Is Your Oncology Practice Ready for Concierge Care?

Andrea Klemes, DO

Keeping your practice financially solvent is difficult because of the uncertainty of regulatory and reform mandates, electronic health records requirements, and diminishing reimbursements. But a type of care delivery, called concierge care, is making some inroads in the primary care arena—and may hold some usefulness in oncology practice.

Traditionally, concierge care describes the relationship with a primary care physician, in which patients pay an annual retainer in addition to any normal charges. In exchange for the retainer, physicians provide enhanced care that is usually outpatient focused, or offer services that may no longer be available in a traditional primary care office. The retainer fee ranges from $500 to as high as $20,000 year. The average fee for a concierge patient is reported to be $1,500 per year, said Wayne Lipton, managing partner of Concierge Choice Physicians, headquartered in Rockville Centre, New York. Many physicians who provide concierge care are accessible to their patients 24 hours a day, 7 days a week.

The draw for physicians is that “most of them really want to be Marcus Welby again. They want to take care of the whole patient, and to be able to have the time to really know their patients,” said Andrea Klemes, DO, chief medical officer at MDVIP, a Florida-based concierge care company with 725 physicians who provide care to more than 215,000 patients across the country. In traditional primary care practices, physicians are generally focused on reactive health problems, and are not always able to spend adequate time to address prevention or wellness. The MDVIP model allows physicians to better manage conditions such as diabetes, cardiac issues, hypertension, and other illnesses that can become more serious, demand more treatment, and become costly for patients.

MDVIP caps the number of patients per practice at 600 patients a year. This allows MDVIP-affiliated physicians to spend more time with their patients. Traditional practices have an average of 2500 patients, but can see as many as 4000 patients a year.

But can this model be adapted to cancer care? “I haven’t seen a whole lot of oncology in concierge care,” said Lipton. But he added that he’s been thinking of re-visiting the topic.

He said that because of the regulatory and reform environment there may be more opportunities going forward for practices that are interested in offering enhancements to the services that are traditionally covered by insurance.

“We’ve solved a lot of the problems that made it difficult for certain specialists to go into concierge programs, like pediatrics and geriatrics. Knowing what we know about what works and what doesn’t work, oncology poses a lot of new questions, concerns, and even possibilities,” Lipton said.

Factors in Concierge Care

Lipton noted that revenues for some specialties— cardiology, gastroenterology, and pulmonology– have been severely affected by diminished reimbursement rates. “Any specialties that garner revenues by performing procedures were far more severely impacted than in the past,” he said. In addition, visit rates have been flat or contained, he said.

Determining if a specialty practice is a candidate for concierge care depends on many factors. First, do patients require more time with the physicians? Is there an interest on the part of the patients to have additional help with caring and dealing with the emotional components of care? In oncology, the answer could be ‘yes.’

“Concierge programs are built around noncovered services,” said Lipton. “So educational programs and programs built around physical therapy, or those programs that involve the patient’s emotional well-being are possible programs that could be covered through concierge care,” he said.

Oncologists have often provided secondary, bundled services from non-clinical providers within their practice. Practices have to determine if these bundled services are important enough to patients to be provided over the long term because there is a real cost involved, according to Lipton. It is hard to justify keeping the service if patient turnover is high. “You would want to have a program with a 90% patient retention rate,” said Lipton.

He said “there may be more opportunities going forward for practices that are trying to offer enhancements to the services that are traditionally covered and put them in a package that could be marketed to their patients.”

Conversely, specialties that involve episodic care, in which patients are seen for a specific problem, receive treatment, and then move on are not candidates for concierge care. Lipton pointed to orthopedics as an example. “There’s not much repeat patient load, so it’s hard to convert many patients to a concierge program,” Lipton said. The other concern is patient turnover. In oncology, patients undergo a course of treatment, and if they experience some degree of cure, they may come back once or twice a year for an examination, and hopefully, for nothing more.

Beverly Hills Cancer Center

Eli Gabayan, MD, a practicing hematologist and oncologist and medical director at the Beverly Hills Cancer Center said that, “Our goal when adding concierge level service was to be able to provide each patient with the best possible cancer care because that is what each patient deserves.” “There’s a lot of planning, research, and administrative work that occurs behind the scenes when delivering cancer care,” he said, “and this allows for each patient to have even more time and personalized care dedicated to him or her.”

“In addition, in this changing and competitive healthcare environment, many of our patients have requested this level of service,” said Gabayan.

“While our private, boutique center was created to deliver the state-of-the-art care, some patients request concierge care for increased comfort and peace of mind. Our program is also structured in a way to best meet the needs of the patient and the timeline they prefer. Our mission is to provide the highest level of care as we heal each one of our patients, and to make their journey as comfortable and convenient as possible each step of the way.”

Concierge Care Is a Puzzle

“The current environment pushes practices towards volume of care because their remuneration is related to how much they bring in in an hour. So the more people they see in an hour, the higher their revenue will be,” said Lipton.

Practices that see many patients per hour had higher reimbursements, but some physicians prefer to see fewer patients and give them more time.

“So the first part is professional and the second part is economic. Professionally, the doctors have been trained to deliver their care, but in the real, practical world, they don’t have that time,” he said. “Concierge programs are like a puzzle. Putting together all the factors like turnover rate, replenishing rate, cost of acquisition for new members, and determining the non-covered services—that’s a big puzzle,” he said. And, for some oncology practices, concierge care may be a puzzle worth exploring in today’s reform environment.