What to consider before switching to concierge medicine

A column examining the ins and outs of contract issues

By — Posted Oct. 8, 2012.

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Some physicians are changing their traditional office-based practices to concierge medicine, also commonly known as retainer medicine. They figure that treating a limited group of patients paying a monthly fee, who then get extra services, is a better situation for the doctors and the patients.

Although concierge medicine frees a doctor from insurance contracts, it doesn’t free a physician from contracts in general. The patient now becomes the party with whom a doctor is contracting, and terms need to be spelled out. So before taking the leap to a concierge medicine model, the following considerations need to be addressed:

Establishing the fee arrangement.

Determining the services that will be included in the set fees, and those that will be extra.

Deciding about the acceptance (or lack thereof) of insurance, government payers and other third-party payers.

Notifying existing patients about the transition to concierge medicine (and whether there are restrictions in your employment agreement or other agreement with your employer about soliciting patients).

Contracting with participating patients.

Complying with applicable federal and state laws.

Determining your fee often will depend on which services you choose to provide, as well as the age and health of your patient base. Many concierge physicians accept payment on an annual or monthly basis. Generally, an annual fee is payable upon execution of a retainer agreement with the patient.

It is important that you clearly define which medical and nonmedical services are included in the fee. These services may include same-day or guaranteed next-day appointments, 24-hour physician availability, telephone and/or email consultations, limited waiting times and coordination of care with specialists. You also may include an à la carte menu of services that can be obtained for an additional fee.

Some physicians choose not to participate in insurance, government and/or third-party plans for various reasons, such as to reduce overhead and administrative costs. Other physicians elect to participate in these commercial and government plans, but charge a concierge fee for additional services exclusive of those covered by the payer. If you decide to go the third-party payer route (whether commercial, government, or both), it is imperative that you separate special services from reimbursable ones so as not to violate any federal or state laws or contracts with third-party payers. Because of the risk for violations, generally concierge practices do not accept insurance.

When you have made the decision to transition your practice to a concierge model, giving adequate notice to your existing patients should be a top priority. Whether you decide to send a letter or have an in-person discussion with your patients, let them know that they are able to seek care from another physician if they do not wish to participate in your concierge practice.

The American Medical Association Code of Medical Ethics states that physicians should facilitate the transfer of their nonparticipating patients to other physicians. This may require making appropriate referrals or continuing to care for some patients until they find other physicians to continue their care. If you wish to engage in a mixed practice, having participating and nonparticipating patients, the AMA states that you should be “particularly diligent to offer the same standard of diagnostic and therapeutic services to both categories of patients.”

After evaluating which patients will participate in your concierge practice, the next important step is to draft a retainer agreement. This agreement is a formal contract between you and your patients and ensures that all parties’ expectations are memorialized in writing. The retainer contract should be concise and understandable. Both parties must be clear about the terms of the contract and must agree to them.

The retainer agreement should clearly define which services are covered by the fee; which are covered by insurance, government payers or other third-party payers (if you choose to participate in those plans); and which services will be provided at an additional cost. Each arrangement is unique, and it is important that services are described specifically to avoid misunderstandings.

The retainer agreement should contain a provision that defines the length of the contract and the ability of either party to terminate the agreement upon written notice within a specified time frame. The AMA Code of Ethics provides that there should be a way for patients to opt out of a retainer contract without undue inconveniences or financial penalties.

Concierge and retainer medicine is an attractive option for some physicians, but this model is not for everyone. Be sure to get the infrastructure and documents in place before offering this option to your patients.

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