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The impact of the Affordable Care Act - OBAMACARE - upon doctors is to reduce their compensation per activity. If you are a doctor you now work harder to keep up.

This reduces your human resources available for improvement, research, family time and private time. It removes or seriously degrades the financial aspirations that, at least in part, enthused you to follow medical practice as your life's profession. If it follows the pattern of most societies where this kind of medicine is practiced, the quality of service and the quality of doctors will be degraded.

While you may not be able to do much for the future doctors, certain among you can do something to preserve and even enhance your own circumstances.

The medical practice business model now in vogue goes by the name of Concierge practice, an essentially cash payment by patients directly to the doctor for professional service and for premier access without restraint by insurance coverage limits. Payment is in cash and periodic, running from per month debited to your credit card or per quarter or annually, in advance.

To be sure, the patient must keep medical insurance in force for all the other things that the direct cash to physician does not include. That is a parallel resource. The patient is not saving money. To the contrary, the patient is paying significantly more to be included in an inner circle of preferred patients of the particular doctor or doctor group.

This practice model is not available to all doctors. It is most ideally feasible for leading edge physicians located in affluent markets. It is also "seasonal" in the sense that many practice areas are Concierge suitable for patients only during certain periods of their lives. Illustratively, even in the environs of Detroit, Michigan there are pockets of wealth to whom this opportunity would be extremely attractive for the "right" doctors. Locations must contain significant wealth pockets for the Concierge system to work.

Leading edge physicians include those with stellar reputations in the medical community who in the ordinary course of practice attract wealthy patients. Stellar reputations include the obvious superstars associated with leading edge practice; practice groups that have enjoyed an outstanding reputation in the community for a long time and that recruit using the highest standards; practitioners who enjoy excellent working relationships with their main hospitals at executive and also at staff levels - Concierge practitioners will need to be able to arrange preferential deference for their patients when they arrive in hospital; and practitioners with a keen sense of social and network marketing. These are the profile elements of physicians who should consider developing a Concierge practice division within or parallel to their normal practice.

Seasonality as used in this article implies that some potential Concierge patients may need Concierge service during periods of their lives. Illustratively, women may be attracted to Concierge service during childbearing years and during that later period of life when their gynecology needs tend to be more acute. People tend to find Concierge service from leading cardiologists, especially surgeons, in the years of impact from heart abnormalities and disease.

People of means would find Concierge service attractive throughout their lives simply as a matter of personal preference and the fact that they can afford it. The feasibility of establishing a Concierge medical practice involves an assessment of the impact of all these criteria; a determination of appropriate pricing levels; a willingness to triage one's patient population economically; and the acceptance of the level of "access" that must be provided to Concierge patients.

A Concierge menu of preferential benefits over and above what is provided to other patients needs to be configured, including things like special phone numbers and email channels; appointments at the patient's venue when needed and appropriate in terms of available resources: expedited hospital admissions with little waiting and lots of "hand holding"; a network of access resources when traveling; and other extraordinary advantages where reasonably practicable.

There needs to be a special marketing program rather adeptly configured and targeted to the potential patients who fit your target profile. Some finesse will go a long way in setting this up.

The Concierge model should be thought of as a dynamic model that will change each year or irregularly as opportunities present. To be sure, OBAMACARE will morph as it is put into effect and adjustments are required either by the vicissitudes of implementation or by the politics of it. This will present as many opportunities for the Concierge capable practitioner as it does problems for those unsuited for this model.

Consults regarding the feasibility and set up of Concierge models are available by contacting Tamerlane Group in Houston through its email at [email protected] and 281 584 0519.

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