The Patient Protection and Affordable Care Act set in motion several challenges for independent physicians wishing to maintain their autonomy, and in response Texas Back Institute has launched a concierge practice to serve a select group of patients with boutique services and care.
"American medicine is rapidly heading to a two-tier system similar to many other countries, like England and Australia," says Scott Blumenthal, MD, Co-Director of the Boutique Spine Program at Texas Back Institute. "We see a coming demand for something above and beyond what the evolving payer system will offer."
Primary care already has established concierge practices across the United States and has attracted patients looking for personal attention as an alternative to the basic medical care. "Spine surgery is such a potentially life-changing event, patients will seek out high quality personalized care options," says Richard Guyer, MD, Co-Director of the Boutique Spine Program at Texas Back Institute.
While a set definition of "concierge practice" doesn't yet exist in spine care, the boutique experience at Texas Back Institute includes access to specialists 24/7, personal services, travel arrangements and telemedicine visits. Patients who subscribe to the concierge practice are generally self-pay, so they can receive medical care without the restrictions from insurance companies.
Building a concierge practice
Concierge-style practices require a core philosophy of dedication to excellent customer service and surgical service, says Dr. Blumenthal. Excellent patient-centric service and high-quality, consistent surgical substance will breed success.
"Trying to attract paying patients by claiming to offer a boutique spine practice will be very attractive to groups and hospital systems, but the infrastructure and surgical core cannot be built overnight," says Jack Zigler, MD, Co-Director of the Boutique Spine Program at Texas Back Institute. "At Texas Back Institute, we have been building this model for six years, having recognized very early on that this would be the direction many patients will look to."
One of the first steps is tracking outcomes data to prove quality and consistency. Armed with that data, surgeons can begin pivoting their practice to accommodating self-pay patients.
Delivering on the boutique promise
Patients are willing to pay for boutique spine care, but your program must meet their expectations. Delivering the end product is the biggest challenge, says Dr. Blumenthal, which means consistently achieving high-quality surgical results.
"Promotion and an attractive waiting room will not suffice if the delivery of high quality service is not there," he says. "Practice-generated data, publications history and surgical experience will become increasingly important to educate consumers that their choice is clear."
Before launching a concierge program, key questions to consider include:
• Does the surgeon have more experience than competitors?
• Can the surgeo
n consistently deliver that service better than competitors?
• Does the surgeon have the surgical experience and expertise to differentiate from competitors with commercials and ads, but no verifiable outcomes?
• Does the practice have outcomes data?
"Our boutique patients have done extensive research and understand that not only were we the primary investigators in key clinical trials and authors of seminal publications in the field, but also have maintained high volume of successful surgeries that offer patients a streamlined experience within our boutique system," says Dr. Guyer. "Our infrastructure has evolved into a seamless system that can engage patients from the initial contact through surgery and aftercare, no matter where they live geographically."
Fighting back against insurance companies
Many patients with low back pain have been through the gamut of conservative treatment, yet symptoms persist. However, in some cases insurance companies deny coverage for spinal surgery for patients with degenerative disc disease. A boutique-style practice allows the surgeon and patient to develop appropriate treatment without insurance company approval.
"The writing is on the wall for patients with functionally disabling low back pain," says Dr. Zigler. "Payers are already telling us surgery for degenerative disc disease of the lumbar spine will not be routinely paid for. Yet patients want definitive treatment rather than lifetime pain management. Educated patients prefer arthroplasty to fusion."
Self-paying patients who are candidates for artificial disc replacement will likely feel more comfortable with surgeons who have done a high volume of procedures, says Dr. Blumenthal, and groups that can provide evidence on their outcomes.
"Centers of Excellence chosen by the self-pay patient will be those with a track record of extensive surgical experience with successful outcomes and happy patients," says Dr. Blumenthal.
A trend for the future?
Factors driven by healthcare reform, such as an increasing patient population and downward pressure on reimbursements, are forcing physicians to make tough choices about the future of their practice. Many are becoming employed, but a boutique-style practice as becoming attractive to physicians in the future.
"The single physician practice is rapidly proving itself to be unsustainable," says Dr. Guyer. Young surgeons are gravitating toward hospital employment or large groups, and the entrepreneurial-minded physician could preserve autonomy with a new practice model. However, quality of care is paramount to the surgeon's reputation and business.
"There will certainly be many pretenders, but few that can deliver on all fronts," says Dr. Zigler. "There has to be strong substance behind the façade of a label and an ad. Empty, unfulfilled promises will result in embarrassment and failure."
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