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When Your Work Spirals Out of Control …

It’s time to change your business model

December 11, 2012 By Denny Hatch

When Peggy and I moved to Philadelphia 20 years ago and were looking for a doctor, someone recommended "Dr. Tom Harrow" (not his actual name), with a practice five blocks from our home across the street from the teaching hospital where he's clinical assistant professor of medicine.

I went to see him for a physical and he was (and is) terrific. Soft spoken, he asked a lot of questions, listened to my replies and took extensive notes. And he examined me expertly from toes to nose.

Peggy and I have since been back to him numerous times and he has been simply great—thorough, meticulous and a diligent note-taker. The specialists he has referred us to are the top people in the Philadelphia area.

On the wall of the little examining room is a huge framed montage of sports photographs along with badges, sideline permits and tickets. I discovered he was not only head team physician for one of Philadelphia's major sports teams, but also lead internist for another. We see him sometimes on TV ministering banged-up athletes.

With the combined salaries of these two teams being roughly $200 million a year, the owners would be nuts to entrust their precious assets to anything less than a world-class physician. From first-hand experience, I can testify that Dr. Harrow is world-class.

When I turned 65, I went to see Dr. Harrow for something or other and we talked Medicare. I said I assumed that the federal government's Medicare reimbursement payments were lousy and that if there were any tests or treatments he wanted to perform that he would lose money on, I would gladly make up the difference.

His icy response: "Under Medicare, it would be illegal for me to take extra money from you. I could lose my license to practice."

The Downward Spiral
Alas, over the past several years, Dr. Harrow's service deteriorated. Sometimes we would phone in to get a prescription renewed and we'd get no return call. Or the line was busy. It got to the point where I would have to walk over to his office and physically hand the pill bottle to one of the office personnel who would arrange to call it into Rite-Aid.

I started resenting him. We'd make an appointment and then wind up sitting in the crowded waiting room for an hour or more.

However, since he is one of the very best in the world-recognized regularly in Philadelphia Magazine's Top Docs issue-we didn't want to start all over again with a new doctor, so we put up with the inconveniences.

The New Concierge or "Boutique Medical Practice"
What triggered this column was Jerald Winakur's Wall Street Journal Story, "'Concierge' Medicine, ObamaCare and the End of Empathy."

Other stories in my archive: "For a Retainer, Lavish Care by 'Boutique Doctors'" and "Some Doctors Downsizing to Improve Care."

Early last spring, Peggy made a doctor's appointment and an associate in Dr. Harrow's office alerted her that his practice would be changing over to a "concierge practice." A direct mail information packet and an invitation to a live presentation would follow.

A Highly Personal, Wrenching Encounter
Last May 17, 100-or-so patients of Dr. Harrow assembled in a small hospital auditorium. After the introductions, Dr. Harrow took the lectern. He looked emotionally and physically drained and frankly admitted it. Among the revelations:

  • While he had a staff of nurses, other M.D.s, assistants and office personnel, his practice had grown to 3,000 patients and he knew that was he not serving any of them well. This was not the kind of medicine he signed up for when he went to medical school.
  • The reporting system required by the hospital health system is overwhelming. He would get home at 6 or 7 p.m. and start transcribing notes during dinner and work until midnight and beyond, sometimes getting up at four in the morning to finish up.
  • Many weekends and some evenings were taken up with the sports teams. Basically he had no life.
  • In addition, many physicians these days who send their patients to the hospital, simply hand them off to the resident staff. "I have always believed that if a patient of mine is in the hospital," Harrow told us, "I want to be there on a regular basis just to make sure everything is okay and the patient is receiving the best of care."
  • The object of this concierge scheme was to get his caseload down to 400 patients. Harrow hoped to be able to schedule eight patients a day. For those patients in his practice that decided not to sign on to the concierge service, he would staff up with additional physicians and support personnel to make the rest of the practice smoother.
  • What if he were on the sidelines of sports event and a concierge patient needed him? "You'll have my cellphone number," he said. Other physicians in the practice would cover for him just as he would cover for them when they are away.
  • In short, the current system was eating him alive. He had to do something.

What the concierge service offers:

  • 24/7 access via member phone line and email.
  • Extended, personalized physician wellness visits and ongoing tailored health and wellness counseling.
  • Same-day/next-day appointments upon request.
  • Medical advocacy services.
  • Private reception and waiting areas with amenities including refreshments and wireless Internet.

Patients of this major hospital system will receive the following additional services:

  • Facilitated care and referral services.
  • A personalized, coordinated and cohesive approach to health care.
  • Access to the hospital system's online health management tool.
  • Access to hospital system specialists.
  • In addition patients are afforded "the peace of mind that comes with having access to the sophisticated treatments and services of the entire hospital system."

The cost: $2,500 per person per year for membership. All co-pays, Medicare and insurance payments, etc., remain in force.

If he sells out completely-signs up 400 patients-that gives him one million bucks year to take the pressure off.

"This is the way I want to practice medicine," he said.

Essentially, we would be buying Dr. Harrow.

We bought.

Takeaways to Consider

  • When your work is spiraling out of control, you probably don't want to ride it all the way to oblivion.
  • How do you change a business model? One possibility: go online and find out what your competitors are doing and then "steal smart."
  • Once you've decided to change your business model, you may want to get professional help.
  • For example, Dr. Harrow hired a consultant in this niche specialty to 1) create thoroughly professional mailings and brochures that would enable him to 2) break the news to his patients and sell them on the proposition as well as 3) facilitate the transition.  As a horrendously busy doctor overseeing 3,000 patients, it would be suicidal to undertake copy, design and mail production (something he knows nothing about) on top of what he's already doing.
  • Need a consultant? Hire one the same way you would hire any employee-thorough background check, testimonials from satisfied clients, etc.
  • Cosndier this recent article from Bloomberg Businessweek, "Is Concierge Medicine the Future of Health Care?'



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