Concierge & DPC

Setting the paging threshold: which member calls wake the physician, and which wait for morning

Concierge members expect access at any hour, but not every call is worth a page. This is how to decide in advance where the threshold sits, what happens to calls below it, and how to audit the line afterward.

Every after-hours member call is answered live, but only calls meeting your paging threshold reach the physician
You set the threshold: which symptoms, which member requests, and which hours it applies to
Routine after-hours traffic, such as scheduling requests and administrative questions, is resolved or logged without a page
Refill requests and medication concerns are captured and relayed to the on-call provider rather than paged, unless your rule says otherwise
Every page carries member name, tier, reason, and urgency, so the physician can judge the call before dialing
The morning log shows what was paged and what was held, which makes the threshold reviewable instead of theoretical

How it pays back

A page worth answering is answered faster

When the phone only rings for calls that clear the threshold, the on-call physician stops triaging their own pages. The signal is worth trusting because routine traffic never reaches it.

Premium access without an open line

Members still reach a live voice at 2 AM, and the call is listened to, triaged, and answered with a next step. The threshold governs who calls them back, not whether anyone does.

The threshold is a decision your practice makes

Chest pain, difficulty breathing, severe bleeding, allergic reaction and trauma are the usual starting point, but the list is yours. Nothing escalates because a vendor decided it should.

A small roster can sustain the rotation

Concierge and retainer practices run on a handful of physicians. Filtering routine calls out of the night rotation is what keeps 24/7 access from turning into 24/7 interruption.

Every after-hours call answered

No voicemail, no missed urgent calls

Urgent calls escalated instantly

Acute symptoms or concerns reach on-call physician immediately

On-call escalation with context

Physician receives member tier, reason, urgency, and history before answering

Callback requests logged and fulfilled

Non-urgent requests scheduled in morning; member is called back on time

Frequently asked questions

How do we decide where to set the paging threshold in the first place?

Work backwards from last month's after-hours calls. For each one, ask whether a page was warranted in hindsight. The complaints that would have justified a page become the escalation list; everything else defines what gets logged instead.

Does the threshold have to be the same for every member?

The criteria are yours to define, and member tier is part of the context passed with each escalation. Whether tier moves the threshold is a decision to make with your clinical team rather than a setting to turn on casually.

What actually happens to a call that sits below the threshold?

It is answered, the member's concern is captured, and the request is logged with reason and callback preference. If the member prefers to wait for their regular physician, that callback is scheduled for the next business day and flagged for the morning.

If we set the threshold too high, how would we find out?

The held calls are logged, not discarded. Reviewing that list in the morning is how practices find a complaint that should have paged, and moving it into the escalation list takes a configuration change rather than a rebuild.

Should weekends and holidays use the same threshold as weeknights?

Many practices keep one threshold for simplicity, but the rules are yours and can differ by day and hour. What matters is that the difference is written down, because an undocumented exception is where after-hours coverage usually breaks.