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Dr. David Winter’s medical practice is one of the most
­prestigious, successful concierge practices in the country. As a
founder and leader of HealthTexas Provider Network, Baylor
Scott & White Health’s affiliated medical group, Dr. Winter
has demonstrated time and time again that he is a visionary
and innovator with respect to the practice of medicine. When
Dr. Winter talks, doctors should listen.

Nathan S. Kaufman
Managing Director
Kaufman Strategic Advisors, LLC

In a time of constant change, the health care industry needs

more leaders like Dr. Winter. Service Extraordinaire provides a
real-life case study of a creative—and effective—care model,
concierge medicine, and how it can positively impact physicians
and patients alike. As a longtime colleague and patient of Dr.
Winter, I have experienced firsthand the passion and dedication
he has for medicine and his patients. His successful commitment
to innovating patient care is a role model example of what’s
working well in health care.

B. G. Porter
CEO
Studer Group, a Huron Solution

Service Extraordinaire will be of great interest to patients and

physicians who are dissatisfied with the way they are currently
receiving or providing medical care. Dr. David Winter is well
qualified to explain how concierge medicine might, or might not,
meet the needs of such patients or physicians. His insight is based
on being the medical director of 1,300 medical providers, and
by his experience as a practicing concierge physician for many
years. As defined by Dr. Winter, the main attraction of concierge
medicine to both patient and physician is based on a retainer
fee that allows immediate physician access to patients in an
unrushed manner. There is a strong emphasis on maintenance
of good health through proper lifestyle. However, this book also
makes it clear that another important factor in concierge medi-
cine is that the doctor has sound medical judgment and deep
and sustained knowledge of all aspects of internal medicine, so
that medical illnesses are promptly diagnosed and appropriately
treated, both in an office setting and in high-intensity hospital
settings. Unfortunately, it is difficult for patients to obtain an
accurate measure of a doctor’s sustained clinical knowledge and
medical judgment.

John S. Fordtran, MD
Director of Gastrointestinal Physiology
Baylor University Medical Center

In today’s consumer-oriented health care system, there is no

more “one size fits all.” In fact, the pressures to customize around
the needs and desires of our patients have never been greater.
Concierge medicine is the ultimate expression of segmentation
and focus. In a world where we must think of an “N of one”
versus an “N of many,” and must find ways to capitalize on the
opportunities afforded by our uniqueness, this model is critical to
our success.

Jim Hinton
CEO
Baylor Scott & White Health
Service Extraordinaire
Unlocking the Value of
Concierge Medicine
Service Extraordinaire
Unlocking the Value of
Concierge Medicine

One Physician’ s Journey into a New

Model of Care
By
F. David Winter Jr., MD, MSc, MACP
CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742

© 2018 by Baylor Scott & White Health

CRC Press is an imprint of Taylor & Francis Group, an Informa business

No claim to original U.S. Government works

Printed on acid-free paper

International Standard Book Number-13: 978-1-138-03558-4 (Hardback)

International Standard Book Number-13: 978-1-315-26692-3 (eBook)

This book contains information obtained from authentic and highly regarded sources. Reasonable
efforts have been made to publish reliable data and information, but the author and publisher
cannot assume responsibility for the validity of all materials or the consequences of their use. The
authors and publishers have attempted to trace the copyright holders of all material reproduced in
this publication and apologize to copyright holders if permission to publish in this form has not
been obtained. If any copyright material has not been acknowledged please write and let us know
so we may rectify in any future reprint.

Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced,
transmitted, or utilized in any form by any electronic, mechanical, or other means, now known
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Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and
are used only for identification and explanation without intent to infringe.

Library of Congress Cataloging‑ in‑ Publication Data

Names: Winter, F. David, author.

Title: Service extraordinaire : unlocking the value of concierge medicine /
F. David Winter.
Description: Boca Raton : Taylor & Francis, 2018. | Includes bibliographical
references and index.
Identifiers: LCCN 2017035959| ISBN 9781138035584 (hardback : alk. paper) |
ISBN 9781315266923 (ebook)
Subjects: LCSH: Medicine--Practice. | Medical care--Finance.
Classification: LCC R728 .W615 2018 | DDC 610.68/1--dc23
LC record available at https://lccn.loc.gov/2017035959

Visit the Taylor & Francis Web site at

http://www.taylorandfrancis.com

and the CRC Press Web site at

http://www.crcpress.com
 I dedicate this book to my loving wife and lifelong
companion, Reneé, and to our children, Dave and Brittany,
who continue to bring joy and happiness to us both.
The landscape of concierge medicine is growing and changing
rapidly. Historically, concierge medicine catered to a small,
generally affluent, segment of patients who wanted, and
were willing to pay for, more personalized attention. Today,
however, both patients and providers are actively seeking
new care models that meet their changing needs: patients
are spending more of their own money on care, and thus are
more attentive to their care experience; providers, burned out
by ever-increasing demands on their schedule, are seeking
opportunities to reset the pace and focus of their work.

The Advisory Board Company  

(Advisory Board)
Contents

Preface.................................................................................. xv
Foreword...........................................................................xxiii
Prologue........................................................................... xxvii
Acknowledgments...........................................................xxix
About the Author.............................................................xxxi

1 The Concierge Model................................................1

What Is Concierge Medicine?............................................... 1
Traditional Payment Systems........................................... 2
Fee-for-Service.............................................................. 2
Capitation...................................................................... 2
Pay for Value................................................................ 2
Bundled Payments........................................................ 4
Financial Structures and Legal Issues for Concierge
Medicine .......................................................................... 4
Who Enrolls in Concierge Medicine?.................................. 7
What Is Included in a Concierge Service?........................... 9
2 What Do Concierge Medicine Practices
Look Like?�������������������������������������������������������������� 17
3 Other Concierge Models.........................................19
Where Did Concierge Medicine Come From?....................21
Patient Frustrations..........................................................21
Physician Frustrations..................................................... 28

xi
xii ◾ Contents

4 Lessons from Other Industries...............................37

Aviation................................................................................37
Banking...............................................................................38
Automobiles and Automobile Sales....................................40
Uber.....................................................................................42
Disney..................................................................................43
Nordstrom...........................................................................45
Ritz-Carlton......................................................................... 46
5 How to “Do” Concierge Medicine...........................49
The Patience Experience and Culture................................49
The Culture of the Clinic....................................................50
The Art of Superlative Care?...............................................55
Smile Therapy?................................................................57
The ABCs of Concierge Care..............................................59
AIDET..............................................................................59
Access..............................................................................61
Computer Challenges......................................................63
Listening Longer............................................................. 64
Extended Visits, Last-Minute Visits, and Talkative
Patients............................................................................65
Forgetful, Stressed Patients.............................................66
Irritable Patients..............................................................67
The Importance of Teamwork........................................67
Health and Telemedicine............................................... 68
Scheduling Tricks............................................................69
Empathy..............................................................................70
Prevention in Concierge Models.........................................74
Management of Chronic Illnesses......................................78
6 Barriers to the Transition to Concierge Medicine....79
7 Concierge Lessons for Non-Concierge Physicians....81

8 Concierge Medicine in a Health Care System.........85

The Future of Health Care................................................. 90
 Contents ◾ xiii

9 Concierge Medicine in the Future..........................93

Parting Words......................................................................93
References.....................................................................97
Index...........................................................................107
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