Patient Relations Management and Concierge Medicine

Characteristics of a Retainer or Cash-Based Practice

By DeeVee Devarakonda; MBA [Former CMO of Quaero, Inc]

By Dr. David Edward Marcinko; MBA

[Publisher-in-Chief]Calendar Calculator

A young concierge medical practice is a business with challenges in these Customer [Patient] Relationship Management’s [CRM] areas that are critical for success.

Areas of Most Challenge

Maturity of Processes:

Processes are often associated with bureaucracy or stuffy hierarchical healthcare systems that are anathema to emerging concierge medical practices. At small practices, doctors are often owners who fiercely pride themselves on flat structures, autonomy and flexibility. However, processes are imperative to conduct a streamlined practice that can be woven around a CM culture that still ensures practice business is conducted in a systematic manner.

Organization Structure:

Young concierge medical practices have challenges managing growth while grappling to incorporate an organization structure that promotes the elite private practice culture.

Multi-tasking, rapidly growing work places:

Young CM practices are often characterized by employees who multi-task and assume several roles to make their resources stretch farther. Especially in the current healthcare reform climate, young practice employees take up a broader set of responsibilities. In addition, as young private CM practices grow, they may become anguished with a growing office workplace that may not be equipped with an evolving infrastructure to cope. They have a fierce need to carefully control growth with tightly managed resources.

Changing business needs and strategy:

In an era after the golden age of traditional medicine, profitability is critical for emerging concierge practices. It is imperative to be nimble and change marketing strategies as socio-political and competitive climates dictate. A good C[P] RM system is tightly integrated, but loosely coupled, to allow CM practices to communicate appropriately with patients.

Little room for Slack:

Small concierge medical practices do not have as much established name-brand equity as larger, established practices of any model type, and patients are less willing to tolerate mistakes. Concierge practices have to run a much tighter ship and build impeccable patient experiences.

Fierce Competition:

The cash or retainer medicine landscape today looks very different from just five years ago. Competition is becoming fierce and practices are fighting for mindshare and patients. Young practices are competing with older concierge practices – large traditional practices, micro-practices, behemoth healthcare systems, enterprise-wide medical corporations and every other practice model in-between – to attract and retain patients with private resources.


The above characteristics form the basis of a compelling strategy to embrace C[P]RM and streamline patient relationships and cash revenue opportunities. Concierge practices still need to build scalable marketing programs that can easily ramp up and down effortlessly as needs and economic environments demand. But, they do need to establish marketing metrics and processes that can demonstrate the Return on Investment (ROI) on their CRM, and marketing programs, and for getting critical cash-paying patient buy-in.

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10 Responses

  1. As many as 5,000 doctors nationwide have opted for full or partial concierge practices. This article, and other surveys suggest that number could quadruple within the next few years.



  2. Nice article. I believe concierge medicine is a great market based healthcare alternative. And in reality, it’s working for many people.

    Feel free to check out our conversation on this topic at

    Kandice Day


  3. Concierge Practice

    A physician starting a concierge practice would face several obstacles and challenges. Most doctors receive little business training during medical school and residency. Few have ever written a business plan. A well-written business plan can help a new practice model in numerous areas:

    – Determine the feasibility of the new business model.
    – Raise money from bankers or investors to start the new practice.
    – Development of a strategic plan and a budget for the new enterprise.
    – Reveal potential problems and risks that the new practice may face.

    Some physicians with an entrepreneurial spirit may decide to tackle this endeavor on their own, or with the help of a few selected professionals.

    For those with interest in CM but no business background or interest, there is still hope. National companies such as MDVIP ( and Concierge Choice Physicians (www.Choice.MD) will take care of the planning, business, and marketing aspects of your practice if you decide to make this transition. The “franchise fee” charged can be substantial, but you can leave the business side of the equation to experts who have done this before, and you can concentrate on caring for patients.

    Brian J. Knabe; MD CFP CMP™


  4. Myths about concierge medicine

    Brian – Myths abound concerning concierge medicine (CM). Unfortunately these myths prevent good doctors from converting their practices to CM.

    Let’s look at those myths—maybe you need to work on yourself and your own beliefs. If you practice quality medicine your patients will value you and your work and will pay a fee to join your CM practice.

    CM is a value story. If you provide solid value, you needn’t believe these myths–value trumps myth.

    Hope Rachel Hetico RN MHA CMP™


  5. Cash-only pioneers teach other docs the ropes

    Although industry estimates indicate that as little as 3 percent of U.S. physicians have made the switch to direct-pay or cash-only business models, the number of doctors exploring practicing without insurance contracts is climbing.



  6. “The Insurance-Free Dental Practice” This sounds interesting. Can you say, “concierge dentistry”?

    “The most important thing to remember is that Quality Dental Plan isn’t dental insurance. Rather, patients pay a simple, set annual membership fee directly to their local dentist, bypassing the third party entirely. In return, they receive a preventive dental care package for the whole year at that dental practice. There’s also a further savings for additional family members, and patients also save on any treatments (restorative, cosmetic, implants), with no limit, and no deductible.”

    What do you think? I’m sincerely interested in your opinion.

    Darrell K. Pruitt DDS


  7. The Ins and Outs of Concierge Medicine

    Physicians today are faced with many options when it comes to decisions related to their practice; from selling it, to adding new products or services to increase revenue, to retiring.

    While many doctors are aware of concierge medicine, and even newer options like the direct pay practice model now available, many have not fully considered all their options due to misperceptions or perhaps even fear.

    Dr. David Edward Marcinko MBA CMP


  8. Alternative business models keep doctors in business and thriving

    As doctors weigh whether to stay in their practices or become employed in a group practice or at a hospital, they’re increasingly looking to alternative business models in order to remain — and thrive.,24

    Here are a few.



  9. More on Should Docs Consider Concierge Medicine?

    Dee Vee – As u know, today’s doctor-patient relationships are under pressure.

    Providers face financial demands from the government and payors, and many feel forced to squeeze as many patients as possible into each day in order to maintain their practice.

    It’s unsurprising that new models of care are emerging that address physicians’ desires to spend more time with each patient.

    According to the American Academy of Private Physicians (AAPP), there were 4,400 concierge physicians in the U.S. in 2012, which represented a 30 percent increase over 2011.

    And, Forbes reported in January 2013 on a study that found 9.6 percent of practice owners planned switch to the concierge model in the next three years.

    Thanks for being ahead of the curve.



  10. Concierge medicine and the PP-ACA

    Congrats to Obama-care. As proponents of the CM business model for the last decade; it is a great boost to our retainer medicine colleagues.

    So; tell of us your experiences; doctors, patients, insurance agents and FAs.

    Dr. David Edward Marcinko MBA CMP™


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