Is concierge medicine right for your small practice?

Why some independent practices pivot to a membership model of care

For many clinicians who have gone into independent practice, the day-to-day reality of delivering care may not live up to the experience they envisioned as medical school students. Instead of getting to know patients in depth, they’re making crucial clinical decisions based on a brief 15-minute encounter. Meanwhile, the administrative burdens of working with public and private payers continue to mount. Reimbursement rates are flat — or falling — while denied claims and delayed payments disrupt cash flow.

With fewer opportunities to connect with patients and more bumps in the road to reimbursement, it’s no wonder some small and medium-sized practices are looking into alternative care models that align more closely with their values and goals. One model gaining traction is concierge medicine, sometimes referred to as membership or retainer-based care. But is it the right move for your practice?

Let’s take a clear-eyed look at the considerations clinician-owners and administrators should weigh before adopting a concierge medicine model.

Understanding the concierge medicine model

How do we define concierge medicine? At its core, concierge medicine involves charging patients a recurring membership fee — typically monthly or annually — in exchange for enhanced access, personalized care, and often a more unhurried clinical experience. The membership fee may cover all primary care services (also known as direct pay primary care) or serve as a retainer that unlocks more convenient access to the clinician.

Because concierge practices typically limit patient panels significantly, they’re able to offer patients additional perks, such as same- or next-day appointments, longer visits, direct communication with the physician, or even 24/7 availability. Depending on their structure, these practices may choose to accept traditional health insurance or not, instead requiring patients to foot the bill for services not covered by the membership fee.

Why some practices are making the shift to membership care

For smaller practices feeling the strain of high administrative overhead, shrinking reimbursements, and patient volume pressures, the concierge care model can offer an appealing way forward. Its advantages include:

• Increased autonomy: With fewer patients and less dependence on the billing and coding requirements of public and private insurance, physicians often regain control over how they spend their clinical time.

• Deeper patient relationships: Smaller patient panels allow for continuity and more time for comprehensive, personalized care, which can be professionally gratifying.

• More predictable revenue: Membership fees can smooth out cash flow inconsistencies and reduce a practice’s dependence on variable insurance reimbursements.

• Reduced burnout: Many clinicians find that a slower-paced practice driven by patient-provider relationships helps combat emotional fatigue and rekindle their passion for medicine.

• Less payer paperwork: Practices that choose to operate completely outside of traditional insurance billing can avoid the administrative burden of submitting claims and managing denials.

For smaller practices feeling the strain of high administrative overhead, shrinking reimbursements, and patient volume pressures, the concierge care model can offer an appealing way forward.

Factors to consider before transitioning to a concierge medicine model

While the benefits of retainer-based care can be compelling, concierge medicine isn’t the right fit for every practice. Consider these factors about your practice:

• Patient demographics and expectations: Would enough of your patients be willing and able to pay you a membership fee for enhanced care? Geographic location, average household income, and competitive landscape all matter.

• Regulatory and legal compliance: State laws vary widely when it comes to retainer-based care. Ensure you have legal guidance before you move forward with concierge healthcare.

• Impact on panel size and access: Moving to a concierge model typically means reducing your patient panel. Consider how you’ll manage continuity of care for patients who may not transition with you.

• Revenue modeling: Will your membership fees cover the cost of operations? What happens if patient retention fluctuates? A detailed financial projection is essential.

• Team readiness and training: Your staff will need to support the new model — from educating patients to adjusting workflows for longer visits and different engagement methods.

• Technology alignment: Concierge practices often rely heavily on technology for patient communication, telehealth, and other virtual touchpoints. Your Healthcare IT systems need to support these workflows seamlessly.

Is a hybrid concierge care model an option?

Some independent small and medium-sized practices dip their toes into concierge care by adopting a hybrid model. In this approach, a subset of the patient panel enrolls in the membership model while the rest remain traditional. It’s a more gradual shift that can offer you the chance to see whether there’s an appetite for membership care among your patients, while seeing how concierge care works in practice. Going the hybrid route will require careful segmentation and operational balancing, as well as clear communications with both sets of patients.

Retainer-based medicine is both a clinical and a financial model

Ultimately, the decision to transition to concierge care is as much a business decision as a clinical one. If, like many small practice leaders, you’re eager to align your daily work with deeper professional values while building a more resilient business model, it may be the right choice for you. It’s about sustainability, lifestyle, and deciding what kind of practice you want to run.

Considering a concierge medicine or membership model?

If concierge medicine is on your radar, it’s wise to gather as much information as possible. Start by speaking with peers who have made the transition, whether they’re membership only or testing the waters with a hybrid model. Ask them how concierge medicine has affected their patient relationships, clinical outcomes, day-to-day satisfaction, and practice stability. Find out what they’d do differently.

You’ll also want to consult legal and financial advisors on the viability and ramifications of pivoting to a membership model and evaluate whether your current systems can support the new structure you have in mind. Choosing the right Healthcare IT infrastructure can make all the difference between a smooth transition and a disruptive one. To make this pivot easier on your staff and your patients, seek out a Healthcare IT partner that can handle both traditional billing models and concierge medicine models without missing a beat. 

athenaOne®, our fully integrated EHR, practice and revenue cycle management, and patient engagement solution, empowers small practices to deliver the best possible outcomes no matter which business model you choose. See how it works.