
What is "Concierge" for you?
Concierge per the dictionary- a person or service that provides personalized assistance/care etc.
I get this comment actually a lot. More in the sense of, "I cannot afford concierge". I get this question before people even give me a moment to provide an explanation.
Before I go into exploring what concierge consulting/management/medicine/coaching is to you, let me tell you what it means to me.
I have long been involved in the model of medicine where insurance drives a lot of how we practice medicine. Not to the extent of how we choose to practice medicine. Many cases we will want to work a patient up for a specific ailment, but we know it will not be covered by the insurance if I run test X first without running test Y first, well knowing the test X is more diagnostic and would have to be run if test Y came up concerning. We have to have a specific diagnosis and rationale for every test or treatment, which is good this ensures safety and compliance, but it is also highly limiting.
In my opinion, it can provide limits to prompt, effective, efficient, diagnosing and treatment. It provides longer wait times for patient's and thus a delay in care. This in itself is something that bothers me to my core, it is a restraint that I feel shouldn't be there, dictating algorithms, and waiting for prior authorizations for approval for diagnostics and treatments to be approved.
With that all being said, concierge care is simple- to me it is the care to drive a model to optimize care quicker, without delay in diagnosis or treatment, which I feel can lead to improved patient outcomes. It is taking out the ability to be constrained by the insurance company to approve what and how you want to do it. It allows one to remain safe and practice under their scope but be able to take as much time as they want and to thoroughly investigate the patient's needs to help optimize the outcome.
In the current insurance driven model, reimbursements are delayed or partially reimbursed as they dictate how much our visit was worth- people who have no nursing/medical degree in many cases. This can put pressure on companies to have clinician's see more patients with less time. Personally, the more you practice in your field you do become more efficient, although less time with patient's in my opinion is NEVER a good thing.
Just the other day I received a bill from my insurance for my co-payment for my follow up visit (credit care machine wasn't working the day I was there), total charged $375 for a specialist, it was a level 3 routine follow up no medication changes done- insurance decided to cover $225.00 amount. The clinician was packed with patients and behind on their day, as they were likely double booked or someone needed more time/someone late. I was seen for 7 minutes. I had 7 minutes of face time. There is no shame on this clinician, as they are wonderful, but we were not allotted the ample time. I was told I had a follow up I could not add a new complaint, I was scheduled in a 15 minute slot, half the time the intake RN is taking that time to get me settled in the room and obtain vital signs and a quick history. This clinician spent likely 18 years of their life devoted to being trained to provide this care and has loads of student loans and needs to see more patients because the insurance does not feel their expertise is worth what the office charges. All around it is a sad scenario. One could then say why would you charge so much for a 15 minute appointment. You are paying for the expertise and the experience and the complexity of health in my opinion has a cost. One could say why do lawyers charge $300-1,000 per hour? Again, price is derived from experience.
I charge less than what this 15-minute appointment with limited face time charges with insurance. I spend 90 minutes with my initial deep dive consultations- and trust me we need every minute of it. I utilized a lot of time behind the scenes make a literally personalized plan for this individual- it is tailored it is unique.
This is concierge- and with everything in life, time is money, but when you step back to look at the big picture, how much is your wellness worth? Concierge is not just for "rich people". I get that a lot. It is for people that need more, and sadly in our medical model with insurance driven care, it has forced many patient loving and passionate clinicians, like myself, to focus on a cash per visit model to provide a level of care that has extended visit times because practices operating with reimbursement by insurance will not allow that. I have no office manager telling me I need to see more people, I can take the time I need and know I am providing excellent care- and I am still well below the average for charging for my level of experience, education, expertise, and services. I am likely undervaluing my services as many have told me, but I charge the rate I do currently to be able to help others, because it is a passion.
Therefore, concierge in my realm, to me, is the optimization of care and ability to provide personalized care. It is holistic, optimal, personalized, and educating- it is HOPE.
I write this blog with passion, as I have had a lot of folks negatively state comments about concierge care. If you have not experienced a concierge experience, then you have no room to speak, concierge is for everyone who decides to value their wellbeing. Every service has a cost. If you are not happy with the way your care has been with your insurance driven model practices, why not try a concierge approach?
Many blessings to you all and just a ray of perspective from someone in the trenches still of both hospital medicine and concierge medicine. I am grateful for all my experiences and positions but do see where we as a medical community could improve.
May you all have good health and optimal lives, it is my wish for everyone. It is why I do what I do.
Cheers!
Katie