthier life balance. Add in higher quality time spent with patients, superior health outcomes and a brighter personal economic future, and this starts making complete sense.

Start by assessing your patient panel and doing some informal polling. Also, take a closer look at the local competitive set—i.e., others in the community providing integrative health primary care—to accurately assess what they’re doing and how they’re positioned. After performing your due diligence and putting the appropriate process in place, the model best for you will clearly emerge.

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About FON

FON is a leading integrative health and medicine business development and strategy consulting firm. FON specializes in custom solutions for growing patient volume, developing programs, and increasing product sales. Our practical business models are driven by innovative marketing, clear messaging, and customer engagement via branded storytelling.

Contact us today to schedule a complimentary 30-minute consultation to discuss your business development or personal brand needs.

FON’s founder, Glenn Sabin, is a nationally recognized thought leader with a reputation for successfully positioning integrative health organizations for sustainable growth. Combining media, marketing and business development expertise with an extensive professional and personal integrative health and medicine narrative, Glenn is deeply passionate about advancing the field as the new standard of care—accessible to all.
Read Glenn’s story.