In the United States we know that our healthcare system has so many faults. Insurance companies are able to dictate what type of tests we can receive determined by their algorithms and not by what our doctors prescribe. They also are able to limit any additional services that we as patients may need. Many healthcare providers have started to provide specific services to smaller populations in order to better meet their needs on a private basis. This is known as concierge healthcare.

Concierge healthcare, also referred to as boutique or retainer medicine, is reshaping the landscape of healthcare by offering patients personalized, highly accessible care. In this model, patients pay a recurring membership or retainer fee directly to healthcare providers in exchange for premium services such as longer visits, same-day appointments, 24/7 access to their providers, and even home visits that would normally not be covered by insurance. This care model is often seen as a response to the frustrations of both patients and providers with the conventional insurance-based healthcare system.

Initially popular among physicians, concierge medicine has expanded to include other healthcare professionals, such as nurse practitioners, pharmacists, dietitians, and physical therapists. These professionals are now exploring concierge care models to provide direct services to patients in an innovative and client-centered way.

Key Players in Concierge Healthcare

1. Physicians

Physicians remain the most prominent players in concierge healthcare. They provide a wide range of services, from primary care to specialized treatments, in a more personalized and attentive manner. Many concierge physicians emphasize wellness and preventive care, allowing patients to receive treatments that focus not only on acute issues but also on long-term health management.

• Pay: One of the key attractions for physicians entering concierge medicine is the potential for increased earnings compared to traditional insurance-based models. The average annual retainer fee for a patient ranges from $1,500 to $5,000, depending on location and level of care. Some high-end concierge services, particularly in metropolitan areas, charge patients upwards of $25,000 annually. These higher fees contribute to concierge physicians’ potential earnings, which typically range from $250,000 to $500,000 annually, though some elite physicians report earnings well beyond that.
• Scope of Services: Concierge physicians often provide comprehensive care, including house calls, unlimited office visits, wellness exams, preventive screenings, chronic disease management, and direct access to specialists. This allows patients to experience a greater depth of care compared to standard practice.
• Control: Physicians are better able to control the number of patients that are in their roster at any time. They are able to set the length of time of their appointment slots without having their pay docked if they do not see a certain number of patients. They do not have to fight with insurance companies for reimbursement, or chase patients for payment.
• Resources you may find useful

1. Cash Pay Healthcare
2. The Doctor’s Expanded Guide to Concierge Medicine
3. Handbook of Concierge Medical Practice Design

2. Pharmacists

Pharmacists are increasingly adopting the concierge model to provide personalized medication management services. These services include medication therapy management (MTM), provide access to compounding services, chronic disease management (such as for diabetes or hypertension), immunizations, and wellness consultations. Concierge pharmacists work closely with patients to optimize their medication regimens, reduce adverse drug interactions, and ensure better health outcomes.

• Pay: Pharmacists can charge a retainer or subscription fee for their services, although exact figures depend on the scope of services and the geographic location of the practice. While detailed salary data for concierge pharmacists is less established than for physicians, independent pharmacists working in personalized care settings typically earn more than traditional retail pharmacists due to additional revenue from direct patient care services.
• Scope of Services: Concierge pharmacists can offer specialized services tailored to specific patient populations, such as the elderly or patients with chronic conditions. This model may involve collaboration with primary care providers, telemedicine consultations, or even home visits for complex medication reviews and adjustments.
• I struggled to find any detailed resources how to start your own pharmacy concierge service, so I would recommend looking at other established businesses, and try and network. Try looking at the Concierge Pharmacist and Haloscripts. 

3. Nurses

Nursing concierge services provided by registered nurses (RNs) offer a different, hands-on level of care that extends beyond what insurance or home health services typically cover. These nurses deliver personalized medical support, often filling in the gaps left by traditional healthcare systems. Concierge nurses can be hired directly by patients, providing everything from wound care to post-operative companionship, ensuring patients receive the attention and care they need.

Concierge nurses offer a wide range of services tailored to meet the individual needs of their patients. Unlike traditional home health nurses, who are bound by insurance company restrictions and only provide limited services, concierge nurses offer more flexibility and availability. Here are some of the key services they provide:

• Wound Care Not Covered by Insurance Many insurance policies and home health agencies only cover certain types of wound care, often leaving patients without the necessary follow-up treatment. Concierge nurses can step in to provide specialized wound care for surgical wounds, chronic ulcers, burns, or other injuries that require frequent attention and dressing changes that they or their family may be too squeamish to do.
• Injections and IV Therapy Concierge nurses can administer injections and IV treatments, such as vitamin infusions and hydration therapy. Many people do not want to give themselves injections, and will happily pay a nurse $100 or more to come to their home to administer it for them.
• Surgical Companion (Plus-One Service) One of the most unique offerings of a concierge nurse is their ability to act as a surgical companion. For patients undergoing outpatient procedures, a concierge nurse can attend the surgery with them, acting as an advocate and providing emotional support. This nurse will remain by the patient’s side before, after, and possibly during the procedure, ensuring they understand everything happening, coordinating post-operative care, and staying with them until they are safely back home. This level of one-on-one support is invaluable for patients who may not have family nearby or who want an expert to oversee their recovery.

Interested in starting your own nurse concierge practice? The Concierge Nurse Network and  Cate at NursePreneurs offers a course to get you started.

4. Other Healthcare Specialties

The concierge model has grown beyond just physicians and nurses, now encompassing a wide range of healthcare professionals who offer specialized services. These include:

• Physical Therapists: Provide concierge physical therapy services in patients’ homes or in personalized sessions at gyms or clinics. Concierge physical therapists often help patients recovering from surgeries or injuries, tailoring treatment plans to fit specific needs.
  
  • Pay: Physical therapists in concierge models can charge $100 to $300 per session, with the potential for higher earnings due to longer appointments and individualized care.
  • Danny at physicaltherapybiz.com offers a course to help you get started.
• Dietitians and Nutritionists: Offer personalized nutrition counseling and wellness plans, focusing on chronic disease management (such as diabetes), weight loss, or sports nutrition. Concierge dietitians may also offer cooking classes or meal planning services tailored to individual patients’ health needs.
  
  • Pay: Concierge dietitians may earn $75,000 to $100,000 annually depending on their client base and service offerings. Fees for consultations typically range from $100 to $300 per session.
• Mental Health Professionals: Psychologists, counselors, and psychiatric nurse practitioners can adopt the concierge model, offering therapy, counseling, and mental health support with 24/7 availability or rapid response appointments.
  
  • Pay: Mental health professionals in concierge practices charge anywhere from $150 to $500 per session depending on their expertise and clientele.

Pros of Concierge Healthcare

1. Personalized, Attentive Care

Concierge healthcare allows providers to spend more time with patients. Instead of the 10-15 minutes allotted in traditional practices, concierge providers often spend 30 minutes to over an hour per visit. This deeper relationship fosters better understanding of patient needs, contributing to more effective care.

2. Convenience and Accessibility

Patients have direct access to their healthcare providers via phone, email, or video call at nearly any time. Many concierge providers offer same-day or next-day appointments, eliminating long wait times for care.

3. Focus on Preventive Care

With more time per patient, concierge healthcare providers can emphasize preventive care. This can reduce the incidence of serious health problems by addressing issues early through lifestyle interventions, screenings, and regular check-ins.

4. Reduced Burnout for Providers

Healthcare providers in concierge models often work with fewer patients, allowing for more manageable schedules and reducing the burnout that’s common in traditional practice settings. Physicians can focus on quality care rather than juggling high patient volumes and administrative burdens.

Cons of Concierge Healthcare

1. Cost Barriers for Patients

The biggest downside of concierge medicine is its cost. Annual fees range from $1,500 to $25,000, putting this level of care out of reach for many. While some patients may justify the expense for enhanced care, others may find it difficult to afford.

2. Limited Insurance Coverage

Since concierge healthcare operates outside the insurance model, patients still need insurance for hospitalizations, surgeries, or specialist referrals. This dual financial responsibility can be a burden for those paying both insurance premiums and concierge fees.

3. Ethical Considerations and Exclusivity

The concierge model has raised concerns about healthcare access and equity. By offering exclusive services to wealthier patients, there’s a risk of deepening disparities in healthcare, where those who can afford concierge services receive exceptional care while others may be left with fewer resources in overburdened traditional systems.

What is Needed to Set Up a Concierge Healthcare Practice?

1. Licensing and Compliance

All healthcare providers must ensure they have the appropriate licensing to practice in their respective fields. In some states, nurse practitioners and pharmacists may need additional approval to practice independently.

• Legal Structure: Establishing the correct business structure (LLC, S-Corp, etc.) is necessary for tax and legal reasons. Providers may also need to investigate state laws surrounding concierge care, particularly in states where direct care models are less established.

2. Insurance and Liability Protection

Concierge providers must have adequate malpractice insurance and may require additional liability coverage depending on the services offered. Since these practices operate outside insurance networks, malpractice insurance is still a critical safeguard against legal action.

3. Technology Integration

Concierge practices benefit from technology, especially telehealth platforms and secure communication tools. These tools allow for easy communication with patients, virtual appointments, and efficient management of medical records.

4. Marketing and Patient Acquisition

Marketing is crucial in attracting a patient base. Providers must develop strong branding, invest in online presence (websites, social media, Google ads), and rely on word-of-mouth referrals. Establishing partnerships with gyms, wellness centers, and corporate clients can also help build a client base.

Conclusion

Concierge healthcare offers a personalized, accessible alternative to the traditional healthcare system, providing enhanced care and attention for those who can afford it. While it presents advantages like better provider-patient relationships, more preventive care, and reduced provider burnout, it also raises concerns about healthcare equity and costs. For healthcare professionals interested in starting a concierge practice, careful consideration of legal, financial, and marketing aspects is essential. As the healthcare landscape evolves, concierge medicine may become an increasingly attractive option for both patients and providers looking for more personalized care solutions.

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