Back on the SOAPM list, I saw an interesting discussion about concierge practices. There was the usual commentary ('Only crazy people in super special circumstances could do that!'), so I thought I'd take a moment to dispel some of the myths. I suspect that if some of the naysayers stopped to do some simple math, they'd be surprised by the results.

Let's pretend that you are a busy practice in northern NJ making good money. What would it take to drop all of your insurance and spend more time with your patients? How much would you have to charge people?

We'll make some grand assumptions:

• You are aggressive with your immunizations.
• You get your kids in for physicals.
• You see your ADHD kids at least 3 or 4 times a year, diabetics are monitored closely, etc.
• You take some Medicaid.
• You're busy, perhaps too busy.
• You are not willing to sacrifice your clinical impact or your financial situation.

Let's say that you end up doing 30,000 visits a year and bring in $100 a visit. You have 7500 active patients who make up these visits.

Do you know how little money you would need to collect from your families instead of the insurance companies to maintain your standard of living and care?

7500 active patients, divided by $3,000,000?
$400 per patient per year.  Not even $40 a month.
Think about that. If you simply skipped the middleman, you'd have to only collect $400 per patient to meet the same level of income you have presently. That's providing all the immunizations, taking in everyone who calls (which you do now), having the same staff, etc.

I realize, of course, that it's not that simple. All your patients won't do it, for example.

But think about it a little more. If only 1/3 of your patients chose this route...you would only have to charge them an average of $1,200 apiece. That's it. $100 a month. And you could spend an hour with them every time they came. Imagine...1/3 the visit volume, only $100 a month. You could probably cut your staff by 2/3s, increase the pay of the ones who are left so they'd never leave, and give each new mom a massage with every visit.

Believe me, this is the math the insurance companies don't want you to see. For once, it isn't the money that's the problem.

[In my mind, there are two great variables here: the age distribution of the practice and the health care you don't provide. Those are both quite manageable.]