Great thread and interesting conversation.
The best that I can tell, i'm the only "concierge physician" thats commented so far (skipped a few posts in the middle ;-)
my 2 cents - concierge family practice will grow to become the standard, drop the concierge, and will be the new "family medicine". Health reform will drive this b/c the current insurance based model (regardless of who resides in the oval office) is unsustainable and unaffordable.
my model of "concierge" is more aptly described as "direct primary care":
by going 100% ins free, and working directly with the patients, then the incentives are appropriately aligned so that my first and last responsibility is to them. now that doesn't mean i rx pain meds or abx when they don't need them...the customer is usually right...and the patient is usually wrong about abx.
The avg practice has 7-10 employees per doc to play the ins game. crazy!
http://goo.gl/FvPBu
We have 1 staff/RN for 3 doctors. Overhead is less than 30% and income is up 40%.
Model: low monthly membership, $10-100/mo/pt based on age only (not on pre-existings) for unlimited home/work/office/tech visits, no coapys, all procedures free and up to 95% discount on medicines and labs = then they can find insurance up to 30-50% cheaper.
doesn't work? too good to be true? drunk? yes only to #3
simple math: $50/pt/mo x 600 pt x 12 mo = $360 - 30% overhead - 240k - employer taxes/benefits - $200ish take home per doc.
oh and does it help that i only saw 25 pts last week? WEEK
wholesale meds = HUGE value, more than pays for the membership for many patients. the poor need this the most. prilosec is $2.49 per month. HCTZ is $0.01/pill. Zofran $3.75/bottle. leflunomide $11 mo for us, $120 generic at pharm and $950 brand at pharm.....uhhhhh...easy call for every pt [with RA that is]
wholesale labs = cbc $2, cmp $4.5, lipids $3, tsh $3, T3/4 $4/ea, etc etc.
included procedures: laceration repair, bx, joint injections, ultrasound (non-dx ob), ekg, holter, spiro, audiometry, UA, rapid strep, dexa (yup, i bought a dexa in residency, long story), home sleep apnea screening, minor surgical procedures, medical laser treatments (aerolase.com).----think about it, all that stuff is cheap to do after you have the equipment. If it keeps the pts coming back, who cares how often they get a $0.40 ekg?!
THEY ABUSE IT -- i'll just address it now b/c it'll be asked. No. They. Don't. they have my cell phone, they text, they tweet, they facebook, [few] skype, they email. But they DON'T abuse it. For 1) its only 600 people, 2) they are very gracious in returning the trust you give them. 3) it drops in their chart (mind blown?)
INSURANCE WILL SQUASH THIS - nope, wrong again. we've shown insurance companies how to rethink their business model. they save so much $$$ when they work with us that its silly. They are working WITH us now b/c it lets them lower their premiums. Ok ok, by now if you're still reading, you think i'm drunk on my own koolaid (flavor: delusions of grandeur). True.
ONLY FOR THE RICH - really? come on, now you're not even trying. $10/mo/kid for unlimited care? for the rich?
ok, thats good for now
thoughts?