Boutique Spine Care for Patients with Back Problems

How concierge, retainer, or membership medical care are different from a conventional practice

Boutique medicine started in 1996, and the trend steadily continues as physicians and patients become increasingly dissatisfied with current health insurance options and existing practice models. Here, Dr. Richard Guyer talks about his boutique practice at the Texas Back Institute.
Member of medical team taking time for personalized care.Think of it in terms of extra-special care for the patient. Photo Source:

What is boutique spine care?

Dr. Guyer: I think of it in terms of extra-special care for the patient. Patients are seen at their appointment times, and a generous amount of time is set aside for each patient, which means I can give my patients all the time they need.

In my boutique spine practice, we provide the patients with a personal navigator—a member of my staff who is dedicated to providing an extra level of patient care. We make all the arrangements for the patient. For example, instead of handing the patient a MRI order and number to call to make the appointment, we set up the appointment. Basically, we do everything for the patient—we want to pamper and spoil each patient.

Patients do not call into an automated electronic system; rather, they speak directly to a member of my staff. Patients are not put on hold or bounced around as is the case in some conventional practices. We give our patients a number they can call 24/7 if there are any issues or problems.

At Texas Back Institute, there are only three of us who have chosen to reduce the number of patients we see.

Why did you make the choice to reduce the number of patients you see?

Dr. Guyer: I wanted to spend more time with my patients; get to know them the way I intended when I first entered medicine. Caring for fewer patients affords me the opportunity to provide a higher level of quality medicine. That’s not saying patients do not receive high quality medical care in a conventional practice—rather, it’s the atmosphere in which medical care can be provided.

Most patients understand physicians are very busy—so busy, that crowded waiting rooms and extended appointment wait times are common. Boutique medicine offers a totally different experience.

How is your boutique practice different from a conventional spine practice?

Dr. Guyer: Most of the patients are old patients of mine. These are patients whom I’ve developed a relationship with, who say, “I don’t care; I still want to see Dr. Guyer.”

If the patient doesn’t have out-of-network insurance coverage and/or can’t afford the surgery, then I send the patient to one of my partners who is equally as good. The point is we want to take care of our patients—whether they are new to the practice or someone we have a relationship with returning years later. New patients often are referred by word of mouth or by our expertise in the diagnosis and treatment of spinal disorders.

Was health insurance a factor in your decision to move into boutique medicine?

Dr. Guyer: Absolutely. We’ve performed more artificial disc surgeries than anyone else in the United States. So, a lot of patients come to us, specifically for artificial disc replacement. You see, some insurance companies continue to view artificial discs as “experimental treatment.” Frankly, we disagree that artificial discs are experimental. We’ve been doing this type of surgery for 14 years and followed-up with those patients over the years.

One experience will help your readers understand our frustration. I had a patient who six years prior had an artificial disc implanted. The procedure was covered by his insurance. When he returned to me to have another level treated using an artificial disc, the same insurance company declined coverage stating they had merged with another insurance company, who views artificial discs as experimental.

It makes no sense. I want to be able to offer patients the medical care that I think is right—not what the insurance company deems for economic or other reasons.

How is payment handled in your boutique medical practice?

Dr. Guyer: We offer boutique patients who do not have insurance coverage a bundled rate that includes the hospital, anesthesiologist, surgeon, surgical assistant, and operative after care. Patients with out-of-network insurance coverage may or may not owe a little more.

I have some patients who say, “Dr. Guyer, you know, I just can’t afford it,” and we do the best to work things out. If worst comes to worst be, I’ll refer the patient to one of my associates—who are excellent surgeons.

Collectively, the 3 of us have 100 years of experience and have published extensively and innovated many new spine technologies, including lumbar disc replacement which we did the first in the US in 2000.  As a result of this, we have opted to have a different type of experience for our patients and for ourselves.

Updated on: 08/27/19
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