Atlanta Doctor Switches From Hospital Practice to Concierge Medicine

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Dr. Espinosa’s Journey to Buckhead Medicine

[/fusion_text][fusion_text]Below is a recent interview Dr. Espinosa did on why and how he made the move to concierge medicine.[/fusion_text][fusion_text]For Espinosa, building a concierge medicine practice from the ground up represented a huge challenge. However, he saw it as the best path to long-term financial stability and career satisfaction.

“Concierge medicine seemed like something that I could continue into my retirement years and still enjoy,” he says. “I went into medicine because I like caring for people and I felt like I couldn’t do that well in an environment where it’s all about volume.”

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Starting Out

[/fusion_text][fusion_text]In between his shifts as a hospitalist, Espinosa talked to friends who were running successful concierge practices in California. He also conducted extensive market research and hired a consultant to help him develop a business plan.

Location is the most important initial consideration, he says. He eventually decided on the Buckhead section of Atlanta, a relatively affluent and vibrant neighborhood with the potential to support a membership-based practice.

While encouraged by the success of other concierge practices, he was cognizant of the unique challenges of his situation. Most physicians who transition to concierge already run established traditional practices and are able to immediately convert a percentage of those patients into paying members.

However, Espinosa started from scratch when he opened Buckhead Medicine in 2008.[/fusion_text][fusion_text]Read to learn more about our Concierge Medicine pricing in Atlanta.[/fusion_text][fusion_text]To stay afloat, Espinosa continued to work full-time at the hospital, while maintaining a part-time schedule at his new office. The traditional seven days on/seven days off hospitalist schedule facilitated the arrangement, allowing him to keep regular outpatient office hours during his weeks away from the hospital.

He maintained that schedule for several years as he gradually ramped up to 50 patients over the first two years. Some of his first patients were those he had cared for as a hospitalist or patients referred by hospital colleagues.

The most effective marketing was through word-of-mouth, he says. The concierge concept was relatively new at the time and its message resonated with people who were frustrated with their current providers and looking for alternatives.

“Many people said they had no meaningful relationship with their physician, had to wait a long time for appointments, and often didn’t even get their phone calls returned,” he says. “What we heard over and over was that their current care was impersonal, and those frustrations were a major factor in growing our practice.”

Gradually, Espinosa began reducing his hospitalist shifts and adding office hours as he reached 150 patients in his fourth year — halfway to his goal. He also added staff, including two nurse practitioners, one front-desk administrator, and one floater who helps wherever needed.

Bedside manner is always important but even more so when hiring in a concierge practice, he notes. He looks for extremely customer-focused employees who will reassure patients that they “have a meaningful relationship with our practice.”

It took seven years to grow his patient panel to 300, but the practice now enjoys steady growth. Espinosa has a waiting list for new patients and plans to hire another physician within the next year.[/fusion_text][fusion_text]

Issues and Challenges

[/fusion_text][fusion_text]Patients who join Buckhead Medicine pay a membership fee that can be as low as $100 per month, which covers an expanded menu of services and 24/7 access to providers.

The practice also accepts all major insurance plans and handles billing for services covered under patients’ plans.

At first, the practice asked for the annual fee upfront but many patients were put off by the prospect of making such a large commitment, says Espinosa. He now uses an automated recurring billing service, which has relieved the front desk of the burden of monitoring collections and ensured a steady revenue stream.

“Automated monthly billing changed things drastically for the better,” he says. “It made it easier for patients to join and created a more predictable finan- cial model for our practice.”

The biggest administrative headache now is billing insurers and tracking reimbursements, he says. However, the practice has continued to offer it as an added service for patients.

“We’ve gone back and forth about whether it’s worth it because there’s so much work involved with getting reimbursement from commercial insurers and Medicare,” he says. “But we haven’t dropped it because our patients want things to happen in a streamlined fashion.”

In recent months, handling growth has become the biggest challenges, he says.

“It’s a healthy, busy practice now and we want to continue to provide the level of service people expect,” says Espinosa. “That requires us to sometimes pull back and resist growing so fast that our customer service would suffer.”

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Reaping the Benefits

[/fusion_text][fusion_text]On a typical day, Espinosa sees between seven and 10 patients, traveling between his office, the hospital, and patients’ homes. That leaves enough flexibility in his schedule to handle emergencies without having to cancel scheduled appointments.

For example, one of his patients came in recently with symptoms of dehydration and a urinary tract infection. He was able to see her in the office that afternoon and administer intravenous fluids and antibiotics, potentially preventing a trip to the emergency department.

If a patient is in the hospital, Espinosa connects with the attending physician and helps coordinate care by transferring patient records and following the patient’s progress throughout his stay.

He then schedules a follow-up visit at his office within three days of discharge and keeps close tabs on the patient’s progress. His EHR system is compatible with the systems used at three major Atlanta-area hospitals, allowing him to easily pull up discharge summaries.

“I have a very close follow-up with our patients to prevent unnecessary readmissions,” he says. “We are tracking our readmission rates and seeing much better results than national averages, and that’s because we have the time and flexibility in our schedule to provide that extra service.”[/fusion_text][fusion_text]When general internist Edward Espinosa began his career at Piedmont Hospital in Atlanta nine years ago, he planned to eventually transition from hospital to office-based practice. However, the more he learned about the frustrations of the traditional fee-for-service environment, the less confident he became about taking that path.

“The hospital was willing to set me up in a clinic but then I found out that I would need to see 25 patients a day,” says Espinosa, 43, who now runs Buckhead Medicine in Atlanta. “It defeated the reason I wanted to practice outpatient medicine in the first place, which was to decrease my volume of patients and be less impersonal and rushed.”

He did some research into alternative practice models and zeroed in on concierge medicine, where patients pay an annual fee or retainer in exchange for enhanced care and expanded access to providers. The model has gained popularity in recent years, according to the 2014 Survey of America’s Physicians conducted by executive search firm Merritt Hawkins, which reports that about 7 percent of all physicians currently practice some form of concierge or direct-pay medicine while 13 percent have plans to do so at some point in their careers.[/fusion_text][/one_full][fullwidth background_color=”#898989″ background_image=”” background_parallax=”none” enable_mobile=”no” parallax_speed=”0.3″ background_repeat=”no-repeat” background_position=”left top” video_url=”” video_aspect_ratio=”16:9″ video_webm=”” video_mp4=”” video_ogv=”” video_preview_image=”” overlay_color=”” overlay_opacity=”0.5″ video_mute=”yes” video_loop=”yes” fade=”no” border_size=”0px” border_color=”” border_style=”solid” padding_top=”20″ padding_bottom=”20″ padding_left=”10″ padding_right=”10″ hundred_percent=”no” equal_height_columns=”no” hide_on_mobile=”no” menu_anchor=”” class=”” id=””][fusion_text]

Lessons Learned

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Physician Edward Espinosa started Atlanta-based Buckhead Concierge Internal Medicine from scratch when he decided to switch from hospital to outpatient practice. He offers the following advice for others looking to make the transition:

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Consider Location

[/fusion_text][fusion_text]Perform an extensive demographic analysis of the zip codes you’re considering before signing a lease, says Espino- sa. Many successful practices are located in affluent, urban neighborhoods that can sup- port growth.[/fusion_text][/one_fourth][one_fourth last=”no” spacing=”yes” center_content=”no” hide_on_mobile=”no” background_color=”” background_image=”” background_repeat=”no-repeat” background_position=”left top” hover_type=”none” link=”” border_position=”all” border_size=”0px” border_color=”” border_style=”solid” padding=”” margin_top=”” margin_bottom=”” animation_type=”0″ animation_direction=”down” animation_speed=”0.1″ animation_offset=”” class=”” id=””][fusion_text]

Seek Help

[/fusion_text][fusion_text]Talking to other physicians with established concierge practices can help you avoid common mistakes, he says.You might also con- sider hiring a consultant to help with initial setup.[/fusion_text][/one_fourth][one_fourth last=”no” spacing=”yes” center_content=”no” hide_on_mobile=”no” background_color=”” background_image=”” background_repeat=”no-repeat” background_position=”left top” hover_type=”none” link=”” border_position=”all” border_size=”0px” border_color=”” border_style=”solid” padding=”” margin_top=”” margin_bottom=”” animation_type=”0″ animation_direction=”down” animation_speed=”0.1″ animation_offset=”” class=”” id=””][fusion_text]

Be Patient

[/fusion_text][fusion_text]It took seven years for Espinosa to reach his goal of signing on 300 patients. To survive financially, he con- tinued to work at the hospital until his new practice took off.[/fusion_text][/one_fourth][one_fourth last=”yes” spacing=”yes” center_content=”no” hide_on_mobile=”no” background_color=”” background_image=”” background_repeat=”no-repeat” background_position=”left top” hover_type=”none” link=”” border_position=”all” border_size=”0px” border_color=”” border_style=”solid” padding=”” margin_top=”” margin_bottom=”” animation_type=”0″ animation_direction=”down” animation_speed=”0.1″ animation_offset=”” class=”” id=””][fusion_text]

Create a Business Plan

[/fusion_text][fusion_text]You should have a clear business plan before you spend a penny on converting. You need to understand the financial model and come up with realistic numbers for your expected growth.[/fusion_text][/one_fourth][/fullwidth][separator style_type=”none” top_margin=”10px” bottom_margin=”10px” sep_color=”#ffffff” border_size=”” icon=”” icon_circle=”” icon_circle_color=”” width=”” alignment=”center” class=”” id=””][button link=”#” color=”default” size=”” stretch=”” type=”” shape=”” target=”_self” title=”” gradient_colors=”|” gradient_hover_colors=”|” accent_color=”” accent_hover_color=”” bevel_color=”” border_width=”” icon=”” icon_position=”left” icon_divider=”no” modal=”” animation_type=”0″ animation_direction=”left” animation_speed=”1″ animation_offset=”” alignment=”center” class=”footer-button modal-trigger-one” id=””]Request Quote[/button]

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FAQ

What services are provided as a part of my annual fee?
  • Same-day or next business day appointments
  • Direct access to Dr. Espinosa via his personal cell phone after hours, weekends, and holidays
  • Minimal office wait times
  • Longer, more comprehensive appointments
  • House Calls (requires additional trip fee)
  • A strong focus on preventive medicine, long-term health and wellness
  • A personal professional relationship with your physician
What is the mission of Buckhead Medicine?

We strive to provide the highest quality medical care, emphasizing a comprehensive approach to prevention and disease management. We want patients to be completely satisfied with every aspect of their care.

Where is your office and are you on the medical staff of a local hospital?

Yes, Dr. Espinosa’s office is in Buckhead, a suburb of Atlanta. He is on the medical staff of Piedmont Hospital in Atlanta, Georgia and Northside Hospital in Atlanta, Georgia. If you require hospitalization, Dr. Espinosa will coordinate your patient care by working with the hospital based physicians. He will also make periodic hospital visits during your hospitalization.

Who will cover for you when you are not available?

On infrequent occasions when Dr. Espinosa is out of town or otherwise unavailable, he will have another qualified physician cover for him. Even while out of town, Dr. Espinosa will generally be available by phone to his patients and to his covering physicians. For practical reasons, we reserve the right to designate another qualified physician to perform any and all services should the need arise.

Do you accept insurance?

Commercial Insurance and Medicare:
Buckhead Medicine is an In-Network provider for Blue Cross Blue Shield PPO, Aetna, Coventry, Humana, Cigna, Tricare and United Healthcare. Our practice fully participates in the Medicare program. Buckhead Medicine accepts all other insurance as an Out-of-Network provider. We, however, do not participate in the Medicaid program. Regardless of your plan, we will bill your insurance for all covered services. It is our intention that no insurance-covered medical services are included in your annual fee.

HMO and Medicare HMO:
We do not participate in HMO programs. As such, HMO patients will not be able to join the practice until they transition to either a PPO or traditional Medicare plan.

Do I still need insurance if I enroll with you?

Yes. Personalized medical practices do not take the place of general health insurance coverage. Buckhead Medicine is a primary care medical practice, not a health insurance program. You are advised to continue your PPO, Medicare or other insurance program. If you are an uninsured individual and desire to enroll in the practice, we will provide you with a discounted fee schedule for office visits, tests and procedures.

What if I don't have health insurance?

For uninsured patients, Buckhead Medicine offers an uninsured patient plan. Although this plan is not insurance, it does cover for all clinic visits and any labs or tests that are performed in our office. In many cases this plan provides for significant cost savings to uninsured individuals. Please contact our office for additional details on this plan.

Will my insurance still be billed for my office visits?

Yes, we will bill your insurance company directly. The annual fee does not cover costs for regular exams or testing conducted inside or outside of the clinic. These costs are billed to your insurance provider in the same manner that traditional practices bill insurers.

Is there a co-payment?

If you have commercial insurance, we will collect the co-payment at the time of service. Medicare patients usually do not require a co-payment.

Do you bill Medicare for the annual fee?

No. The annual fee is not covered by Medicare. The fee only includes services that are not covered by Medicare and, as such, cannot be paid for or reimbursed by Medicare. We will bill Medicare for your sick visits and for any additional services performed at this practice that are covered by Medicare.

Will my commercial insurance reimburse my annual fee?

No, commercial insurance does not typically reimburse for the annual fee. However, some Flexible Spending Account and Health Savings Account plans may pay for all or part of the annual fee. In addition, some insurance plans allow the concierge fee to apply towards the annual deductible. Members are advised to consult their human resources representative at their place of employment.

Is the annual fee tax deductible?

In many cases the annual fee is a tax deductible healthcare expense. Patients are advised to consult with their tax consultant to clarify qualification in their particular circumstance.

Does the annual fee cover lab, x-ray, specialist fees and hospitalization?

Services such as labs, x-ray, specialty visits or hospitalizations are covered based on coverage determined by your insurance plan.

Are there age limits?

Dr. Espinosa is an Internal Medicine physician. His specialty is Adult medicine. Dr. Espinosa is trained to manage acute and chronic medical illnesses among adults. As such, the practice is limited to patients 17 years of age and older.

What if I have an emergency?

If you have a life threatening emergency, call 911 immediately. After you call 911, please call Dr. Espinosa. He will contact the hospital and notify the emergency room of your tentative arrival. In addition, Dr. Espinosa will provide the emergency room with pertinent medical history information

How far in advance do I need to book an appointment?

Dr. Espinosa is committed to providing his patients with easy access to care. All urgent visits will be accommodated either same day or next day, placing the greatest priority on the sickest patients. Annual physical exams will be booked 1 to 2 weeks in advance.

What do I do if I become ill while traveling or away on an extended vacation?

Call 911 if you have a life threatening emergency. Then call Dr. Espinosa. Call Dr. Espinosa first if the problem is minor. With the exception of a few controlled substances, most prescriptions can be ordered anywhere in the country. If necessary, it may be possible for Dr. Espinosa to find you a resource in your area. If you seek care at an emergency room or urgent care center out of our area, we request that you have the doctor seeing you call Dr. Espinosa for coordination. Dr. Espinosa will be readily available by phone for consultation with you and/or other health care personnel. If you should require hospitalization while away, at your request, Dr. Espinosa will establish phone communication with you and your attending physician(s) to ensure continuity of care.

Do you make house calls?

House calls will be available to Buckhead Medicine members, within a limited radius from the clinic. These will be done as deemed appropriate by Dr. Espinosa on a case-by-case basis. Home visits will be billed to your insurance provider similar to an office visit. A separate trip fee is required for house calls.

What if I need to see a specialist or a surgeon?

Of course, Buckhead Medicine patients are free to see any specialist they wish. We are available to help you decide what specialists to see and to coordinate such consultations. Patients may frequently request for “doctors in my area”, and we can accommodate this. We will ensure that the most appropriate resources are used, the earliest arrangements are made, and your applicable medical information is sent in advance of your specialist visit.

What about the cost of prescription medications?

The cost of prescription medications are the patient’s responsibility and in most cases should be covered by their insurance plans. We have expertise in assisting patients in purchasing medications in the most cost effective manner.

Will I be required to pay my annual fee even if I do not use your services?

Yes. Paying your annual fee allows you to be a member of the practice whether you are sick or well. We encourage our patients to utilize the amenities offered such as wellness consultations and emails for appropriate non-urgent health related questions, regardless of your state of health.

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