Some physicians looking for the steady income and slower pace of concierge medicine who have not wanted to give up their traditional practice have found a new solution: a hybrid practice that lets them devote a small percentage to the retainer side while keeping their roster of traditional patients.

So far, the full concierge model has not proven to be very popular. Only a tiny fraction of the nation's almost 1 million physicians have chosen the concierge route, according to a recent study for the Medicare Payment Advisory Commission (MedPAC).

Researchers at the University of Chicago's National Opinion Research Center and Georgetown University determined that about 750 physicians have gone to such retainer-only practices in which patients pay a monthly fee in exchange for longer appointments, same-day appointments, annual physicals, and the ability to reach the physician directly by e-mail or cell phone.

The hybrid model is being promoted as an alternative by Concierge Choice Physicians, a Rockville Centre, N.Y.–based private company. CCP says more than 300,000 traditional and concierge patients are being managed by physicians who have contracts with the company.

Dr. Gary Levinson, an internist in private practice in San Diego, is one of the physicians who has chosen to try a hybrid approach with CCP. Dr. Levinson said that he was looking for a way to spend more time with patients; besides a busy office practice, he is also on call.

After hearing CCP's pitch, Dr. Levinson says he was sold, largely because the company's model would give him an opportunity to keep his existing patients. He and his partner have 3,500-4,000 patients. Of those, less than 100 are in the concierge practice. These patients pay $1,800 a year for an annual physical (the practice bears the costs of all diagnostics), faster and longer appointments, and direct access to the physicians.

Initially, CCP mailed letters to the practice's patients to let them know there was a new concierge option and invited them to meet with Dr. Levinson and his partner over two evening sessions. At those sessions, the physicians described why they went into medicine, and what they saw as the merits of the concierge practice, Dr. Levinson said. Some patients signed up on the spot, while others joined later.

So what kinds of patients signed up? Some have serious chronic illnesses, but others are just more proactive about their health, he said.

Dr. Levinson said that his office has a separate staff member who's devoted to concierge patients. An hour each morning is blocked for the concierge patients; if the slot is unused, Dr. Levinson takes advantage of the time to catch up on paperwork or uses it to accommodate a non–concierge patient.

He's also found that the concierge patients do not abuse the 24/7 personal access. So, while it could be a burden, it has ended up being completely manageable, he said.

Even so, to keep an appropriate balance between the concierge side and traditional practice, he's capping the number of patients he'll enroll at 150.

Aside from the revenue boost that's come with the hybrid model, everyone – from his staff, to his patients, to himself – is happier, Dr. Levinson noted. He gets to know the concierge patients better, which makes him a sharper practitioner. The traditional practice patients reap the benefits of his lowered stress levels. “Overall, I'm happier. I enjoy my job more because I'm not beating myself up to make a living,” he said.

Dr. Robert Altbaum, an internist in Westport, Conn., said that he's also been a lot happier since adopting the CCP hybrid approach. He first began looking at a concierge model about 8 years ago when Medicare physician fee cuts appeared to be something that could happen.

But he and his six partners decided to table the idea because they worried that they would lose too many patients. Ironically, a few years later, some of the practice's patients started migrating to a concierge model.

The partners started searching again for a way to fend off Medicare cuts and better serve patients. After reading about the hybrid approach, four of the seven partners decided to give it a try a year ago.

Dr. Altbaum said he's limited his concierge patients to 5% of his practice, or 100 patients. He comes in a half hour earlier and leaves a half hour later – concierge patients get the first and last slots of the day – which has added 5 hours to his week.

He has given up what used to be a day off, but, it has added 20% to his bottom line for about 10% of his time. And, he said it's made him more available to his other patients because, in a sense, he's now seeing 100 fewer patients.

All his patients are “uniformly happy,” he said, adding that he's more relaxed.

Dr. Altbaum and Dr. Levinson both reported no conflicts of interest.

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Dr. Gary Levinson has less than 100 concierge patients out of 3,500-4,000 in the practice.

Source Courtesy Dr. Ari Laliotis

Hybrid Model Blends Concierge Care, Conventional Practice