MDNews - Minnesota

flying Solo At another point along the concierge medicine continuum are physicians such as Dr. Falk, a 40-year veteran of medical practice in the Washington, D.C., area. Eleven years ago, her exasperation with managed care nearly led her to quit her profession. "The only way I could pay my bills … was to see too many patients," she says, citing high rent and other costly overhead. "Medicine doesn't work that way. It's not an assembly line." Her frustration ultimately led her to stop accepting insurance and establish fees for services. She lost half her practice and was initially "very worried." Over time, however, she fared better financially as patients recognized the value of the personalized attention she could provide. In January 2013, Dr. Falk realized the model she followed — practicing hands-on medicine, limiting the role of physician extenders and devoting ample time to patients — resembled concierge care, so she adopted that term to describe her practice. She also instituted a $1,500 annual fee. She has approximately 400 patients and would feel comfortable adding as many as 200 more. "I gave patients the option of joining the concierge part of the practice or staying feefor-service for the first year," Dr. Falk says. "I won't lose patients over money; some I see at a modest fee, and some I don't charge." Today, she is considering eliminating the fee-for-service model and going to total concierge care. "But I have a percentage of patients I know can't do that," she says, "so I'm going to try to keep those patients because they've been coming to me 25 to 30 years." The evolution of her approach to care has transformed her outlook. "I am happy because I practice good medicine — the kind of medicine managed care never allowed me to do," Dr. Falk says. Physician, know thyself Regardless of model, not every physician is suited for concierge medicine, says Guy David, PhD, Associate Professor of Health Care Management at the Wharton School of the University of Pennsylvania. For instance, interpersonal skills that may be merely helpful in a traditional practice can become indispensable in concierge care. "If you're going to enter people's homes and treat whole families, you'd better be good with names," David says. "You have to hold this clientele. People are going to pay thousands of dollars to be members [of a concierge practice], so they want good services. Can you meet that expectation?" And to a greater degree than in conventional primary care, a concierge care physician is expected to be the "go-to person" for a family or an individual member, he adds. "You are delivering a different kind of service — much more holistic, in a way, than the type of niche service being delivered today in primary care," David says. "Can you do that?" Even for physicians possessing those attributes, there are no guarantees — particularly if patients in the areas where they practice cannot afford concierge services. "You can have all the right personality and business skills," David says, "but there might not be returns in the community you're operating in." ■ MdNewS.CoM ■ MD News Twin Cities |7

• Cover