Do I target an “A” List?

Author:  Amy Shulman

Most physicians go into the transition process with a preconceived notion of the patients who are going to join and the ones who are not. They therefore believe that they can save a lot of time and money concentrating on the “A” list of patients. GSC has not found this to be the best way to approach the marketing process. First and foremost this assumes that the doctors have an accurate assessment of their patients. In some cases they are relatively astute, but every physician is surprised by some of the people who do not sign up.

Even assuming relative accuracy identifying the “A” list, let’s take a look at what is being passed up. Say that that 10% of the practice makes the “A” list. This leaves upward of 2000 patients who are relegated to second class status. If only 5% of these patients opt to sign up, that is 100 potential members that are being left behind – more than enough to differentiate a successful from an unsuccessful transition.

On the other side of the equation is the cost to market to each incremental patient which is actually insignificant. A mailing is required from a continuity of care perspective and it might as well serve as a marketing piece also. GSC usually suggests a second round, but this cost can be justified on a case by case basis. Also, a process needs to be put into place to talk to patients who have an appointment during the transition phase since face to face is the most effective sales methodology. It does not cost more and is actually logistically easier to talk to every patient who walks in the door than cherry picking the ones to talk to.

Obviously, the ones who show initial interest are worth more time than the ones that dismiss it out of hand. Also, it cannot hurt for the doctor to personally inquire with some of the more obvious omissions from the member rolls.

The bottom line is that with only a short time to achieve a critical mass of retainer based patients and the marginal value of a patient being as high as it is, there is no reason not to market to the largest group possible.

What is one patient worth?

Author: Marc Grossman 

This perception is one of the issues that physicians we at GSC have worked with have had the toughest time overcoming when transitioning to a concierge practice. In a concierge practice, the worth of a patient almost cannot be overestimated. Let’s take for example a practice whose annual revenue is $1700 per patient. ($1500 retainer and $200 average in insurance billing and co-payments). Assuming we are talking about on on-going practice that has already has enough patients to cover its major fixed costs (rent, staff, etc.), we can say conservatively that 90% ($1,530) of this amount can be considered profit.

Evidence shows that a well run concierge practice retains 80-90% of its patients from year to year (including deaths, moving, and voluntary exits). If at most only 20% of the patients leave every year, then the average patient stays in the practice for 5 years.

Therefore, a new patient is worth $7,650 (1,530 x 5) in average profit to the practice – Not an inconsiderable sum and one worth some investment of time and money to secure. This figure is especially important to keep in mind when you are first embarking on a transition and you are trying to justify marketing, staffing, office space, and consulting costs that would have been out of the question in a traditional practice.

What if my retainer patients Underutilize?

Author: Bert Polacek 

In the concierge environment, it is no longer enough to wait for patients to call.  Part of superior service is to reach out to patients for both medical and non-medical reasons.  Medical follow up is crucial to instilling trust with the patient that his or her care is being closely watched.  Outreach also establishes the patient as a valued member of a practice focused on personal attention.  When done on a regular basis, this is another point of differentiation from the traditional practice and reinforces the value of a concierge practice. 

The follow up could come as a result of a prescribed regimen or simply as a call to monitor ongoing conditions and progress.  Every opportunity to connect with the member should be taken advantage of.  This includes the obvious post-specialist visit, test results, etc. Outreach should also encourage the well patient to visit for wellness and preventive purposes.  A member who hasn’t taken advantage of your unique services may not readily see value in your practice when the time comes to renew.

There are also a number of ways to make contact with your whole patient population at once. This could be a well-timed seminar like one of GSC’s client’s conducted recently on selecting a Medicare Part D Plan or through a periodic newsletter which includes relevant health information as well as the comings and goings of the practice.

Lastly, with the aid of standard customer relationship management software, non-medical outreach should recognize personal milestones in the lives of patients.  Recognition of anniversaries, birthdays, special events, etc. continue to enhance the patient-physician relationship.  The Concierge dynamic is most successful when patient and physician interact and it is up to the physician to be proactive in this activity.

How does a greeting impact success?

Author: Bert Polacek 

Many, if not most, patients join a concierge medicine practice with the expectation for more of the physician’s time and attention – at the moment it’s needed. And since the phone is usually the first and most often used point of contact, the way you use this important tool can differentiate you from the traditional practice.  Phones should be answered personally by the physician or staff within a few rings.  The use of automated systems should be avoided unless absolutely necessary.  A professional yet friendly script should be implemented and adhered to.

Over time, staff must be able to recognize the caller and acknowledge their place as a welcomed member.  Obviously, this protocol needs to be extended to visits. All staff should know which patients are in the office at any given time and greet them in a friendly and relaxed manner. GSC has found it helpful when its client practices keep a log of non-medical facts about each patient (e.g. they are planning to go to Europe in July) so the interactions can be on a more personal level.This applies to physicians in particular. The doctors must make himself available 24/7 and usually will not have a staff member to act as a buffer after hours.  Calls should be returned at the earliest time possible.  E-mail, for those patients who prefer it, should be used on a regular basis.  Scheduling should be configured to allow for ample patient time and for the unexpected patient need.When it comes to superior service, a pleasant surprise for the patient is the goal.  Stories abound about how patients are shocked when the doctor answers his phone, especially after hours or weekends.  These experiences, when added to other surprise opportunities in service delivery, assure continued good word of mouth and retention of existing patients

What does my staff need to do differently?

Author: Bert Polacek 

Because of the personal nature of the successful Concierge practice, every member of the staff plays a vital role in delivering superior customer service.  To a great extent, your staff represents a distinguishing feature of the practice that weighs heavily on the level of success you enjoy.  And, because most concierge practices enjoy much lower staffing levels, there’s a greater need for cross training and multi-tasking. 

Staff must be exceedingly professional and part of a team that is clear on the objective of satisfying patient needs.  A pleasant and outgoing personality is invaluable, second only to professionalism.  Regular team meetings should be established to assure that all members are fully informed of daily, weekly, and monthly objectives.  Staff should be encouraged to develop closer relationships with patients and to take note of key patient requirements, peculiarities, personalities, milestones, etc.  Because of the increased level in expectations and accountabilities, and to maintain continuity and dependability in staff, the concierge physician may want to consider enhanced pay and benefits. In a traditional practice, the office manager’s primary roll is to ensure that the flow of the office is as efficient for the physician(s) as possible and that all information flows properly and timely for billing purposes. In a concierge practice  the concierge coordinator (the replacement for the office manager) main purpose is to make sure that the flow of the office is efficient for the patient as possible and that the information is gathered and disseminated for the optimum use in providing proper care and follow-up and billing will virtually handle itself (that is why GSC usually recommends outsourcing it). A skilled, motivated, engaged, and properly empowered Concierge staff plays a critical role in patient growth and retention and, therefore, the success of the practice. 

When do I fire a patient?

Author: Marc Grossman 

After opening day comes and the physician realizes he actually can attract a decent number of patients into his concierge practice, they realize there are patients who have signed up that maybe should not have – this may be because they had unrealistic expectations for the practice or maybe there is a personality incompatibility which precludes a proper doctor patient bond from forming. While not every patient is ideal and high-maintenance patients are necessary components of any practice, there needs to a recognition of when the contract between doctor and patient is not meeting the standards set by the doctor.

The number one concern should be the effect on other patients. If the extra attention that one patient needs is not detracting from your ability to treat them or to tend to other patients, then it probably is a situation that can be tolerated. If you are risking losing more desirable clientele then action needs to be taken.

The first step should always be a conversation with the challenging patient and discuss with them how you believe the relationship should be. In many cases it is ignorance and not belligerence that is driving the inappropriate behavior. Also, even if the conversation ends that it is best for both parties for the patient to leave the practice, they are less likely to start complaining about you to other potential patients than if the separation is not handled well. To this end, if there is any question as to the appropriate refund amount, error on the side of the patient. And it goes without saying that any transition to another practice should take into account all continuity of care issues.

What do I do with all this paper?

Author: Marc Grossman

One of the benefits of switching to a concierge practice is that even if you do not implement an EMR (Electronic Medical Record) you will only have a tenth of the number of charts you used to have to manage. However, as much as you may want to, regulators will not just let you incinerate the other 90%.

The simplest way to handle the problem is the way it has always been done. When a patient requests their medical records, they can be copied on an individual basis. Once the flood of record requests surrounding the transition has passed, all the boxes can be sent to off-site storage. However, this will incur 7 years of rental charges and most likely a large headache on the occasions where you actually need to have access to one of the archived records. And at the end of the archive period, they still need to be destroyed. The other approach is having the records scanned. This will require a lot more upfront work but once it is done, it is done. If all records are scanned, when a patient requests their records during the transition, you hand them the original. Instead of having to store a roomful of boxes, you have a handful of DVD’s, one copy of which you can keep in the office for easy access and another is an off-site location. The interesting fact about these two approaches is that over the seven year period, GSC has found they are comparably priced is many cases. While this, like most decisions in the transition process need to be applied to your particular situation, the right path taken in an expeditious manner can make the transition process go a whole lot smoother.

Does an Attractive Office Really Matter?

Author: Bert Polacek 

A warm and inviting office can reflect a tangible improvement from the traditional medical practice.  Because space needs in a Concierge environment are typically less, more resources can be diverted to space of a higher quality, location, more amenities, and upscale décor.  Even though waiting rooms are unnecessary in a well run concierge practice, the overall visual impact of a high-end space reassures the patient that this is indeed a practice worth talking about and remaining with.

In this new environment of Concierge medicine, superior customer service effects both continued growth and retention of patients.  Concierge physicians take great risks and make substantial investment in the pursuit of a better patient care model.  Investment in keeping existing patients is more important than gaining new ones.  Delivering on the promise and attention to detail will insure that these objectives are met.  The successful Concierge practitioner will learn and take cues from his everyday interactions with vendors, servers, customer service representatives, hotel and restaurant staff, and all service organizations he comes into contact with.  He will incorporate the best practices of these and avoid the worst.       

However, less is many times more. A few of the correct adjustments to the décor can truly make the office have the appropriate feel. Too many items will hinder the feeling of freedom and openness that is necessary to make the patient feel special and too expensive items will make the patient think that too high a percentage of their retainer fee is going to unnecessary luxury.

If I build it, will they come?

Author: Marc Grossman 

Since most physicians are not fortunate enough to have a mysterious voice coming from a corn field to give them accurate advise, they are (and should be) concerned about if there is a enough interest in a concierge practice within their current patient base to create critical mass in the new practice.

Most physicians start off trying to answer this question with the obvious method – they ask some of their patients. However, human nature skews these results – a person is more likely to ask someone who they have a good relationship with instead of a random person and patients are not comfortable telling doctors directly to their face that they are not worth the retainer amount.

The other half of the problem occurs when trying to apply the results to your patient population as a whole to determine how many patients to expect on opening day of the new practice. First, you have the issue of who is actually still in your practice. At any given time in a traditional primary care practice, 15 to 40% of the patients who have had an appointment in the last year are never planning to come again and probably have not bothered to tell anyone in the doctor’s office about it. While there is a slight chance that your concierge practice might appeal to them, it is unlikely. Also, there is a major step between seeming to like the idea of concierge medicine and actually writing the check. This drop off must be accounted for. And the list goes on and on. A thorough demographic analysis of the practice and the surrounding community is required to come up with reasonable answers to these questions.

Finally, how many of them will need to come in order to make the practice viable? The biggest variable is this is what is each going to pay. Two hundred patients at $2000 a piece generates more revenue than 250 patients at $1500. And because the practice has a maximum number of patients, the retainer price is directly related to the maximum revenue the practice can generate. On the flip side, a lower volume at a higher price is not always better – a critical mass is required to pay the bills as well as to provide word of mouth advertising.

Ergo, the high level exploring of “If I build it, will they come?” just generates more questions. The only way to come to a realistic answer is to perform a comprehensive patient survey and demographic and financial analyses. Maybe they will come to the same conclusion as your gut instinct – but they are a lot less risky.