Throughout the COVID-19 pandemic, most physicians have been canceling or rescheduling non-urgent appointments. In fact, Dr. Deborah Birx, coronavirus response coordinator for the White House Coronavirus Task Force, advised in mid-March, “Things that don’t need to be done over the next two weeks, don’t get it done.”
But this reduced access to physicians and medical care comes at a time when patients have an increased need for medical advice and reassurance in the face of a never-before-seen virus.
There are some physicians who have been uniquely positioned to provide continuous, personalized care to their patients during this time of intense need: those practicing in a concierge model.
Concierge physicians address increased patient needs—remotely
Dr. Jean Beaton, a primary care physician in Washington, D.C., explained that with the emergence of COVID-19, “There’s been a sudden increased need for care, for information and explanations, for getting questions answered and fears addressed. … I’ve never seen patient need so acute.” These sorts of questions and concerns are typically things that she would have covered during office visits—but she’s had to close her office and struggle to get alternative telemedicine offerings up and running.
Dr. Alan Morrison, also a primary care physician in Washington, D.C., has had a similar experience with heightened patient anxieties. He explained, “The phone doesn’t stop. The emails don’t stop. The texting doesn’t stop.” What are all these calls and emails and texts about? Dr. Jeffrey Graf, a primary care physician and cardiologist with a solo practice in New York City, said he has received many calls with questions about COVID-19 symptoms, whether his members should get tested, where they can get tested, whether or not they should risk getting tested, when blood tests will be available, and more.
But the difference for Dr. Morrison and Dr. Graf is that they were both already established as concierge medical practices with Castle Connolly Private Health Partners (CCPHP). Unlike Dr. Beaton, they already had a robust telemedicine offering in place before the pandemic hit. Dr. Morrison noted, “My ability to get back to people and respond to them in times like this is totally different than what it used to be, primarily because of the connectivity. The fact that we were ready to go with connectivity and telemedicine from the start, that changed everything.”
The ability for concierge physicians to care for their patients during this challenging time is not just about the connectivity, though. One of the hallmarks of a concierge, membership-based practice is a smaller patient panel. Thanks to a smaller panel—generally a few hundred patients instead of a couple thousand—concierge physicians are able to spend more time with and build a deeper relationship with their members. Dr. Graf explained that he’s been able to get to know his concierge members at a level that allows him to hear the true meaning of their concerns and make better judgment calls in a remote setting.
“The people in this program are people who I know well and typically have a long-term relationship with,” said Dr. Graf. “This helps me to understand what these people are really thinking when they’re asking medical questions and to deal with their issues without seeing them in person.”
Quality information and communication are key
With so many unknowns surrounding COVID-19, patients haven’t been the only ones with endless questions. Physicians have been facing many uncertainties as well, plus a deluge of information with varying levels of quality. Castle Connolly Private Health Partners has stepped up to curate the most important and reliable information for its physicians and patients alike, regularly communicating with all doctors and members.
“They provide regular email updates on where to gather the best information,” said Dr. Steven Schneider, a primary care physician in New York City who also has a concierge practice through CCPHP. “There’s so much information out there—you could spend 24 hours reading articles that have some value, great value, or even no value. They direct us to where we can get the best summaries of the current situation.”
These valuable sources include live connections with the experts themselves on weekly Zoom calls hosted by CCPHP. One of those Zoom calls featured Dr. Marisa Montecalvo, an expert in infectious disease; another featured Dr. Gabriella Farkas, who spoke on emotional wellbeing.
To make sure every member feels informed and supported, CCPHP has also been facilitating a regular series of emails customized for each practice. “They’ve been putting out emails to all of my patients, keeping them updated on the status of the infection, continuously reinforcing my availability via text, email, and phone,” explained Dr. Schneider. “Lots of doctors [in traditional practices] are hard to get in touch with right now, but my members have been getting special attention.”
Going above and beyond for patients
Thanks to both smaller patient panels and high-quality resources available through CCPHP, these concierge physicians have been able to go above and beyond in a variety of areas to deliver exceptional care for their members during this pandemic.
Dr. Schneider, for example, began preparing his patients for the virus outbreak in January, handing out masks, gloves, and disinfecting wipes to patients at their visits. For those members he didn’t get to see before closing his office, he’s been directly mailing them supplies. He has also been personally calling each and every one of his members to check in on them. As he explained, “This is a good time to know your doctor is available 24/7.”
Dr. Graf has been able to take exceptionally good care of his cardiology patients from afar, thanks to a remote monitoring solution CCPHP suggested. “I spoke with Dean [at CCPHP], and he told me about this remote monitoring solution for patients with hypertension and connected me with the company that provides it,” said Dr. Graf. “Now I can care for them from a distance with real data.”
Dr. Morrison decided that since he had the ability to provide COVID-19 testing to his members in one of the safest environments possible, he should do it. “Since we have a smaller practice, we can bring one patient in at a time, then clear the room and disinfect it after they’ve been here,” he said. “I have a small group of members, and I’m able to test them while protecting myself, so I feel obligated to do it.” He admits it would have been impossible to offer testing safely with a typical patient panel.
Physicians find a financial safety net
Beyond dealing with an entirely new and devastating disease and its medical implications, physicians in small and private practices across the country have been facing devastating financial situations, too. A recent article in Medical Economics explained that physician practices are seeing declines in patient volume of 30% to 75%, and the business of primary care practices is down 40% to 50%. Even with reimbursement for virtual appointments, many small practices are struggling to get telehealth up and running.
Thankfully, concierge medical practices have a bit of a safety net in the form of their membership fees.
“I’m in practice by myself. I run a business. I have salaries to pay. I have overhead, which is enormous in Manhattan,” said Dr. Graf. “Financially, this is a disaster. Were it not for the concierge program, I could not survive.”
Dr. Beaton and her business partner, Dr. Lisa Kaufman, have a unique perspective on this issue, as they have yet to officially transition their practice to the concierge model. “At places like big hospital groups, those physicians are on salary and they’re still getting paid,” said Dr. Kaufman. “Our situation is not that. We only get paid if we see patients. So, it’s a scary time for everybody right now.”
She recalled a story told by a colleague in a concierge practice: “A lot of his members have left the area [New York City]. They’re calling him from all over the place now. If he’d been in a regular practice, he wouldn’t have any way of staying in business. But he feels he can take his time with people, take good care of them, and doesn’t have to worry if he’s going to still be in business in six months.”
Dr. Beaton said that she considered pausing the transition to concierge medicine as the COVID-19 crisis grew, but she thought it would be shortsighted. “Right now, we’re seeing that our patients need more care,” she said. “If we were already working in a concierge model now, or if we are when the next crisis hits, we’ll be in a much better position to address their needs through both increased time and flexibility.”
Predicting some certainties in an uncertain future
While the future of the pandemic is still extremely uncertain, these physicians feel sure about one thing: Practice is unlikely to be the same moving forward.
Dr. Beaton predicts that telemedicine is here to stay: “It’s useful for patients, not as a replacement for good relationships, spending the time with patients, bringing them into the office, but as another venue to connect with your doctor that’s more flexible.”
“I think we’re going to have a whole new reality,” Said Dr. Schneider. “We’ll have to screen people before they come in, have their temperatures checked, they’ll all have to wear masks.”
Dr. Graf also predicts changes in the way he’ll be seeing patients: “I’m going to need to make schedules accordingly, spacing patients, organizing the waiting room, providing things like hand sanitizer, and protective equipment—this is the first time I’ve bought scrubs since being a fellow! I’m not sure how many days I’ll open per week. I’m sure this will be a slow and painful experience for everybody. I think the change will be long-lasting, unfortunately.”
That reality makes Dr. Graf thankful for the support he has for his practice. He said, “The people at Castle Connolly are really invested in my success. They want me to be happy, to be able to interact with my colleagues in the program. They care. That’s a nice thing these days—and many physicians don’t have it.”
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