Don’t quit medicine.
Quit the system.
Stop being a provider. Be a doctor again.
There are two ways in. Add a concierge tier to the practice you already own, and keep every patient you have. Or start a concierge practice of your own, on the side, at your own pace. Pick your door.
Add concierge. Keep every patient.
Your senior doctor goes concierge. Your team keeps the insurance practice running. Nobody gets cut loose.
- Start with the patients most likely to say yes. Widen it as you learn.
- Keep billing traditional Medicare and PPO plans.
- Primary care and specialists.
- We set it up with you, start to finish.
Start on the side. Grow at your own pace.
Keep the job you have while you build a practice you own. Your patients pay you directly for a doctor they can reach.
- Keep your paycheck while you build.
- Telemedicine, house calls or an office. Your pick.
- You own it from the first day.
No chatbot on this site and no automated reply sequence. You get a person.
Most firms convert and cut.
We keep the practice.
The big concierge firms all sell the same plan. It fixes the senior doctor’s schedule by giving away most of the practice he spent his career building. There’s a better way, and doctors are already running it.
Convert and cut
- Write to all 2,000 or 3,000 of your patients and ask every one to pay a yearly fee.
- A few hundred say yes.
- Everyone else has to find a new doctor. The industry calls it “attrition.”
- Patients you’ve known for twenty years get a letter, and your team loses most of its work.
A smaller practice, and a lot of patients let go.
Keep them all
- Study your patient list together. Start with a few patients you’re sure will love it. You only get one first impression.
- Everyone else stays. Your team carries their everyday care, billed to insurance, the way it is now.
- When a patient needs the senior doctor, medically, he’s still there.
- As you get better at it, invite more. Add more membership levels when members ask for them. No hurry. Do it right.
The whole practice, plus a concierge tier at the top.
“You don’t throw away an asset to fix a schedule.”Adrian Keith Skane, CPA
Three layers. One practice.
The senior doctor’s time is the scarce thing. A strong team protects it, so he can give it to the patients who pay for it, and step in for everyone else when it matters.
The senior doctor
Members pay for more of his time.
- Sees two or three scheduled concierge members a day, with time to really talk.
- Does the thorough yearly physical with them.
- Pops in when the team hits something unusual: five minutes in the room with the patient and the clinician, sharing what he knows.
- The patient gets his experience. The clinician gets a lesson.
The rest of your team
Your associate physicians, nurse practitioners, physician assistants and nurses.
- Handle routine and follow-up visits for every patient.
- Billed to insurance: traditional Medicare and PPO plans.
- When a case stumps them, the senior doctor comes in and shows them what he’s doing, and why.
- Get more skilled and more sure of themselves every month.
- In time, can take concierge members of their own.
The next senior doctor
An associate physician, trained and mentored by the senior doctor.
- Takes on insurance patients the senior doctor used to carry.
- Learns the concierge side from the inside.
- When he’s ready, becomes a senior associate doctor with members of his own.
- Stays part of the practice and the team. The patients belong to the practice.
One rule: never charge twice for the same thing.
The membership pays for what insurance doesn’t: access, time and the thorough yearly physical. It can’t pay for a visit you also bill to insurance. A health care attorney reviews every membership agreement before the first patient is invited.
Your senior doctor gets time to teach.
Next to keeping your best doctor in medicine, this may be the biggest win of all. A busy doctor does the work himself because it’s faster. A doctor with time teaches his team to do it.
“It’s quicker if I just do it myself.”
It saves five minutes today and costs years. The team never grows, and every hard case still lands on the senior doctor.
“Come in here. Let me show you what I’m doing, and why.”
He hands off everything he can. When the team gets stuck, he pops in for five minutes and turns it into a lesson. Every month they need him a little less.
I’ve run my firms this way for decades. Delegate everything you can, and use the time to develop your people. The good news is it works. The bad news is I kept growing people who wanted to buy me out of the practice. I’ll take that trade every time.
Adrian Keith Skane, CPACan’t afford it? Earn it.
Some patients need more of the senior doctor and can’t pay the full fee. Some practices let them earn part of it by doing good work in their town.
Set up the program with your health care attorney before you offer it, especially for patients on Medicare. It must follow a written policy and be offered the same way to everyone who qualifies.
The patient asks for help
The practice offers a community service scholarship under a written policy.
He volunteers in town
At a food bank, a school, a church, a shelter. The hours are verified.
The hours earn credit
Verified hours pay down part of his membership. Everyone wins.
Better for the doctor. Better for the team.
Better for the practice.
Grow without the grind
An insurance practice gets harder with every patient you add. Two thousand patients is a practice. Eight thousand is a building to run. A concierge tier grows the practice without piling more visits on the senior doctor.
Two kinds of income
Members pay for access and time. Their covered care is still billed to insurance. You stop living on one number you don’t control: what the insurance company decides to pay this year.
Your best doctor stays in medicine
Burned-out senior doctors retire early, sell out, or just stop caring. This gives your most experienced doctor a reason to stay, and the time to pass on what he knows.
A practice worth more
When you sell, your insurance patients are still worth what they’ve always been worth. In my experience, buyers pay more for steady membership income than for visits.
No income or practice value is promised. Your numbers depend on your practice, your town and your patients.
Specialists can do this too.
Some of the most interesting concierge practices we saw this year belong to specialists. The same idea works: patients pay for time with the most experienced doctor in the practice, and the rest of the practice keeps billing insurance.
The radiology second opinion
For a patient worried about a scan, that time is the whole point.
From the first talk to the first members.
A practice that already exists moves fast. Most of the work is paperwork, procedures and the right conversations, and we do it with you.
A conversation
You, me, and whoever you want in the room: your spouse, your partners, your practice manager.
The design
Who goes concierge, what members get, what the team does, and one membership level to start. Your attorney and accountant weigh in.
The setup
Agreements reviewed by a health care attorney, procedures, systems, and a website overhaul.
The first letters
A few personal letters to the patients most likely to say yes. Not a sales pitch. A real letter from their doctor.
The first members
Long visits and thorough physicals. Then we tell your town what changed, and invite the next group.
A typical plan, not a promise. State rules, your attorney’s review and your own pace set the real timeline.
We hold your hand the whole way.
You keep practicing medicine while the change happens. We do the rest with you.
The legal documents
Membership agreements and the paperwork behind them, set up with a health care attorney who has done this for years.
Who to invite first
We study your patient list with you: how long each patient has been with you, where they live, and who your doctors and staff think will say yes. Then we start with the surest few.
The conversations
The letters, what to say when a patient asks, and how to tell a patient who doesn’t join that nothing changes for him.
Procedures and systems
Scheduling, member billing kept apart from insurance billing, and the tools that run it day to day.
Your website
An overhaul, or a first website if you don’t have one, that explains the new tier in plain words.
Telling your town
A goodwill campaign that brings referrals from the patients you already have, and new patients when you want them.
I’ve spent my career across the desk from the person who owns the business. For more than thirty years, a lot of them have been doctors.
Adrian Keith Skane, CPA · Founder
Don’t own a practice yet? You can still own one.
Most doctors work for somebody else. If that’s you, you don’t have to quit to find out if this works. Start a concierge practice of your own on the side, and grow it at your own pace.
- Keep the job you have while you build.
- Four ways to practice: telemedicine only, house calls, a part-time office or a full office.
- You own the practice, and the patients are yours.
- We help you find members from scratch.
One conversation. Not a decision.
Whether you own a practice or want one of your own, talk to me. Bring your spouse, your partners, your attorney or your accountant. If it isn’t a fit, you’ll hear that from me too.
Adrian Keith Skane, CPA