August 9, 2023
DermWorld | Not just another cog in the wheel
Dermatologists and experts in concierge and cash-only practice models discuss how it can be a game-changer for the right physician.
Imagine a world without rushed appointments, insurance denials, and ever-diminishing reimbursement. While this may seem like Tolkien fantasy, some dermatologists have made it a reality by transitioning to concierge or direct pay practice models. Concierge medicine implies having a membership model with a monthly fee that would include benefits (discounts, visits, access, etc.). Direct-pay medicine implies a doctor who is not contracted with any insurance companies; in hybrid practice, the physician is contracted with some insurance but not others. A direct pay model may be concierge as well. Concierge practices may still take insurance but offer special memberships with certain benefits for patients, such as access or discounts.
“Any time you are exiting the private insurance market, you are removing a portion — sometimes a significant portion — of your potential patient base,” said Trevor McElhaney, JD, director of consulting at Doctors Management LLC.
“However, if you are successful in a concierge model, physicians can maintain higher flexibility in the way they interact with, schedule, and receive payment for their services. Regardless, and before you exit any commercial or governmental contracts, ensure you understand the ramifications of that, including the ability to get back in-network if needed (e.g., wait periods, closed panels, etc.), as well as general market research on your market’s willingness to pay out of pocket for services that would otherwise be covered by their health insurance plans,” he continued.
The most important aspect of a concierge contract, or any contract, is to be clear about what will and will not be provided by the physician, McElhaney said. “Physicians should consider whether they will offer cell phone access and response-time expectations, night and weekend availability, limits on total visits in a particular time period, etc.”
Trevor McElhaney, JD | Director of Consulting | [email protected]
Lauren T. King, CMPM | Director of Healthcare Business Solutions | [email protected]