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Chronic Care and Concierge: An Innova1ve Business Model for Independent APN Prac1ce John Zubro, DNP, FNP 855-914-2273 [email protected] Texas Tech University Health Sciences Center, Lubbock, Texas The Modern Healthcare ‘gap’: A Bridge Too Far? The Advance Prac;ce Nurse (APN): Bridging the Gap Concierge in Heathcare: The Basics Future of Nursing Report The Triple Aim Chronic Care Model: Framework for APN Concierge Prac;ce Affordable Care Act Falling supply of primary care physicians Rising health care costs In 1996, Drs. Howard and Maron of SeaSle, Washington are widely credited for first coining the term “concierge medicine” based on their retainer medical prac;ce The central theme of a retainer style prac;ce is maximizing the ;me available to care for pa;ents by enhancing the access pa;ents have to their healthcare provider. The enhanced services offered may vary widely but oXen include such benefits as significantly longer office visits, expanded hours of opera;on, weekend visits, house calls and 24 hours / 7 days a week electronic/phone access to the provider. CraXing a Concierge Business Plan The economics of retainer healthcare prac;ce is much different than tradi;onal models as it typically relies almost exclusively on membership fees paid under a contract between the provider and pa;ent. Healthcare costs have risen to over 17% of the U.S. GDP The concierge prac;ce may elect to forgo all insurance claims, or may also bill the insurance carriers directly but this design must be carefully constructed so that the concierge membership fee is not collected for payment of healthcare services otherwise considered, by the insurer, a covered benefit. Ethical considera;on include the limited number of pa;ents in any given prac;ce, the poten;al crea;on of a mul;;ered system of care, the conversion of exis;ng prac;ces may impose disenfranchisement upon pa;ents unable or unwilling to pay the fees and the risk of doublebilling for insurance covered services. A concierge prac;ce’s primary financial strength, the membership fee, is also its principle financial weakness. Membership based financial models can be vulnerable to economic downturn and must be supplemented by other revenue streams. Revenue sourcing in bou;que medical prac;ce is not new to healthcare but is rela;vely new to primary care arena. Popular sources include allergy tes;ng, hormonal evalua;on and aesthe;cs. Now, more sophis;cated approaches have been developed for early detec;on of cardiovascular and cerebrovascular ailments. The author has developed a concierge model based on a monthly fee ($59) wherein pa;ents are offered enhanced access by both conven;onal means and advanced telecommunica;on systems as well as through social media outlets. In the author’s prac;ce model, a cardiovascular health screening program franchise was selected thus appropria;ng a separate and robust source of revenue. Legal barriers restrict APN prac;ce to the full extent of training. Must improve pa;ent experience & outcome while reducing costs Success or failure of the ACA rests squarely upon primary care Only about 10% of gradua;ng physicians choose primary care
