Boutique medicine mystique: Hybrid concierge care model offers best of both worlds


It’s a whole new, bustling, busting world out there for caregivers.

A shortage looms. A massive healthcare regulation stands. A boomer populace assembles. And yet the hectic life of the physician provider, for many living it and for those living off of it, remains frustratingly unchanged.

Born from this tumult was the concept of concierge care, a method that has come to mean, for several doctors, a return to the bright-eyed medicinal vigor of their training years — a desired relapse back into a modus of treating patients more comprehensively, some have ventured.

But while the boutique form of care has been the saving grace for some practitioners, concierge medicine is still met by others in the field and outside it with a skeptical eye. Accusations of two-tier medicine and class-based care have been lobbed at the model from its inceptions, complicating matters and warding curious docs off the idea.

So, can a supposedly two-tiered system do right by the nation and its providers? Conversely, can a physician-dubbed return to more quality based care do wrong?

Join PhysBizTech for an extensive exploration into the multifaceted phenomenon known as concierge care, beginning with the initial series installment below.

The hybrid solution
As with most beasts, regardless of their bent, concierge care takes on several forms, one being what providers refer to as the hybrid model. The hybrid allows for the best of both worlds, where subscribing physicians take on a certain number of concierge care patients (who pay additional fees), whilst keeping the rest of their clientele under the same level of care as has become accustomed.

For Steven Fisher, MD, who runs his own practice, Fairfield County Medical Group, in Trumbull, Conn., the hybrid model has provided balance and opportunity for both himself and his patients.  

“The three physicians that are participating agree to take no more than 100 patients in the concierge model and the rest of the practice remains your typical internal medicine practice,” Fisher explained. “So it’s different than what had been out there more commonly, like the VIP model where doctors will take anywhere from 100-600 patients, a pure concierge care practice, and basically get rid of all their other patients.”

For Fisher and company, the hybrid change became a possibility following the success of a neighboring practice.

“We found it by accident actually,” Fisher said. “One of the practices not too far from us in a neighboring town, there was a write-up in a sort of industry journal we get, and I know them, so I asked them how they came to it and then explored it with the company they had hooked up with. To me, the hybrid model doesn’t require much thought...in terms of going forward in that because unlike a pure concierge practice, where you’re making this decision to jettison a whole lot of people, this does not do that. It doesn’t affect any of your other patients in terms of their ability to see you."

Despite the model not requiring much cognition, the no-brainer solution did demand that the Fairfield County Medical Group physicians establish an open forum for the public to learn and inquire.

“What happened is the company that we hooked up with put together a series of town hall meetings,” Fisher said of the company charged in aiding his practice with the concierge transition. “They do a lot of touching base with your patient population, sending out letters, etcetera. We actually held three meetings at night where essentially all the patients were invited and we had fairly large turnouts. They explained, and of course we participated, why the doctors are doing this, what it is, what it means for you [the patient]. So the bulk of the patients that we have [under the model] ended up signing up directly from those meetings, hearing about it fresh for the first time.”

While the benefits vary from practice-to-practice, Fisher identified three major capabilities afforded to him due to the hybrid transition:

1. Reclaiming the hospital hat: “The reality of internal medicine, what I cannot offer my patients in this day and age, is really my availability, access to me and the hospital,” Fisher mused. “We’ve given up our hospital practice except for the concierge patients. That’s the only group where we admit them, we take care of them in the hospital, we are in charge of their hospital care start to finish, we see them every day. The rest of the patients now, as in many parts of the country, are being turned over to hospitalists.”

2. Speak up, speak often: “The second [biggest impact] is the availability to talk to me. I see patients from seven o’clock in the morning until six o’clock at night nonstop. There is no way for me to talk to you on the phone. People say to me ‘I can’t believe you don’t have five minutes.’ I do have five minutes, but there are a hundred people who want five minutes with me and 500 minutes, I don’t have that.”

3. No wait, no holds: “The other problem is, the only way you can run an internal medicine practice now is to be full over-time, particularly if you don’t over-book or double-book, which we don’t. I’m booked weeks ahead, so if you get sick today, there’s no chance you’re going to see me,” Fisher said. “You end seeing the nurse practitioner or another younger doctor who might have more spots available. My concierge patients see me, they always see me. They can call me 24/7, they have my cell phone, they can see me whenever they want. Their appointments are longer. They bypass the entire rigmarole of most people’s offices — they either call me or a designated concierge care nurse. They never get put on hold.”

Furthermore, regarding ethics, the hybrid model is a sound bet, Fisher argued — unlike full concierge care, physicians don’t need to drop potentially large numbers of patients. If anything, it offers patients willing to make the additional investment an added dimension to their care, while those not interested suffer no setbacks.

“Your care delivered by me won’t get any worse, but things you guys complain of now aren’t going to get any better. That’s really the difference in the concierge.”

“There is absolutely nothing unethical about offering, for people who find value in it, some extra services that you had no availability to give them otherwise,” Fisher concluded.