What to Consider Before Quitting Medicare When Planning Your Transition to Concierge Medicine

Are you considering a transition to Concierge Medicine? Integrating Medicare patients, Chronic Care Management (CCM), and Remote Patient Monitoring (RPM) presents unique challenges and opportunities.

Key Challenges:

1. Patient Base: Switching to concierge means shrinking your patient list. Don’t assume quick growth; it often takes years to ramp up.
2. Medicare Re-entry: Quitting Medicare is a two-year commitment. It will affect your other managed care plans.
3. Contract Review: Know your contracts inside out before making the switch. Make sure you have all pages of all contracts for Maria to evaluate before finalizing your decision to transition to a membership or subscription model

Financial Considerations:

• Subscription Fees vs. Medicare Fees: Align your concierge subscription model with Medicare’s fee-for-service if you plan to continue with Medicare. There are various compliance issues that are critical to your planning and operations.
• Reimbursement Rates: Ensure sustainability when integrating Medicare for CCM and RPM services. Staffing and documentation are paramount with CCM and RPM. 

Regulatory Compliance:

• Billing Medicare: Understand Medicare regulations. You can’t double-bill services covered by both Medicare and your subscription. it is your responsibility to know the billing rules. Mistakes can cost you triple what you received if Medicare deems you violated the rules intentionally or flagrantly disregarded them.
• Documentation: Proper timekeeping and task logs are essential for CCM and RPM.  They add to the cost of care delivery. Will you recover your investment into staffing, training, time, materials, and EMR/PM?

Service Offerings:

• Unique Selling Proposition: Your concierge model should be unique in your community; Maria will research your market and competition as part of her services. She may end up recommending a few minor tweaks to your plans to make them come to life.
• Technology: Investing in RPM devices is a must.  Expect that each device will cost about $100 per unit and that you’ll end up with some that get lost, damaged, or wear out and need to be replaced over time.
• Quality of Care: High-standard chronic care management is non-negotiable. But standard of care is tied to your services and also your EMR and documentation and staff training and execution. 

Patient Management:

• Patient Fit: Not all Medicare patients will be right for your concierge or CCM model. There are also some you won’t want in the program! Trust us on this! They may qualify by conditions they have, but you may find that having them in the program is unpleasant for you and for your staff. You can say “no”. There’s a nice way to decline. Ask us for advice if you need this.
• Patient Engagement: Keep patients actively involved for optimal health outcomes and sustained program reimbursement. Otherwise, your projected revenues may be invalidated. That’s because CCM and RPM are time based reimbursement programs.

Staffing and Operations:

• Skillsets: Your team should be trained in CCM and RPM. We can train them for you. You could also outsource the entire program. We have many vetted options for that.
• Workflow: You may need to adapt existing processes to fit your new service models. 

Marketing:

• Value Proposition: Maria can explain the benefits and complexities of combining concierge medicine, CCM, and RPM in easy to understand terms.
• Patient Acquisition and Retention: Have strategies for reducing your panel from traditional primary care, strategies to deal with organic annual attrition, slow growth, and for pricing for your services. Don’t assume your Medicare or managed care patients will follow you as you announce your transition.