The dichotomy in healthcare between in-network providers and out-of-network providers is growing starker with each passing day, and those two options are shaping future healthcare delivery and patient experience.
"Corporations are taking over healthcare. Are we really going to allow a publicly-traded company to make decisions about healthcare?" asks James L. Chappuis, MD, FACS, founder and owner of SpineCenterAtlanta. "If you have insurance plans where patients are forced to see an in-network provider, essentially a gatekeeper for the insurance company, before they will look to see if you're indicated to see a specialist, some patients won't receive the best care for their condition. The patient might not meet the criteria to see a specialist, especially one who does not subscribe to the insurance company's in-network model, so they aren't able to get the care surgeons and other specialists would recommend."
The influx of new patients with insurance plans and exchange plans means more patients are insured, but many don't fully understand their financial responsibility and care limitations.
"Having insurance does not ensure the patient will receive the care they need nor in a timely manner; adjusters, case managers, physician reviewers and the like control the care of patients they've never met and certainly never examined. It's exciting for me to see consumers gain control of healthcare, and as Americans we are great consumers," says Dr. Chappuis. "Patients have options today and they are more closely studying the healthcare plans. A new trend is termed CDHP's, Consumer Driven Healthcare Plans, which give patients control over their healthcare dollars. As practitioners we have to embrace the evolution of healthcare, as the in-network model is broken. For entrepreneurial practitioners, changes in healthcare open the door to new opportunities."
Patients who aren't happy with their in-network provider, or those who have health savings accounts, can see private practice, out-of-network specialists. Patients with out-of-network access look online for specialists and the latest and most current treatments available; when they find what they are looking for, they are willing to take back control of their personal healthcare and pay out-of-network prices.
"Most private practice physicians are being forced to decide between remaining private or joining a large healthcare network," notes Dr. Chappuis. "Those of us who want to continue in private practice must meet and exceed the expectation of the patient; if the patient is going outside of their network and pay more for their services, they expect and demand good customer service and a stellar experience. To be a good private practitioner in the current healthcare economy, you have to offer a comprehensive program so the patient receives all the treatment needed in one group or one location."
Private practice physicians entering into boutique or concierge practice models rely on out-of-network or self-pay patients to keep the practice financially solvent. Those patients are holding their healthcare dollars close to the cuff, becoming better consumers of healthcare as a result.
"The patient pays more of their cost, so they are looking for value," says Dr. Chappuis. "Does Gucci provide enough value for people to pay two or three times the normal price for a purse? It's a premium product. So is the boutique medical practice. Patients have to pay more for services so they need to feel like they've received premium healthcare."
For physicians who want to pursue a private concierge or boutique-style practice, key concepts for success include:
• Launch a good website to market services;
• Show pictures of the practice online;
• Accept appointments online;
• Display a good bedside manner;
• Limit patient wait times;
• Hire staff who treat patients like customers, ie: be "patient-centric";
• Offer different payment plans and payment options;
• Provide a clean, well-appointed and inviting facility;
• Encourage patients with positive experiences to leave online reviews
"People look online at rating sites for big purchases like washing machines and refrigerators to see which brand is best and what other people are saying," says Dr. Chappuis. "If consumers buy a washing machine based on online reviews, why wouldn't they do the same thing to find a surgeon or specialist? In fact, now they do."
Good self-esteem is also an important quality for surgeons opening these types of practices. Surgeons who are small business owners are banking on their skill and their ability as a surgeon to survive. That is no longer enough. The private practice physician must have an entrepreneurial spirit and a staff that buys into the boutique experience in order to drive the high value patients are seeking. Not every surgeon wants this situation. Not every surgeon is suited for this situation.
"If the surgeon wants to walk in and just be a physician, joining an in-network facility is probably best," says Dr. Chappuis. "But if you are willing to hustle and market the practice, attend business seminars and surround yourself with a leadership team that understands the business of healthcare, the out-of-network model is sustainable; if you're an entrepreneurial physician, you'll be stifled by in-network situations."
Private practices must provide the individualized attention their patients require. It takes extra time to become familiar with every patient and their condition, which is why the boutique-style practice charges more; as a spine specialty healthcare organization, we can't be a high-volume, quickly in-and-out practice. Attention to detail cannot be rushed, especially when the patient is paying more for their care and they need intimate and in-depth information to make a decision about spine surgery.
"The patients rarely remember what you did or said, just how you make them feel," says Dr. Chappuis. "The patients want their issues acknowledged, especially if it involves pain. And they want to know their options. As an out-of-network provider, I try to get to know each patient and see if they are a surgical candidate or simply need conservative care. When we listen carefully to our patients, they'll usually tell us why they're there, what they need and what they expect."