Sarasota, FL is simply the best Florida location for the practice of quality medicine and for family living.

• Name of Contact Person: David Novak
• Email: david@emedprivateservices.com
• Website: http://emedprivateservices.com
• Employment Contact Info. (Tel, Address, Email, Fax, Etc.): David Novak david@eMedPrivateServices.com
• Telephone: 941-228-2903
• Job Title: Physician-Owner
• Date Posted: April 24, 2014
• Job Type: Full Time

Job Location: Sarasota, FL

Duties/Responsibilities/Job Description: Community desires physician to establish new practice to replace current retiring physician. Local Philanthropic Foundation will support with most startup costs. This is a solid, rare opportunity. Practice can serve concierge members while accepting non-members on a time-available basis. Highly affluent community that expects great service. FP or IM Board-Certified required. Concierge experience preferred.

Are Direct Practices Insurance?

John R. Marquis

Jack Marquis has more than forty years’ experience in business, tax and health law. He founded the firm’s concierge medicine practice and has helped physicians across the country establish these practices. Recently he was named 2013 Tax Lawyer of the Year in the Grand Rapids area by the Best Lawyers in America publication. Tel: 616-396-3054 http://www.wnj.com

I. Introduction.

A “direct” practice is one where the patient pays a pre-determined periodic fee directly to the physician in exchange for the physician’s promise to care for the patient at no additional charge.

Another example is the case of Dr. John Muney, where the New York State Insurance Commissioner (“NYIC”) asserted that Dr. Muney’s direct practice violated the New York insurance laws. Dr. Muney agreed to settle the dispute by agreeing to charge $33 per “sick visit,” a modification that in the Commissioner’s mind transformed his practice from an insurance company into a run-of-the-mill physician’s clinic.Implicit in the NYIC’s position and the eventual settlement of the matter was a concept that is instructive in contemplating the “risk” element that leads some to argue that direct practices should be regulated as insurance companies – the distinction between a “well visit” and a “sick visit.” Although Dr. Muney did not distinguish between the two, his practice, like virtually all direct practices, called for a predetermined periodic fee (in Dr. Muney’s case a monthly one) that entitled the patient to an unlimited number of visits. “Well visits” means “preventative” encounters with a physician or at least visits that do not arise because the patient is sick or injured. A “sick visit” is when the patient is sick or injured and needs treatment or advice, an event that is not volitional – the patient has no choice in the matter, as she would if she were to decide to visit the physician for a preventative examination or discussion (that is, a “well visit”).

By Michael Tetreault, Editor

APRIL 25, 2014 – Concierge Medicine Today, the industry’s oldest and most respected independent trade publication for the concierge medicine marketplace released findings this week from a recent poll asking their readers ‘Among which generation is Concierge Medicine or Cash-Only doctors most popular?’ The resulting conclusion of the poll tells readers that the two most popular generations utilizing concierge medicine and cash-based, membership medicine healthcare are Baby Boomers followed closely by the population that will financially support the aging Boomers, Generation X. Generation X encompasses a population of 44 to 50 million Americans born between 1965 and 1980.

When Concierge Medicine Today asked ‘Among which generation is Concierge Medicine or Cash-Only doctors most popular?’ they found the following [1]:

• 1925-1945 – Silent Generation – 6%
• 1946-1964 – Baby Boomers – 42%
• 1965-1979 – Generation X – 28%
• 1980-2000 – Millennials or Generation Y – 18%
• 2000/2001-Present – New Silent Generation or Generation Z – 6%

Now that Generation X is all grown up, they’re the latest group of adult children who will soon be caring for their aging parents. On the whole, Generation X is far more ethnically diverse and better educated than the preceding Baby Boomers and makes up a growing percentage of patients in this industry.

Dr. Ellie Campbell, DO and Michael Tetreault on Physician Radio HealthGate, July 2013.

“What our practice offers is total transparency in fees, total certainty who your physician will be, and expert guidance in treatment targets and wellness from physicians who have the time to devote to true prevention and lifestyle education,” says Ellie Campbell, DO of Campbell Family Medicine in Cumming, GA.

“We have a number of Generation X-ers who have opted into our practice in Boulder,” says Ginnie Meyers of Foundation Health, located in Boulder, CO. “The old model works worse for Generation X than for any other segment of the population. On average Generation X is not in the office as much for consistent check-ins as the preceding generation, but they need more service than the Millennials do.”

“Interestingly, doctors across the country are becoming more transparent about their fees,” says Catherine Sykes, Publisher of the industry trade publication, The Direct Primary Care Journal. “This is all happening at a time when the cost of health care is rising. We have an era coming with more innovation in health care delivery in our country than we’ve had in a decade. The way health care is delivered will radically change and the focus will be on the customer. Employers are on alert as well and are switching to high-deductible health plan policies where employees are now responsible for a higher amount of dollars upfront before the company picks up the cost. As that expands, patients are going to start looking at health care from more of a consumer perspective, become more cost conscious and less reliant on a piece of plastic in their wallets.”

Generation X, however, is currently the group hit the hardest by the slow economy. They have less money than their parents did at the same age. In fact, the average worth of someone from the age 29 to 37  has dropped 21% over the last 30 years. Generation Xers however, are extraordinarily resourceful, independent and self-sufficient. Members of Generation X are largely in their 30’s and early 40’s and more than 60% of Generation Xers attended college.[2]

The Millennial Generation however, is the second most dominant demographic today in this industry.[1] For Concierge Doctors, direct-pay clinics and those cash-based medical physicians who simply want to make their name known to this large demographic, word-of-mouth advertising won’t guarantee they will step up to your service window or walk through your door. It takes a lot of factors to grab their attention and their business.

Dr. Josh Umbehr, AtlasMD or Wichita, KS, DPC Journal and CMT Contributing Physician.

“I believe the Baby Boomers Generation will be a key reason that membership medicine practices will continue to grow,” says Dr. Josh Umbehr of AtlasMD, a concierge medicine practice based in Wichita, KS. “They are the sandwich generation. They are caring for aging parents and grown children living at home. They are experiencing the failure of insurance-based medicine on both ends of the spectrum.  They will not tolerate the poor healthcare and service that has become the norm. They will demand a better product and will find it in our style of medical practice.”

The book, The Marketing MD notes that in today’s healthcare culture, the 55-plus audience hasn’t been entirely abandoned but the advertising aimed at this population segment is simply aimed at maintaining brand loyalty and establishing that the products they love are still good, still function and most likely being improved. Conversely, you can watch any primetime television show that’s targeting the 25-54 demographic, and you will learn what those people think is cool, hip, and where our culture is trending. You will not see advertising aimed at the 55-plus demographic population that’s designed to get them to switch brands. The advertising aimed at 25-54 is all about that. And, by the way, most doctors, consultants and advertising agencies know that.[3]

A story in Time magazine shows that Millennials want more ‘me time’ and crave nearly nonstop feedback and advice. This could be a great fit for Concierge Medicine and DPC practices because these medical practices encourage a closer patient-physician relationship with regular communication. However, the ‘Me’ Generation, (i.e. Millennials) are often described as confident, self-expressive, liberal, upbeat and receptive to new ideas and ways of living.

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“The Baby Boomers have had the opportunity to build relationships with their physicians and administrative constraints are becoming unmanageably burdensome on PCPs,” said Meyers. “In addition, with the prevalence of the internet, I think Generation X-ers are more comfortable with membership-based purchases, in general. The business models of Amazon, Costco, REI, credit card companies, wine clubs, online resources, and gyms all encourage membership for service. These factors combined, I think have created an openness and an increased comfort-level for X-ers toward the idea of a membership model of care.”

“There are many residents in my area that are part of Generation X and they seem interested,” said Dr. Shahzad Anwar of Point Health in Roseville, CA. “They have been exposed to the current health system and its fluctuation over time. They’re ready for a new solution. We account for the fact that our Gen X patients are consumers and people as well so they are looking for more than just a Healthcare visit but also want wellness care. By offering Aesthetic and Wellness services along with primary care we feel ready for the surge in interest for our practice.”

Related: The Anti-Aging Side of Concierge Medicine Boosts Patient Retention For The Modern Medical Home

“Baby boomers will feel stuck between what they have been used to over the past few decades of (i.e. Insurance Company) health care and going back the old-fashioned way when there were no third party intrusion, hassles and disappointments, says Adel Eldin, MD, of Brooksville Cardiology in Wesley Chapel, FL. “With the right price for services delivered, personalized healthcare delivery with improved customer service and patient education and compassionate care along with technology to enhance the delivery of healthcare, I believe that a significant proportion of the baby boomers will gravitate towards the Concierge Medicine Model for sure.”

“Interesting differences were seen in how the genders, generations and regions view various brands,” says Catherine Sykes, Publisher of The Direct Primary Care Journal. “The Millennial generation enjoys interacting with brands in social media like One Medical Group which has nearly 100,000 followers on their Corporate Facebook Page. Gen Xers find membership medicine programs through MedLion and Qliance more influential than traditional primary care clinics. Among national American brands, MDVIP is very influential among physicians and the Mayo Clinic ranks particularly high among Men, Boomers and those executive travelers who enjoy medical tourism type services.”

According to Concierge Medicine Today, Generation X represents nearly 30% of the U.S. cash-only and membership medicine patient population. This generation marks the period of birth decline after the baby boom and is significantly smaller than previous and succeeding generations.[1]

The lack of preparation around finances and transfer of family assets is probably the biggest challenge that face the Baby Boomer consumer. As self-reliant Gen Xers, many Gen Xers find themselves asking aging parents about their finances, healthcare alternatives and treatment options. Many Gen Xers are able to “ease” the financial sticker shock of the upscale healthcare communities by explaining to them the benefits, services and affordability of cash-only and membership medicine doctors.

A mass-market variant of Concierge Medicine, distinguished by its low prices, Direct Primary Care (DPC) is also quite popular by many Gen Xers and the Boomer population.[4] Due to much smaller patient panels than traditional primary care and insurance-based medical practices, DPC doctors say they spend more time with patients discussing treatments, procedures, prescription use and other healthcare options. Similar to its older familial medical model, Concierge Medicine, DPC doctors frequently promote the fact that they can provide “unhurried appointments” and same-day access to a physician. Most DPC medical clinics and doctors with price points under $100 per person per month are slowly gaining traction in the highly competitive healthcare marketplace in the U.S. DPC’s strength has not been in the number of physicians signing up to change their business model but in the low monthly fee they charge their patients.[5]

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Presently, eight large practice organizations that use the DPC model have patient rosters estimated to serve over one million people throughout the U.S. and growing [6], [7], [8], [9], [10]. These organizations include:

• White Glove Health (includes self-insured employers, families and dependents)
• WeCare Clinics
• One Medical
• Paladina Health
• MDVIP
• Qliance Medical Management
• Iora Health
• MedLion

As the population ages and the impact of healthcare reform continues to be felt, navigating the medical landscape is only getting more complex for employers and patients. There will be an even greater need for healthcare advisory services in the coming years as patient choices grow more complex and access to appropriate clinicians becomes increasingly difficult. PinnacleCare, a health advisory firm started in 2001, connects individuals to top physicians for customized advice on their unique medical issues – avoiding unnecessary care and minimizing the risks in today’s healthcare system.

Patient advocacy and healthcare advocacy firms such as PinnacleCare do not provide medical care but do provide healthcare management services. This might include: researching medical centers; doctors and treatment options; arranging for timely access to top physicians; handling all details related to appointment scheduling; organizing the Members’ medical records and history; providing global resources on a 24/7 basis; and, in general, advocating what’s best for each Member. DPC doctors, Concierge Medicine Physicians and membership-based medical clinics vary in that these are primary-care practices that provide care to a limited number of patients for low fee. At these primary care practices, referrals to specialists, when needed, typically are limited to the doctors’ personal referral network and tend to be confined to a specific geographical location.

As the nation’s healthcare system prepares to cope with an influx of 30 million newly insured Americans as a result of the Affordable Care Act, physician entrepreneurs are leading medicine down a new path that will see more doctors listing their prices and connecting with patients much like the days before managed care and administratively-burdened insurance. DPC physicians are able to run a very low cost practice that is for the most part, cash only. Clinics and physicians, like Qliance, are now being opened across the country, many with extended hours that offer a more patient-centered relationship with a physician.[4]

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Many people are unaware that there was a clause written into the Affordable Care Act (ACA) allowing retainer practices to be included in the proposed insurance exchanges – with the caveat that these practices be paired with a wraparound insurance policy covering services outside of primary care. According to the report by The California HealthCare Foundation[7], it is the only non-insurance offering to be authorized in the insurance exchanges slated to begin this year. There is not a requirement that Direct Primary Care be included.

In September of last year, Qliance Medical Management Inc. of Seattle, WA and Physician Care Direct (PCD) of North Carolina announced the nation’s first health insurance plan for Direct Primary Care, an increasingly popular model of flat-fee medical care. The offering wraps a proven insurance product around an innovative primary care platform — provided by multiple Puget Sound physician groups — to let employers better manage healthcare costs while benefiting patients and providers alike.[6]

Related: Qliance and Physician Care Direct Introduce Nation’s First Health Insurance Plan for Direct Primary Care

One Georgia DPC physician we spoke to recently checked with a health insurance agent about the effect of ACA, insurance, catastrophic care plans and the effect the healthcare law may have on her patients. She learned that if catastrophic care plans are offered, they do not meet ACA Minimum requirements for coverage. Meaning, policy holders with only this coverage would be in violation of the law and subject to fines, as if they had no insurance, unless the healthcare law is somehow changed. For a single policy holder, this could be as little as $95 or   as much as 1% of the amount by which your income exceeds the sum of a single person’s personal exemption and standard deduction in the federal income tax for each family member not insured.

Jeff Gordinier, author of “X Saves the World,” writes that Xers are “said to be the defiant demographic, dedicated to shredding whatever raiment the marketing apparatus tries to drape us in; because we’d prefer not to be categorized at all, thank you very much.” Still, like other generations before them, Gen-Xers share a common past and certain characteristics.

Generation X grew up with corporate downsizing, massive layoffs, governmental scandal, and come from two income and/or divorced families. With their parents often dedicating their lives to work, Generation X children were often left to accomplish tasks alone or with their siblings, therefore, they became an independent, self-reliant group of smart individuals.[2] Gen-Xers are comfortable with diversity and more globally aware of innovation than any other previous generation. They are the first generation to grow up with CD’s, remote controls and computers. Their circle of friends likely include people from other cultures and they are one of the first generations to benefit from easier world travel and unlimited access to world-wide current events.This generation is comfortable using PDAs, cellphones, e-mail, laptops, Blackberrys and other technology employed in the legal workplace.

“I think the Millennial generation will be the driving force, as they are not as quick to accept the antiquated and bureaucratic third-party payor system as being the way to do things,” says Robert Lamberts, MD, who opened a direct-pay medical practice recently in Augusta, GA. “They will look to use technology to connect with their doctors and have care at their convenience rather than to fall in line with the “normal” way things are done.  I think this is both true of the patients of that generation, and even more so with the doctors who are not at all excited about a system that thrives on frustrating complexity and disconnectedness to force patients to come to the office and pay for care.  The generation that has never gone to a record store, instead downloading or streaming music; the generation that has never opened an encyclopedia, instead going to the internet for information; the generation that sees the bad mistakes of their predecessors (global warming, huge government deficits, social injustice) will seek a simpler and fairer way to do it using the technology they grew up with.”

Gerlinda Grimes writes that Gen-Xers are often referred to as the first latchkey kids. As the divorce rate rose in the 1970s, Gen-Xers were left to look after themselves while both parents entered the workforce. As a result, many Gen-Xers developed independence and self-reliance. They prefer to do things their own way and thrive in casual, friendly work environments [2].

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“As long as we live in a world of drive-though windows, ATMs, and garage door openers,” notes Dr. Campbell, “patients are going to value and pay for any service that gets them in and out quickly, on their time schedule, with their desired objective. Primary care doctors need to learn to adapt, as this  model of care delivery seems here to stay. Unless we offer on-site dispensaries, extended hours, and no appointment needed delivery, we will be deferring more urgent issues to these models. Perhaps then we will have more time to devote to preventing disease and reversing the burden of chronic conditions, if only we can convince third party payors that there is value in that.”

[1] Concierge Medicine Today, March-April 2014.

[2] AmericanBar.org; Theilfoldt and Scheef; Law Practice Today;http://apps.americanbar.org/lpm/lpt/articles/mgt08044.html

[3] The Marketing MD Book, © 2013-2014; http://www.amazon.com/The-Marketing-MD-Attract-Patients/dp/1494433109

[4] The Direct Primary Care Journal, © 2013-2014.

[5] The Concierge Medicine Research Collective, © 2009-2014.

[6] Qliance and Physician Care Direct Introduce Nation’s First Health Insurance Plan for Direct Primary Care, September 2013; http://www.digitaljournal.com/pr/1482448#ixzz2zopL3jnj

[7] The California Health Foundation, April 2013; http://www.chcf.org/publications/2013/04/retainer-direct-primary-care

[8] Health Plan Rorschach Test: Direct Primary Care, Dave Chase, July 2013, Forbes.com; http://www.forbes.com/sites/davechase/2013/07/06/health-plan-rorschach-test-direct-primary-care/2/

[9] Healing health care, Michael Jonas, Winter 2014, CommonWealth; http://www.commonwealthmagazine.org/News-and-Features/Features/2014/Winter/002-Healing-health-care.aspx#.U1kYCVcvCWG

[10] Healthcare Costs: Low-Hanging Fruit, Todd Hixon, April 4, 2014; http://www.forbes.com/sites/toddhixon/2014/04/04/healthcare-costs-low-hanging-fruit/

About Concierge Medicine Today

Concierge Medicine Today (CMT), is a news organization and the industry’s oldest national trade publication for the Direct Primary Care and Concierge Medicine marketplace. Their web site, www.ConciergeMedicineToday.com, is the online destination for consumers, businesses, physicians, legislators, researchers and other stakeholders to learn about the history of this industry, various business aspects of the marketplace, trends, breaking news and more that drives the conversation that Concierge Medicine and Direct Primary Care is creating on a national and international level. To locate a Concierge Doctor or learn more, visit: http://www.ConciergeMedicineToday.com or http://www.DirectPrimaryCare.com.

By Michael Tetreault, Editor

APRIL 28, 2014 - Concierge Medicine Today’s research and data collection arm, The Concierge Medicine Research Collective (The Collective), examined 500 medical practices in four of the most popular states in concierge medicine, boutique healthcare and direct-pay offices from April of 2013 – April of 2014 looking at them from a specialty perspective. They found that among the operating physician practices in California, New York, Georgia and Florida, four of the top 5 most highly populated states in this industry, the following:

• 42% of Concierge Care Practices are Internal Medicine/Primary Care
• 27% of Concierge Care Practices are Family Medicine.
• 17% of Concierge Care Practices are Osteopathic Medicine.
• 14% of Concierge Care Practices are specialty physicians, which range which include: pediatric concierge care; neurology; cardiology; urgent care; chiropractic; anti-aging and hormone replacement; acupuncture; gynecology; dentistry and addiction recovery medicine.
• Many practices are expanding their operating hours to accommodate working Moms and Dads while continuing to remain open scheduling and offer same-day visits, Saturday’s also.

By Rob Lamberts, MD | Physician | DPC Journal/CMT Contributor — http://more-distractible.org/

Unlike the high-end retainer-based practices that made the news a decade ago, most concierge care, membership medicine, and direct-pay physician practices cost less than $130 per month. But, when our team examined these practices a little deeper, looking at basic service offerings, etc., we learned that general primary care and visits to the practice for annual physical examinations are not enough to keep patients happy and coming back year after year.

“It’s the one and done patients that take the most time and cost my practice the most,” says direct primary care doctor Rob Lamberts, MD who operates a unique medical home in Augusta, GA.

Adding Value To The Practice

Concierge Medicine Today learned very quickly that only four out of every ten concierge and direct-pay doctors offices are working with and negotiating discounts with local labs in their area for services such as: PAP Smears; X-Rays; MRIs; Colonoscopy; Genetic/DNA Tests; and more.

“I’ve been working on adding new services as well,” adds Dr. Lamberts. “One of the first things I did when I opened the office was to negotiate a very inexpensive fee schedule from a lab who would bill me for the tests.  Most docs mark up the tests and make a profit off of it, but I do very little mark-up of the tests, instead offering things like a CBC for $4.50 and a TSH for $8.00. I am now working on doing the same thing with an x-ray facility, giving them the opportunity to get guaranteed cash up-front [reducing their overhead] while avoiding the many traps of compliance with Medicare billing [which forbids providers from giving discounts to other patients that they don’t give to Medicare patients].”

Dr. Robert Nelson of MyDoc in the Atlanta metro area, a DPC doctor, states “If you walk into a Quest or Lab Corp facility the cash price for a routine blood chemistry panel (CMP) will be $62.58 and $46, respectively. I can offer the same exact lab test to my patients for $15, which covers my costs and the time related to clinical follow up as well. This shows the power of free-market leverage when you get out from under the third-party payment model. The good news is that these direct fees paid to direct-pay physicians or discount labs can still be applied towards a deductibles and always go towards total out-of-pocket expenses for the year.”

CNNMoney reports “By cutting out the middleman, [one doctor] said he can get a cholesterol test done for $3, versus the $90 the lab company he works with once billed to insurance carriers. An MRI can be had for $400, compared to a typical billed rate of $2,000 or more.”

“We also had to acknowledge that, while our services were extensive [at our physical practice], certain activities couldn’t be performed at North Vista Medical Center,” said Drs. Clint Flanagan and David Tusek of Firestone, CO. “We’ve always believed in being a patient’s ‘healthcare quarterback,’ so we negotiated highly competitive rates for lab and imaging services within our market. We determined the services most crucial to our patients, educated ourselves about available resources in our community, and created a list of options with full cost transparency.”

Related: Medical Centers Concierge Alliance Conference Targets Hospital Physicians, Administrators and Medical Center Executives

A sampling of Nextera Healthcare rates provide by Nextera to Concierge Medicine Today is as follows:

• CBC – $5
• CMP – $5
• HgbA1C – $11
• Lipid panel – $5
• Uric acid – $5
• Vitamin D – $28
• Ferritin – $8
• TSH – $8
• Cardio CRP – $16

“The cost savings we achieved for our patients was tremendous, thanks to our long-standing community and business relationships,” adds Flanagan. “For example, the combined costs of the above tests would be $630 for a self-pay patient, yet our rates meant all tests combined would cost a Nextera Healthcare member just $91 out-of-pocket.”

“We negotiated similar discounts for imaging services,” notes Tusek. Nextera Healthcare’s fees are as follows:

• MRI non-contrast       $450
• MRI with contrast      $650
• Athrogram                   $650
• CT without contrast    $300
• CT with contrast         $400
• CT with both               $450
• Ultrasound                  $190
• Ultrasound – vascular  $250
• Ultrasound – pelvic     $250
• Ultrasound – breast     $100
• Upper GI                     $130
• Barium swallow          $90
• X-ray – 2 to 3 views    $60
• X-ray – 4-plus views   $90

Interestingly, this is all happening at a time when the rise of health care costs has gone into pause.

Dr. Tiffany Sizemore-Ruiz, physician, author and blogger. Dr. T is known for giving a little tough love, but she cares immensely for her patients. She truly treats every patient as if they were a family member, and will always give advice based upon that ideal. Tel: 954.523.4141

“I have noticed that any patient that comes in as a “cash pay” will always pay less than what a hospital or imaging center is billing the insurance for the same test. Also, remember, that some tests ordered are not typically covered by insurance (like a coronary CT) so, cash prices are extraordinarily important for these scenarios,” says Dr. Tiffany Sizemore-Ruiz, a concierge doctor in the Miami/Fort Lauderdale Area.

The actual cost of medical care fell for first time since Gerald R. Ford was president of the United States.

“I can get much cheaper prices for my patients. My PSA’s are $30.00 and Lipids $15.00 … and that is with a mark-up. General Health Screens (CBC, Thyroid, Liver Kidney and glucose tests) are $35 at my office. Next door at the lab, GHS SOT is greater than $200 and Lipids are higher than $100,” says Dr. Sizemore-Ruiz.

So what’s behind the slowdown in health care spending?

Clark Howard writes, ‘First, employers are switching to high deductible health plans where you are responsible for so many thousands of dollars upfront before the company picks up the tab. When that happens, you start to treat health care like a consumer and become more cost conscious. Second, generic drugs are on the rise, which keeps the cost of health care down.’

Bob Adelmann wrote in The New American, ‘Naturally the insurance industry isn’t too happy about it, but at present there’s little they can do. For the moment, “concierge” medicine and its more modest iteration, “direct pay” medicine, is increasingly being seen by patients and doctors alike as a way out of the maze of medical practice requirements caused by government intervention in what used to be a simple transaction: a private matter between a doctor and his patient.’

The Anti-Aging Side of Membership Medicine

“Incorporating unique anti-aging and medical home solutions into their practice across the U.S. from 2012 to 2014,” says Catherine Sykes, Publisher of The Direct Primary Care Journal. “These [concierge and direct care] doctors are by choice and nature, treating nearly 90% of their patient’s healthcare concerns, ailments and needs each year. But that relationship can get repetitious year after year so doctors are adapting. They’re learning what’s successful from their own patients and finding out what’s appealing to their audience because these physicians and staff are actually talking consistently with each patient more often than before.”

“My focus is on being a trusted advisor and I don’t want to have any potential conflict of interests,” said Shira Miller, MD of Sherman Oaks, CA. “For example, a lot of doctors make money on supplements, for me I take that out of the equation. In terms of my practice, I just want to  focus on providing the best advice I can give my patients, not worrying about making money off retail.”

“There was a time when patients valued their family doctor, trusted our opinion and called us after hours to help decide if symptoms needed urgent attention or could wait,” says Dr. Ellie Campbell of Campbell Family Medicine in Cumming, GA in an interview with Concierge Medicine Today. “Our phone trees, answering services, and after hours call-sharing doctors make it unlikely that any  given patient will actually speak to their own doctor. So they don’t bother, and they seek care wherever it is most convenient.”

Many Concierge Medicine and direct-pay doctors are incorporating a vast number of added-value services for patients to aid in patient satisfaction and retention. Services include: Heart burn and gastrointestinal disorders; B12 injections; Vitamin deficiencies; Hormone balancing therapies; Mole checks; Testosterone injections; Medically supervised fat loss programs and a diverse collection of other wellness-focused and anti-aging solutions.

“I give a lot of B12 injections and testosterone injections for those who need it,” says Dr. Sarah Mildred Gamble, D.O. of Greenwich, CT who runs a thriving concierge medicine practice. “I also do a lot of in office procedures like mole checks and removal, trigger point injections … and then there is my Botox/fillers appointments too.”

The Collective has also found that the concierge medicine and direct primary care clinics that are introducing anti-aging service and a medical home philosophy in their local markets are seeing patient foot traffic double or even triple in each and every age group from six to sixty.

Shira Miller, M.D. The Integrative Center for Health & Wellness A Concierge Holistic Medical Practice in Sherman Oaks, CALIF.

Dr. Shira Miller runs a Concierge Holistic Medical Practice in southern California that focuses specifically on anti-aging and Menopause. So popular infact, she’s become ‘Facebook’s Most Popular Menopause Doctor.’

“I work to ensure 100% of patients… visit at least once per year,” notes Dr. Miller. “When Mother Nature quits, I’m here to help you keep your [the patient's] mind, body, and sex life healthy as you age.”

“The anti-aging and medical home delivery model fits well inside a concierge medicine [and direct care] practice,” says Tetreault. “The nutritional component, the wellness solutions, the anti-aging and team-focused health care delivery professionals led by a concierge [or direct care] doctor are providing comprehensive and continuous health care services to patients year after year that they simply can’t find elsewhere. This combination is increasing patient retention and patient interest in the concept. The goal here is healthy outcomes for patients followed by increased patient retention outcomes for the physician year after year.”

“Many of my female patients choose for me to their annual gyn [gynecology] exam, but those who have their own gynecologist follow with them,” writes Dr. Alexa Faraday to Concierge Medicine Today. Dr. Faraday is a Board Certified Physician in Internal Medicine operating a successful concierge medicine practice based in Baltimore, MD.

“What I found interesting was that when I left my old practice — I had a 10% Medicare population. That fraction has grown to almost half, suggesting to me that some of the folks most interested in this model are older patients,” adds Faraday.

Concierge Medicine Today has also reported that Menu-style lists displayed inside doctors offices with simple price lists for healthcare services [think restaurant or Value Menu Meals at Fast Food chains] which require payment up front or before they leave the office is becoming more and more popular. The Wall Street Journal reported just last year that when physicians eliminate insurance billing from their daily activities, it can cut 40% of the practices’ overhead expenses, enabling them to keep fees low.

Related: Wall Street Journal: “Pros and Cons of Concierge Medicine”

Dr. Ellie Campbell is the founder, owner, and sole physician in Campbell Family Medicine in North Metro Atlanta — Tel: 678-474-4742

“Patients value speed and low cost most of all for most minor complaints,” notes Dr. Campbell. “Even my patients who pay a membership fee for all of their covered and non-covered services including 24-hour access to my personal email and cell phone number, and whose care for these complaints would be covered without additional cost, still use these [retail medicine style] health providers [i.e. CVS, MinuteClinic, TakeCare Clinic, etc.]. Many patients say, ‘I just did not want to bother you on the weekend, and I was near there anyhow.’ As long as we live in a world of drive-though windows, ATMs, and garage door openers, patients are going to  value and pay for any service that gets them in and out quickly, on their time schedule, with their desired objective. We [Concierge Medicine and Direct-Pay Doctors] need to learn to adapt, as this delivery model of care seems here to stay. Unless we offer on site dispensaries, extended hours, and no appointment needed delivery, we will be deferring more urgent issues to these models. Perhaps then we will have more time to devote to preventing disease and reversing the burden of chronic conditions, if only we can convince third party payors that there is value in that.”

Until just a few years ago, people mostly based choosing a doctor on the personal recommendation of a trusted friend or relative. Now with the advent of social media, word of mouth marketing is changing from a spoken word referral to a social media link referral. To find a concierge medicine or direct care doctor near you, visit http://www.ConciergeMedicineToday.com.

About Concierge Medicine Today

Concierge Medicine Today (CMT), is the premier news and multi-media organization that is the industry’s oldest and most respected national trade publication for the concierge medicine and direct primary care marketplace. Our web site is the online destination for people and physicians to go deeper into the top stories driving the conversation and generating the national buzz about concierge healthcare and direct primary care. For more information, visit: http://www.ConciergeMedicineToday.com.

About The Concierge Medicine Research Collective

The Concierge Medicine Research Collective is an independent health care research and data collection depository of the multimedia news and trade publication, Concierge Medicine Today based in Atlanta, GA. The Collective serves as an educational resource on all things concierge medicine and is geared towards those businesses, lobbyists, physician associations, health care advocacy groups and general consumers of healthcare who want to learn more about information available on the topic of concierge medicine. The Collective works in partnership with Universities, physicians, associations, businesses, individuals and even Graduate medical Students to further advance the educational awareness and facts surrounding unanswered questions about concierge medicine care in the U.S. and Canada. For more information, visit: http://www.AskTheCollective.org or http://www.ConciergeMedicineToday.com.

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FOR IMMEDIATE RELEASE

MAY 1, 2014 — On July 25th and 26th, 2014 in Costa Mesa, CA, ExL Events, an independent, educational healthcare conference coordinator that serves the pharmaceutical and healthcare community has designed 2 highly anticipated events for physicians wishing to learn more about patient acquisition and concierge medicine and direct-pay medical business models.

“I had to do this to be able to do my job,” says Dr. Marcy Zwelling, who has been an concierge internist since 1987. “I get to practice the way I think I can practice best. It’s capitalism at its best.”

Dr. Marcy Zwelling, a concierge internist and many others will be featured speakers at an independent ExL Events and Practice Builders sponsored educational conference in Costa Mesa, CA in July 2014.

Editor-In-Chief, Michael Tetreault, Author, Speaker, Educator, Media Liason

ExL Events, Practice Builders, Concierge Medicine Today, Vitals.com, HFM, ACPP and the Society of Physician Entrepreneurs have all teamed up to design an unprecedented healthcare learning opportunity for a diverse audience. Those invited include: Healthcare professionals; staff; practice management advisors; physicians; medical practice business owners; marketing consultants; healthcare physician specialists; lawyers and industry innovators.

“Until just a few years ago, people mostly based choosing a doctor on the personal recommendation of a trusted friend or relative,” says Michael Tetreault, Editor-In-Chief of Concierge Medicine Today and its healthcare trade journal companion, The Direct Primary Care Journal. “Now with the advent of social media, word of mouth marketing is changing from a spoken word referral to a social media link referral. When you think of Andy Griffith-style medicine, the doctor had a clinic in the local town. It’d be strange for him to say, ‘What kind of insurance does Opie have?’ The people you entrust to help your practice grow must be aware of how to effectively promote this new, old-fashioned message and delivery model of healthcare.”

AGENDA, Speakers, Hot Topics and Event Brochure

If you are focused on growing your practice through innovative marketing tactics or you are interested in learning more about launching or expanding a concierge or direct pay medical practice:

• Hear Leading Case Perspectives in Concierge Medicine on How Others Launched or Grew Their Concierge Practice.
• Learn How to Launch or Grow your Concierge Practice
• Receive a Customized Marketing Plan Specific to your Practice Needs
• Determine Which Concierge Model is Right for your Organization and Potential Implications
• Capitalize on the Trends That are Fueling the Growth of Concierge Medicine in the United States and Deliver Better Healthcare
• Understand the Legal and Political Considerations to be Aware of when Starting or Building a Concierge Practice
• Examine the Upsides and the Downsides of Running and Operating a Concierge Medical Practice
• And much more!

Shira Miller, M.D. The Integrative Center for Health & Wellness A Concierge Holistic Medical Practice in Sherman Oaks, CALIF.

Dr. Shira Miller runs a Concierge Holistic Medical Practice in southern California that focuses specifically on anti-aging and Menopause. So popular in fact, she’s become ‘Facebook’s Most Popular Menopause Doctor.’  “I work to ensure 100% of patients… visit at least once per year,” notes Dr. Miller. “You simply can’t build your practice, hang a sign on the door and expect people to walk-in. You’ve got to build that know, like and trust factor – and this is done over time, strategically and methodically. Think drip, drip, drip – but over a period of weeks and months. Remember, there’s no magic theory or system that will provide you patients tomorrow. There are only tools and strategies that you can use to accelerate their decision(s) to visit your practice.”

LEARN FROM THESE KEY EXPERT SPEAKERS

• David Albenberg, MD, Founder, ACCESS HEALTHCARE
• Carrie Bordinko, MD, Personal Physician, CONSOLARE PRIVATE PHYSICIAN SERVICE
• James Eischen, JD, Partner, HIGGS, FLETCHER & MACK
• Adel Eldin, MD, CEO & Cardiologist, BROOKSVILLE CARDIOLOGY
• Tracy Ganske, PhD, Founder, VIATU PROACTIVE HEALTH
• Nina Grant, Vice President, Agency Managing Director, PRACTICE BUILDERS
• Thomas LaGrelius, MD, FAAFP, SKYPARK PREFERRED FAMILY CARE
• Jim Lindberg, MD Managing Physician, PERSONAL CARE PHYSICIANS
• Troy Medley, President & CEO, PERSONAL CARE PHYSICIANS
• Shira Miller, MD, Founder & Medical Director, THE INTEGRATIVE CENTER FOR HEALTH & WELLNESS
• Michael Tetreault, Editor, CONCIERGE MEDICINE TODAY & The DIRECT PRIMARY CARE JOURNAL
• Jonathan Vidal, Senior Director of Consulting Services, PRACTICE BUILDERS
• Marcy Zwelling-Aamot, MD, Owner, CHOICE CARE

“You will never regret being a doctor if you work only for patients,” says Dr. Thomas LaGrelius, MD, FFAFP Skypark Preferred Family Care, a concierge medicine practice in Torrance, CA. “But if you don’t work only for patients, you will regret your decision in the end.”

Dr. Thomas LaGrelius, MD, FFAFP Skypark Preferred Family Care, a concierge medicine practice in Torrance, CA

“Consolaré offers an alternative to the traditional business model of the medical practice. I only work with a limited number of members. This allows me to know you on a personal basis and understand your unique health concernss.” Carrie Bordinko, MD of Paradise Valley, AZ.

“Moving in to Concierge Medicine is not solely about providing excellent medical care without the restraints of insurance industry mandates,” tells Dr. Carrie Bordinko of Consolaré Primary Care in Paradise Valley, CA and featured speaker at the July event. “You have to also appreciate the lost art of customer service so long ago forgotten when visiting a healthcare institution. Many times my clients (notice I do not use the word “patients”) have noted why they refer their friends to my practice. It is the attention to detail, always delivering exactly what is promised and then some, and keeping their unique needs positioned first with a flexibility to offer new programs or meet needs as quickly as they are identified. This is the cornerstone of customer service.”

“In today’s healthcare culture, the 55-plus audience hasn’t been entirely abandoned,” adds Tetreault, “but the advertising aimed at this population segment is simply aimed at maintaining brand loyalty and establishing that the products they love are still good, still function and most likely being improved. Conversely, you can watch any prime-time television show that’s targeting the 25-54 demographic, and you will learn what those people think is cool, hip, and where our culture is trending. You will not see advertising aimed at the 55-plus demographic population that’s designed to get them to switch brands. The advertising aimed at 25-54 is all about that. And, by the way, most doctors, consultants and advertising agencies know that. This is just one of the many helpful topics you’ll learn about at this conference.”

How Are You Growing Your Practice?

From 2009 to January of 2014, Concierge Medicine Today asked some local medical practice owners what form of marketing they found to work best to grow their practice, acquire new patients and stimulate more positive patient feedback and referrals. The results were as follows:

• 7% use Facebook to grow their business and get new patients.
• 2% use Twitter to grow their business and get new patients.
• 5% use postcards to grow their business and get new patients.
• 5% use a letter alone, to grow their business and get new patients.
• 18% use a letter with a brochure about their business and get new patients.
• 21% say hiring a marketing/PR company that used both online and offline marketing strategies helped grow their business and generate new patients.
• 3% say hiring a business management consultant to organize internal processes grew their business and obtained a few new patients.
• 9% participate in local area networking activities and events.
• 16% say local area advertising combined with low-risk offers helped grow their business; and
• 14% say word of mouth from existing patients helped to grow their business.

By Michael Tetreault, Editor

April 17, 2014

Designing Our Practice, Nextera Healthcare in Firestone, CO

According to North Vista Medical Center and Nextera Healthcare Co-Founders Drs. Clint Flanagan and David Tusek, “The DPC model was very attractive to us because, under this approach, we could sustain the value of the patient/provider relationship and create more accessible care for our patients. We wanted to restore the ‘art’ of healthcare delivery and not focus just on the science of it. We are credited with being one of the first to market in Colorado with a DPC program via Nextera Healthcare.

An in-depth analysis of our financials revealed we needed to continue operating under the fee-for-service model for their insured patients, and then introduce the DPC option alongside. We did not want to undermine our existing patient relationships by declining traditional insurance, but we also wanted a tangible option for patients who were uninsured or under-insured and forced to seek alternatives due to rising healthcare costs.”

Determining the right price point for the monthly DPC membership, and what services would be included in said membership were both of vital importance. At first we considered charging a monthly fee accompanied by a very low fee per office visit. However, we both agreed the dual fee structure would create complexities and we were trying to simplify the delivery of primary care. Thus, we set a $99 per month individual price, $139 per month for couples, $179 per month for a four-person family, and $39 per month per child for additional dependents.

We were fortunate to be uniquely qualified to handle a broad range of healthcare issues due to our extensive training in both family and emergency medicine. Thus, the services covered by our monthly membership fee were equally wide-ranging:

• Routine pediatric care
• Adult medicine and wellness
• Gynecological care, including Pap tests
• Care and treatment for chronic conditions, such as high blood pressure and diabetes
• Dermatological services, including treatment and/or removal of precancerous and certain cancerous lesions, cryotherapy and removal of warts, skin tags, age spots and cysts, and acne treatment
• Acute care for non-life threatening emergencies and medical problems
• Wound repair, including stitches or surgical glue
• Fracture care, including casts and splints for broken bones not requiring surgery
• Trigger-point and cortisone joint injections
• Annual physicals
• End-of-life care
• Customized weight management
• Treatment of depression, anxiety and mood disorders
• ADD and ADHD evaluation and management
• Smoking cessation and alcohol abuse management

Our fee also included some critical relationship-building elements that would set us apart, such as (1) unrestricted visits with providers at our three North Vista Medical Center locations; (2) extended office hours, including Saturdays; and (3) remote or virtual access to providers via email or phone.

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Due to the additional benefits provided to our Nextera Healthcare members, we created a staff education program on how to handle traditional fee-for-service patients and DPC members concurrently based on their health issues. Because DPC members were promised round-the-clock access, more urgent patient issues meant DPC members took priority over fee-for-service patients. Also, if DPC members needed urgent care after regular office hours, the on-call provider would meet them at a North Vista Medical Center facility for care. Fee-for-service patients might visit a 24-hour urgent care facility, in contrast. Staff understanding of the flow of their system was critical to fulfilling our promise to our Nextera Healthcare patients.

We also had to acknowledge that, while our services were extensive, certain activities couldn’t be performed at North Vista Medical Center. We’ve always believed in being a patient’s ‘healthcare quarterback,’ so we negotiated highly competitive rates for lab and imaging services within our market. We determined the services most crucial to our patients, educated ourselves about available resources in our community, and created a list of options with full cost transparency. A sampling of rates follows:

• CBC                $5
• CMP                $5
• HgbA1C         $11
• Lipid panel      $5
• Uric acid         $5
• Vitamin D       $28
• Ferritin             $8
• TSH                 $8
• Cardio CRP    $16

The cost savings we achieved for our patients was tremendous, thanks to our long-standing community and business relationships. For example, the combined costs of the above tests would be $630 for a self-pay patient, yet our rates meant all tests combined would cost a Nextera Healthcare member just $91 out-of-pocket.

We negotiated similar discounts for imaging services, as follows:

• MRI non-contrast       $450
• MRI with contrast      $650
• Athrogram                   $650
• CT without contrast    $300
• CT with contrast         $400
• CT with both               $450
• Ultrasound                  $190
• Ultrasound – vascular  $250
• Ultrasound – pelvic     $250
• Ultrasound – breast     $100
• Upper GI                     $130
• Barium swallow          $90
• X-ray – 2 to 3 views    $60
• X-ray – 4-plus views   $90

Ongoing analysis also helped us understand what staffing we would require to accommodate our DPC membership. We used the following rationale to determine provider staffing levels:

The average family medicine physician has a panel of approximately 3,000 patients under the fee-for-service model. However, a DPC provider can generate similar revenue with a patient base of approximately 1,000 members, which reduces patient volume and increases the amount of time spent with each patient, a cornerstone of the DPC value proposition. Our DPC model allows us to split shifts. Ideally, four providers work out of one location, with two providers working on weekday mornings, two on weekday afternoons, and two on Saturdays. Under our model, DPC providers work a 30-hour week, far less than the typical fee-for-service primary care provider who works a 50 to 60-hour week.

About Dr. Clint Flanagan and Dr. David Tusek
Nextera Healthcare
8308 Colorado Blvd, Suite 200
Firestone, CO 80504
Office: 303-501-2600
www.nexterahealthcare.com
https://www.facebook.com/NexteraHealthcare/

How to ensure you and your doctor are speaking the same language.

By Marvin Lipman, M.D., Chief Medical Adviser and Medical Editor

APRIL 24, 2014 - During a recent visit, a patient read from her notes taken during a conversation she had with a cardiologist. He had told her: “Your echocardiogram was unremarkable; the ejection fraction was 68 percent. There was no LVH. All of your laboratory tests were negative. I’ll send a note to your doctor.” With some embarrassment, she admitted that she had no idea what he was talking about.

Source: http://www.consumerreports.org/cro/news/2014/04/7-steps-to-better-doctor-patient-communication/index.htm

Three-Month Personalized Primary Healthcare Membership for One or Two at R-Health (Up to 65% Off)

Choose Between Two Options — View GroupOn Deal

• $99 for a three-month personalized primary healthcare membership for one ($240 value)
• $169 for a three-month personalized primary healthcare membership for two ($480 value)

A primary healthcare membership includes unlimited doctors visits, mobile access, preventative care, basic onsite labs, and healthcare coordination.

Same-day and next-day appointments are available and can be scheduled online; evening and weekend hours are also available.

R Health — http://www.rhealthconnect.com/

1528 Walnut St.
Ste. 950
Philadelphia, Pennsylvania 19102
215-600-4590

By Jackie Pilossoph | For Sun-Times Media

APRIL 29, 2014 - There is a reason some patients go to the doctor and feel like they’ve been handed a prescription and rushed out the door.

HYBRID CONCIERGE MEDICINE: Pros and Cons of Business Model — Click Here TO Learn More.

Because the overhead costs of health care have increased significantly over the last several decades, it’s hard for many doctors to give their patients a lot of time and personal attention, according to Dr. Jeffrey Glass, who has been in private practice for 38 years.

That’s why Glass, an internist with a specialty in gastroenterology, recently changed the structure of his Highland Park practice and began offering a hybrid concierge medical program that allows him to spend more time with his patients.

“The extra time is what I enjoy the most with a patient because you can ask your normal questions and then you have the time to pause and say, ‘What else would you like to talk about?’” said Glass. “That’s important because a lot more information will come out when they see you aren’t rushed, and a lot of times we can intervene and make other things better for them, not just the symptom they came in for that day.”

Patients who enroll in the hybrid concierge program keep their traditional health insurance plan, but pay an annual fee to the doctor for which they receive many benefits. These include same-day appointments, more time allotted for visits, the physician’s cell phone number, which they can call 24 hours a day, seven days a week, and help with accessing and scheduling appointments with specialists, if needed.

The program also includes an annual physical exam that is much more intensive than a standard physical. It is tailored to the patient’s needs and includes a broader array of tests.

“Doctors have been reduced down to taking care of the problems of the moment, unlike the past, when they acted as an advocate, a counselor, an advisor, and almost a family member,” said Wayne Lipton, who is the founder of Concierge Choice Physicians, the New York-based company that developed the program Glass offers. “Concierge care enables doctors to act as health care quarterback.”

“This program is allowing me to practice medicine the way it was when I first started practicing,” Glass said.

Edith Trilling of Wheeling has been a patient of Glass’s for 35 years, and has signed up for the program.

“Prior to this, there were times I wasn’t feeling well and if Dr. Glass was out of town I would call and talk to the other physician and they really didn’t know my history so they really couldn’t help,” she said. “I like the idea, especially at my age, of accessibility.”

A hybrid concierge program, which is what Glass offers, differs from a traditional concierge program in that the hybrid program gives patients a choice of whether or not they want to enroll, whereas in the traditional program, patients must either enroll or leave the practice.

“I have a patient population of 2,700, many who have been with me for 30 years,” Glass said. “There was no way I could tell them to go find another doctor. When I heard about the hybrid option, that made sense.”

BUSINESS: Should You Franchise Your Concierge Medicine Practice?

Glass said the program has been very popular so far, with 100 patients signing up in the first two weeks he rolled it out, and that he continues to get enrollments daily.

“Medicine has become ‘Take care of you, get you out, see the next person,’” said Lipton. “Should it be that way? No, but it’s the reality, and if you have a simple issue, that’s fine. But, if you have a complex problem, sometimes you need more than a prescription and a pat on the back.”

Along with his new practice structure, Glass also has a new location. This spring, he moved his office from its Park Avenue location to First Street in downtown Highland Park.

Source: http://highlandpark.suntimes.com/people/drglass-HPN-04242014:article

By CMT Staff Writer

April 30, 2014 – Identity, reach, and engagement is a medical practice web sites most defining expression of success. At its heart it influences visitors, conveys trust and a commitment to a mission to deliver extraordinary service when you visit your doctors office. It’s an extension of your brand’s behavior and heart: who you are, what you stand for, what motivates you. The best web sites in concierge medicine, direct-pay healthcare and membership medicine give each company a unique place in the world.

From small medical offices to larger clinics with unique value propositions, the list of web sites reshaping the healthcare delivery model is increasingly present in these offices. From med-spas to primary care, osteopathic medicine to pediatrics — these brands have created an engaging web site experience, culture and personality. And when it comes to design, these are the web sites to watch and quite possibly, the brands of the future.

The web sites seen in the survey below celebrate their physicians and brand through creative, patient-driven design, illustrating that at the core of each private medical practice — a commitment to connect and remain connected with the patient.

WHO IS YOUR FAVORITE ?

Three-Month Personalized Primary Healthcare Membership for One or Two at R-Health (Up to 65% Off)

Choose Between Two Options — View GroupOn Deal

• $99 for a three-month personalized primary healthcare membership for one ($240 value)
• $169 for a three-month personalized primary healthcare membership for two ($480 value)

A primary healthcare membership includes unlimited doctors visits, mobile access, preventative care, basic onsite labs, and healthcare coordination.

Same-day and next-day appointments are available and can be scheduled online; evening and weekend hours are also available.

R Health — http://www.rhealthconnect.com/

1528 Walnut St.
Ste. 950
Philadelphia, Pennsylvania 19102
215-600-4590

FOR IMMEDIATE RELEASE

MAY 1, 2014 — On July 25th and 26th, 2014 in Costa Mesa, CA, ExL Events, an independent, educational healthcare conference coordinator that serves the pharmaceutical and healthcare community has designed 2 highly anticipated events for physicians wishing to learn more about patient acquisition and concierge medicine and direct-pay medical business models.

“I had to do this to be able to do my job,” says Dr. Marcy Zwelling, who has been an concierge internist since 1987. “I get to practice the way I think I can practice best. It’s capitalism at its best.”

Dr. Marcy Zwelling, a concierge internist and many others will be featured speakers at an independent ExL Events and Practice Builders sponsored educational conference in Costa Mesa, CA in July 2014.

Editor-In-Chief, Michael Tetreault, Author, Speaker, Educator, Media Liason

ExL Events, Practice Builders, Concierge Medicine Today, Vitals.com, HFM, ACPP and the Society of Physician Entrepreneurs have all teamed up to design an unprecedented healthcare learning opportunity for a diverse audience. Those invited include: Healthcare professionals; staff; practice management advisors; physicians; medical practice business owners; marketing consultants; healthcare physician specialists; lawyers and industry innovators.

“Until just a few years ago, people mostly based choosing a doctor on the personal recommendation of a trusted friend or relative,” says Michael Tetreault, Editor-In-Chief of Concierge Medicine Today and its healthcare trade journal companion, The Direct Primary Care Journal. “Now with the advent of social media, word of mouth marketing is changing from a spoken word referral to a social media link referral. When you think of Andy Griffith-style medicine, the doctor had a clinic in the local town. It’d be strange for him to say, ‘What kind of insurance does Opie have?’ The people you entrust to help your practice grow must be aware of how to effectively promote this new, old-fashioned message and delivery model of healthcare.”

AGENDA, Speakers, Hot Topics and Event Brochure

If you are focused on growing your practice through innovative marketing tactics or you are interested in learning more about launching or expanding a concierge or direct pay medical practice:

• Hear Leading Case Perspectives in Concierge Medicine on How Others Launched or Grew Their Concierge Practice.
• Learn How to Launch or Grow your Concierge Practice
• Receive a Customized Marketing Plan Specific to your Practice Needs
• Determine Which Concierge Model is Right for your Organization and Potential Implications
• Capitalize on the Trends That are Fueling the Growth of Concierge Medicine in the United States and Deliver Better Healthcare
• Understand the Legal and Political Considerations to be Aware of when Starting or Building a Concierge Practice
• Examine the Upsides and the Downsides of Running and Operating a Concierge Medical Practice
• And much more!

Shira Miller, M.D. The Integrative Center for Health & Wellness A Concierge Holistic Medical Practice in Sherman Oaks, CALIF.

Dr. Shira Miller runs a Concierge Holistic Medical Practice in southern California that focuses specifically on anti-aging and Menopause. So popular in fact, she’s become ‘Facebook’s Most Popular Menopause Doctor.’  “I work to ensure 100% of patients… visit at least once per year,” notes Dr. Miller. “You simply can’t build your practice, hang a sign on the door and expect people to walk-in. You’ve got to build that know, like and trust factor – and this is done over time, strategically and methodically. Think drip, drip, drip – but over a period of weeks and months. Remember, there’s no magic theory or system that will provide you patients tomorrow. There are only tools and strategies that you can use to accelerate their decision(s) to visit your practice.”

LEARN FROM THESE KEY EXPERT SPEAKERS

• David Albenberg, MD, Founder, ACCESS HEALTHCARE
• Carrie Bordinko, MD, Personal Physician, CONSOLARE PRIVATE PHYSICIAN SERVICE
• James Eischen, JD, Partner, HIGGS, FLETCHER & MACK
• Adel Eldin, MD, CEO & Cardiologist, BROOKSVILLE CARDIOLOGY
• Tracy Ganske, PhD, Founder, VIATU PROACTIVE HEALTH
• Nina Grant, Vice President, Agency Managing Director, PRACTICE BUILDERS
• Thomas LaGrelius, MD, FAAFP, SKYPARK PREFERRED FAMILY CARE
• Jim Lindberg, MD Managing Physician, PERSONAL CARE PHYSICIANS
• Troy Medley, President & CEO, PERSONAL CARE PHYSICIANS
• Shira Miller, MD, Founder & Medical Director, THE INTEGRATIVE CENTER FOR HEALTH & WELLNESS
• Michael Tetreault, Editor, CONCIERGE MEDICINE TODAY & The DIRECT PRIMARY CARE JOURNAL
• Jonathan Vidal, Senior Director of Consulting Services, PRACTICE BUILDERS
• Marcy Zwelling-Aamot, MD, Owner, CHOICE CARE

“You will never regret being a doctor if you work only for patients,” says Dr. Thomas LaGrelius, MD, FFAFP Skypark Preferred Family Care, a concierge medicine practice in Torrance, CA. “But if you don’t work only for patients, you will regret your decision in the end.”

Dr. Thomas LaGrelius, MD, FFAFP Skypark Preferred Family Care, a concierge medicine practice in Torrance, CA

“Consolaré offers an alternative to the traditional business model of the medical practice. I only work with a limited number of members. This allows me to know you on a personal basis and understand your unique health concernss.” Carrie Bordinko, MD of Paradise Valley, AZ.

“Moving in to Concierge Medicine is not solely about providing excellent medical care without the restraints of insurance industry mandates,” tells Dr. Carrie Bordinko of Consolaré Primary Care in Paradise Valley, CA and featured speaker at the July event. “You have to also appreciate the lost art of customer service so long ago forgotten when visiting a healthcare institution. Many times my clients (notice I do not use the word “patients”) have noted why they refer their friends to my practice. It is the attention to detail, always delivering exactly what is promised and then some, and keeping their unique needs positioned first with a flexibility to offer new programs or meet needs as quickly as they are identified. This is the cornerstone of customer service.”

“In today’s healthcare culture, the 55-plus audience hasn’t been entirely abandoned,” adds Tetreault, “but the advertising aimed at this population segment is simply aimed at maintaining brand loyalty and establishing that the products they love are still good, still function and most likely being improved. Conversely, you can watch any prime-time television show that’s targeting the 25-54 demographic, and you will learn what those people think is cool, hip, and where our culture is trending. You will not see advertising aimed at the 55-plus demographic population that’s designed to get them to switch brands. The advertising aimed at 25-54 is all about that. And, by the way, most doctors, consultants and advertising agencies know that. This is just one of the many helpful topics you’ll learn about at this conference.”

How Are You Growing Your Practice?

From 2009 to January of 2014, Concierge Medicine Today asked some local medical practice owners what form of marketing they found to work best to grow their practice, acquire new patients and stimulate more positive patient feedback and referrals. The results were as follows:

• 7% use Facebook to grow their business and get new patients.
• 2% use Twitter to grow their business and get new patients.
• 5% use postcards to grow their business and get new patients.
• 5% use a letter alone, to grow their business and get new patients.
• 18% use a letter with a brochure about their business and get new patients.
• 21% say hiring a marketing/PR company that used both online and offline marketing strategies helped grow their business and generate new patients.
• 3% say hiring a business management consultant to organize internal processes grew their business and obtained a few new patients.
• 9% participate in local area networking activities and events.
• 16% say local area advertising combined with low-risk offers helped grow their business; and
• 14% say word of mouth from existing patients helped to grow their business.

Concierge medicine on the rise

By Jill Monier, FOX 10 News | WATCH VIDEO INTERVIEW …

“Consolaré offers an alternative to the traditional business model of the medical practice. I only work with a limited number of members. This allows me to know you on a personal basis and understand your unique health concernss.” Carrie Bordinko, MD of Paradise Valley, AZ.

APRIL 30, 2014 - The Norman Rockwell image of the family doctor making a house call seems to be making a comeback, concierge doctors are growing at a fast pace.

“I love not having a doctors office,” said Dr. Carrie Bordinko.

You could call Scottsdale doctor Carrie Bordinko, the modern day Marcus Welby only, her black bag is a Rebecca Minkoff.

Bordinko is what’s called a concierge doctor she went to a cash only house call practice in 2008.

“We just set up shop right here in an office or in their living room, and we do the same exact tests from drawing blood to ultra sounds all of that now is this big and portable,” said Bordinko.

She guarantees 24/7 cell phone access and unhurried, unlimited home visits that average an hour or longer.

“I get a call at 4 in the morning I know somebody’s had a procedure they’re having shaking chills I say call 911 ill meet you in the er,” she said.

“The whole medical office was something very off putting to me,” said patient bob hunt.

Bob hunt of hunt construction group likes the convenience and Bordinko’s expertise.

“If you need a specialist for something Carrie has a resources group of her own she knows how to find the right people anywhere in the country and then she’ll go with you if you want her to,” he said.”

Bordinko does everything from stitches in home to writing prescriptions, and she takes her practice a step further.

The doctor hikes with her patients, “the first stop is going to be the juice stop,” she said.

And even takes them to the farmers market on weekends, to show them how to eat better. “so obviously guys a much easier way to get high dose vitamins,” she said.

“I’ve lost about 60 pounds and its been a whole behavior modification,” said Bruce Lefco.

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It is not cheap, Dr. Bordinko’s concierge service costs, $9,500 per person, per year over the age of 35. It’s a one time fee regardless of how often you call, text or email her.

“So we have emergencies, then I have I’m walking down the hi-health vitamin aisle, and there’s three different forms of vitamin D, which one do you recommend,” she said.

“For me its an investment for my wife and I in our well being in our health in our life,” said hunt.

Concierge doctors say eliminating insurance billing cuts 40% of the practice’s overhead expenses, but clients still need insurance.

“I pay Carrie but any test she orders or specialist she wants me to go to or pills she wants me to take its covered under insurance just like any other doctor you see,” said hunt.

While a typical physician can have 25 hundred patients, a concierge doctor can have a few hundred, Bordinko only accepts 65.

Her clients range from 11 years-old to 92 years-old they can be CEO’s, vice presidents of companies and attorneys.
They live around the world.

While many of her patients are wealthy, she says she’s recently seen a change in clientele looking for concierge services.

“Now its the average person lost their relationship with their primary care doctor or realize times are changing with access to their primary care Dr.,” she said.

Studies show concierge services are growing about 25 percent a year Bordinko is now expanding her business.

She plans to keep operating her cash only house call practice as long as she can.

“Certainly other countries have made accepting cash payment directly from patients illegal I hope we never see that happen,” said Bordinko.

A modern day doctor is treating people the old fashioned way.

“Without going into great detail it has saved my life,” said hunt.

There are more expensive and less expensive concierge services of the estimated 55 hundred concierge practices nationwide about two thirds charge less than 135 dollars a month but services range.

For more on concierge medicine visit: http://conciergemedicinenews.wordpress.com/

Source: http://www.myfoxphoenix.com/story/25384970/2014/04/29/concierge-medicine-on-the-rise

The fatal error in health care

Rob Lamberts, MD | Policy |

By Rob Lamberts, MD | Physician | DPC Journal/CMT Contributor — http://more-distractible.org/

May 1, 2014 – The janitor approached my office manager with a very worried expression.  ”Uh, Brenda …” he said, hesitantly.

“Yes?” she replied, wondering what janitorial emergency was looming in her near future.

“Uh …well … I was cleaning Dr. Lamberts’ office yesterday and I noticed on his computer …”  He cleared his throat nervously, “Uh … his computer had something on it.”

“Something on his computer? You mean on top of the computer, or on the screen?” she asked, growing more curious.

“On the screen.  It said something about an ‘illegal operation.’  I was worried that he had done something illegal and thought you should know,” he finished rapidly, seeming grateful that this huge weight lifted.

Relieved, Brenda laughed out loud, reassuring him that this “illegal operation” was not the kind of thing that would warrant police intervention.

Unfortunately for me, these “illegal operation” errors weren’t without consequence.  It turned out that our system had something wrong at its core, eventually causing our entire computer network to crash, giving us no access to patient records for several days.

The reality of computer errors is that the deeper the error is — the closer it is to the core of the operating system — the wider the consequences when it causes trouble.  That’s when the “blue screen of death” or (on a mac) the “beach ball of death” show up on our screens.  That’s when the “illegal operation” progresses to a “fatal error.”

The fatal error in health care

Yeah, this makes me nervous too.

We have such an error in our health care system.  It’s absolutely central to nearly all care that is given, at the very heart of the operating system.  It’s a problem that increased access to care won’t fix, that repealing the SGR, or forestalling ICD-10 won’t help.  It’s a problem with something that is starts at the very beginning of health care itself.

The health care system is not about health.

Yes, the first word, “health” is inaccurate.  Our system is built to address the opposite of health, sickness, exchanging money for addressing illness.  The clinician is paid for matching diagnosis with procedure (ICD for CPT, in code).  Economically, more (or more serious) diagnoses and more (or more complex) procedures result in more pay.  Last I checked, more/more serious diagnoses and more/more complex procedures are not in the definition of “health.”

So is this just a case of bad nomenclature, or not wanting to use the term “sick care system” for PR reasons?  What does it matter what it’s called?  The problem is that health is what the patient wants (although it’s hard to call someone a “patient” if they are healthy), but the system does nothing to help people each this goal.  In fact, our system (as constructed) seems to be designed to discouraging providers from helping people toward the goal of health.  After all, the system itself becomes unnecessary in the presence of health.

Getting what we pay for

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So what do you get from such a backward system, one that rewards the outcomes people are supposed to avoid?  You get what you pay for:

• A premium is placed on making diagnoses, since they are rewarded.
  • Unnecessary tests are done to “fish” for problems to treat.  I got my vitamin D level drawn at my last doctor’s visit, but was not displaying any symptoms/signs of a deficiency and know of no evidence that treating it in someone like me would do any good.  To what end do I have this diagnosis?  I am not sure.
  • New diseases are created to promote intervention.  ”Low T” syndrome is a perfect example of this, not only rewarding the provider by adding complexity for the visit and the lab for the test run to make the diagnosis, but also the drug company who brought the “disease” to the public consciousness.
• The likelihood of a person being considered “healthy” is much less.
  • Obesity, depression, poor attention at school, social maladjustment — things that used to be considered different points along the range of normal human existence — are now classified as diseases.  Risk factors, such as high cholesterol, are made in diseases to be treated.  The end result is a diagnosis for everyone.
  • Overdiagnosis leads to overtreatment with medications that themselves can cause problems (which is rewarded by increased pay for doctors, hospitals, drug companies, etc).
• Little effort is made to do things that would lead to health.
  • Spending more time/resources on people to educate them about their health is bad business, as it decreases the number of diagnoses and procedures a clinician can do in the course of the day.
  • Since there is no motivation to prevent little problems from becoming big ones, they tend to be neglected.  Patients often report the need to be “sick enough” to go to the doctor’s office, and seem embarrassed when their concerns are found to be “nothing serious.”

Why payers won’t change

So why don’t payers just stop paying for unnecessary medications, tests, and procedures for invented diagnoses?  The did once, actually.  Back in the early days of HMOs, when most doctors and patients were used to getting any medication, test, and procedure without question, the payors changed: they stopped paying for everything.  ”No, sir, you don’t need an MRI scan for back pain.”  ”No, ma’am, you don’t need the brand name drug that costs 20 times more.”

This attempt to control cost was not met with praise, but instead by the demonization of payers by both doctors and patients.  Insurance companies quickly became public enemy #1, said to be denying care to those in need.  In reality, they were not denying care; they were simply refusing to pay for it.  Patients could get the MRI or brand medicine if they wanted, they’d just have to pay for it themselves.  But that wasn’t in the discussion.

In the end, they did what every God-fearing person does with a problem they don’t want: They passed the buck.  Instead of refusing to pay for unnecessary procedures, they did two things:

1. Required authorization by providers — this meant that the denial was because of the provider’s inability to justify it, not the payer’s unwillingness to pay for it.
2. Started penalizing/reporting “bad” providers — this started with the use of “pay for performance,” and has come to full fruition recently by the “transparency” movement, where doctors’ and hospitals’ utilization are publicly reported.

The analogy I’ve used in the past is that of an alcoholic who blames their spouse for their inability to control their drinking: “If only those damn doctors would stop ordering those unnecessary tests and prescribing those unnecessary drugs, I wouldn’t have the need to irresponsibly pay for them.”

Rethinking reform

The root financial arrangement in the health care system is to promote more: more diagnosis, more disease, more tests, more interventions, and more medications, with each of these being rewarded with more revenue.  It seems the obvious cause of our out-of-control spending — spending which does not yield better health.

Attempts to reform the system have ignored this root problem, instead focusing on other things:

• Improving access to care (a la the ACA) — which addresses the real problem of uninsured/underinsured people, but ignores the fact that care became inaccessible for a reason: it costs too much.
• Measuring the care of providers and hospitals, attempting to manipulate them into reducing the cost of their care.  The HITECH act (and our old pal “meaningful use”) does this via computerizing and capturing the data of clinicians, as do the ACO’s (accountable care organizations) for hospital systems.  While there is a small shift of financial incentives in these arrangements, they greatly increase the complexity of the system, creating huge areas of spending that did not previously exist (yes, I am talking about the EMR companies, with Epic at their head).
• Changing who is in charge — either by privatizing Medicare and Medicaid or by going to a single-payer system.  If a ship is sinking, the priority is to fix the hole, not to change captains.

For any solution to have a real effect, this core problem must be addressed.  The basic incentive has to change from sickness to health.  Doctors need to be rewarded for preventing disease and treating it early. Rewards for unnecessary tests, procedures, and medications need to be minimized or eliminated.  This can only happen if it is financially beneficial to doctors for their patients to be healthy.

What a coincidence!  That’s what my new practice does!  Who’d have thought it? The healthier my patients are, the less of me they need and the larger my patient panel can get.  I am motivated to keep problems small, to avoid complexity, and to think in terms of true prevention rather than the invention of diseases.

Obviously, the system still must address the inevitable/unpreventable medical problems that arise despite my best efforts to prevent them.  This is where the high-deductible plans come in: covering problems that the patient cannot afford.  Yet my job will aways be to prevent patients from spending that deductible, wherever possible, avoiding unnecessary tests, medications, or ER visits.  Why?  Because in doing so I justify the monthly payment.  It turns out that this is not very hard.  This is a win/win/win, as patients are healthier, I make more money, and insurance companies don’t have to pay for nearly as much.

The bottom line

Any significant change, whatever the means, won’t happen until there is an even more basic shift, a shift in the very center of health care: we must focus again on people.  The patient (or the person trying to avoid becoming a patient) has moved from the center of the health care transaction and has become the raw-materials for what we call “health care.”  The doctor/hospital needs the patient to generate the codes necessary to be paid by the payer, which is the bottom-line reason for our problems.  A system that has incentives to create disease and procedures, will be satisfied (and even happy) with a lack of health.  But a system which rewards health will be radically different.

Changing the focus of care to this is more than just emotional idealism, it is good business.  Care should not be about codes, procedures, medications, tests, or interventions, but instead about helping people live their lives with as few problems as possible.  We need an economy that thrives when the patient costs the system less.

Any attempt to reform without this change will ultimately fail.

Rob Lamberts is an internal medicine-pediatrics physician who blogs at Musings of a Distractible Mind.

Source: http://www.kevinmd.com/blog/2014/04/fatal-error-health-care.html

LATEST UPDATES:

• MAY 2, 2014 - Summit Partners releases press release stating that Summit Partners will Acquire MDVIP — CEO Dan Hecht of MDVIP says “Summit Partners shares my vision for MDVIP – to continue growing as a national leader in primary care.”
• APRIL 25, 2014 - According to The WSJ, Bloomberg Businessweek, LBO Wire and investment news watch site, SeekingAlpha.com, Piper Jaffray is out shopping MDVIP to interested parties. The WSJ story writes that GTCR of Chicago has been actively bidding for health-care assets recently. LBO Wire has reported that the firm is in the final round of the sale process for Procter & Gamble Co.’s personalized health-care unit, MDVIP. Insiders say a P-E firm will be the most likely buyer. (Source: WSJ, April 25, 2014; SeekingAlpha.com &  Bloomberg Businessweek) — The Editors here at Concierge Medicine Today (CMT) have been regularly connecting with sources at MDVIP and no further information is available at this time. MDVIP has a national network of physicians and practices that extends to 700 physicians in 42 states with a membership price of $1.5K per year.[1 - Source: Bloomberg Businessweek] Please stay up-to-date on the LATEST news at ConciergeMedicineToday.com
• APRIL 24, 2014 – GTCR, of Chicago, has been actively bidding for health-care assets lately writes Amy Or and Shasha Dai in the WSJ in late April 2014. LBO Wire, citing a person familiar with the situation, reported last week the firm is in the final round of the sale process for Procter & Gamble Co.’s personalized health-care unit, MDVIP. (Source: By Amy Or and Shasha Dai, WSJ, April 24, 2014)
• MAR. 5, 2014 - Concierge Medicine Today (CMT) has learned that insiders say a P-E firm will be the most likely buyer. The Procter & Gamble Company (NYSE:PG) (P&G) is known to be looking at divesting its MDVIP concierge business unit. Last week the company reaffirmed that it would exit ventures that won’t help it grow. The Wall Street Journal reported citing unnamed sources that P&G has retained Piper Jaffray & Co. as its adviser on the sale. (Source: SeekingAlpha.com &  Bloomberg Businessweek)
• FEB. 25, 2014 - Concierge Medicine Today (CMT) has learned that Procter & Gamble Co. (NYSE: PG) has hired Piper Jaffray & Co. to find a buyer for MDVIP, a Boca Raton, Fla.-based provider of personalized healthcare services for the wealthy, according to Dow Jones.
• FEB. 24, 2014 - Concierge Medicine Today (CMT) has learned that earlier in February 2014, Procter & Gamble Co. was rumored to be seeking a buyer for its MDVIP Inc unit, a Boca Raton-based provider of medical and health services, according to sources at TheMiddleMarket.com.

NOTE: Concierge Medicine Today (CMT) is attempting to reach out to several physicians, industry business resources, and others, including MDVIP leadership, for comment and will continue to follow this developing story and apprise you of any comments, statements and/or developments. Thank you for reading Concierge Medicine Today (www.ConciergeMedicineTODAY.COM)

—————————————————————————————————————————————

By Amy Or, The Wall Street Journal

P&G bought a minority stake in MDVIP in January 2007 and acquired full ownership in 2009. The terms of the transaction weren’t disclosed then. P&G said at the time of the investment that the proactive approach leads to lower hospitalization rates and significant cost savings to patients, employers and the health-care system as a whole.

Feb. 24, 2014, 9:41 a.m. EST - Procter & Gamble PG +0.51% Co. is seeking to sell MDVIP, a personalized health-care operator catering to the wealthy, in what would be the latest divestment by a consumer goods and health-care company, people familiar with the situation said.

P&G has mandated investment bank Piper Jaffray PJC +1.15% & Co. as its adviser on the sale, one person said.

Corporate makers of health-care products that have aggressively expanded over the past few years are getting a reality check on their various business units, as they seek to cut costs and enhance efficiency amid slow global economic growth. A few have started to cut ties with operations that aren’t star performers.

Peer Johnson & Johnson JNJ +0.13% last month sold its blood-testing unit, Ortho-Clinical Diagnostics, to Washington, D.C., private-equity firm Carlyle Group in a $4.15 billion deal as part of its plan to shed slow-growing products and businesses.

Boston-based buyout shop Thomas H. Lee also bought online contacts lens company 1-800 Contacts Inc. from U.S. health insurer WellPoint WLP +2.51% Inc. last month. WellPoint, which bought the Draper, Utah-based contact lens retailer for close to $900 million just 18 months ago, said it would record an impairment charge of $153 million to $168 million as a result of the divestment.

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Potential buyers for P&G’s MDVIP unit would likely be private-equity firms, a person familiar with the situation said, as the business may not be a good fit with health-care operators, which either aren’t interested in such a niche segment of the market or find it hard to grow a network of independent doctors willing to focus on a smaller number of patients.

Boca Raton, Fla.-based MDVIP is what is often referred to as a “concierge health-care operator.” It offers personalized health care to the wealthy at a time when insurance reimbursements have squeezed primary-care doctors to take on a large number of patients.

P&G said MDVIP‘s network of 700 MDVIP-affiliated physicians—which span 42 states and the District of Columbia—each care for 600 patients or fewer, much lower than the average of more than 2,000 patients among traditional primary care practitioners. It added that the doctors also provide preventive, personalized health-care to patients, not just the detection and treatment of disease. MDVIP—founded in 2000—currently serves more than 215,000 patients, up from 50,000 when P&G first invested in MDVIP in 2007, the consumer goods giant said.

The memberships don’t come cheap. MDVIP said on its website memberships start at $1,500 a year.

The person familiar with the situation said MDVIP posted $16 million in earnings before interest, taxes, depreciation and amortization last year.

P&G declined to comment on the sale process, noting only that “MDVIP is highly valuable, rapidly growing, and the undisputed leader in personalized and preventive health care.”

At this point, it is unclear how the health-care overhaul passed in 2010, which began its rollout last year, could affect demand for personalized physician-care networks such as MDVIP, which charge anywhere from $100 a month to $25,000 a year for services not covered by insurance companies.

While insurance costs are likely to increase, squeezing household spending for additional health-care services such as concierge medicine, consumers may look to take better care of their health to prevent punitive measures that employers could impose for various conditions such as high blood pressure and thick waistlines. Concierge health-care providers, which pride themselves on knowing their patients so well they can detect medical conditions early on, hope to meet that need.

Trade publication, Concierge Medicine Today tells The Wall Street Journal in November of 2013 that it estimates there to be approximately 5,500 doctors in the U.S. now run such boutique practices, charging an average $135 a month for such services.

P&G bought a minority stake in MDVIP in January 2007 and acquired full ownership in 2009. The terms of the transaction weren’t disclosed then. P&G said at the time of the investment that the proactive approach leads to lower hospitalization rates and significant cost savings to patients, employers and the health-care system as a whole.

Sources:

• http://www.marketwatch.com/story/pg-seeks-to-sell-health-care-operator-2014-02-24-94494120
• http://online.wsj.com/news/articles/SB10001424052702303426304579402841866668148

Direct pay models offer risks and rewards, and experts agree a solid plan is required to achieve a successful transformation.

By: Lisa Zamosky

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APRIL 24, 2014 – Most family practice and internal medicine physicians working in private practice today are burdened by ever-shrinking reimbursement rates and a growing list of administrative tasks required by insurance companies. In response, many primary care physicians are exploring alternative practice options, some of which are being encouraged by policy changes embedded in the Affordable Care Act.

Some doctors are embracing the economic security and reduced administrative burden that comes with employment. Others are selling their practices to hospitals and/or larger groups. And a small but growing number are showing interest in direct- pay practice models that allow doctors to reduce, or in some cases eliminate entirely, the administrative hassles and costs of dealing with insurance.

There are several models in which physicians collect a monthly retainer fee directly from patients instead of relying on fee-for-service reimbursement from third parties. Although the services provided for this charge varies, some of the benefits to physicians in adopting a direct-pay model include:

• reducing patients panel sizes, often by as much as half,
• minimizing administrative and staffing costs,
• increasing the amount of time spent with patients, and
• potentially increasing incomes

The services covered by the monthly retainer fee vary across practices. Often, however, patients can expect to have all primary care services covered, including care management and care coordination. Typically these include seven-day-a-week, around the clock access to doctors, same-day appointments, office visits of at least 30 minutes, basic tests at no additional charge, and phone and email access to the physician.

Although these models can look different, at their core, experts say, they share the common aim of providing high service levels, and increased access for patients.

Monthly membership models are especially attractive for patients with chronic conditions, but healthy people interested in a higher level of service find these models appealing as well.

Medical Economics spoke with experts to discuss some of the more common direct-pay practice models, along with some of their benefits and drawbacks.

Concierge Medicine

Concierge medicine practices charge an annual fee that can range from $1,200 to $10,000, depending on the practice.

There are several models that physicians can choose from when transitioning a practice to concierge from traditional fee-for-service.

Full Conversion

One of the main goals in moving to a concierge-style practice is to reduce a practice’s patient panel size to just 300 or 400, rather than several thousand, which is now more typically the case.

Some doctors start with a full conversion of their practice whereby they terminate all patients who choose not to participate and pay the monthly retainer fee.

“It’s a high-risk, low-reward model,” says Matt Jacobson, founder and chief executive officer of  Signature MD, a national concierge medicine provider headquartered in Los Angeles, California.

Benefits of this approach include reduced physician work hours and the ability to eliminate many of the administrative burdens that come with insurance contracts, but not much increase in income.

Immediate conversion to concierge medicine is also high risk. “What happens if you don’t get the 300 or 400 patients that you need? What if you only get 200?” Jacobson says. “You’re going bankrupt, or you’re working at the urgent care [center] or something else to supplement.”

Hybrid concierge model

In the hybrid concierge model, a physician delivers differing levels of care to two distinct patient groups—those who pay the concierge fee and those who don’t.

“If you pay me $2,000, you’ll have my cell phone number, and you’ll get to the front of the line at the office. If you don’t pay me $2,000 it’s business as usual,” Jacobson says.

Although doctors operating under this model can see a small increase in their income, they increase their clinical hours, Jacobson says.

In addition, there are ethical issues inherent in a two-tiered practice in which some patients pay for a higher level service than others. For example: does the physician spend 30 minutes with a healthy patient who has chosen the concierge model and only a fraction of that time with a patient facing myriad health issues who has chosen not to pay the annual fee?

Market segmentation

Jacobson describes a third model of concierge medicine—a market segmented approach—that he says was developed by SignatureMD. “It’s a high-reward, low-risk model,” he says.

Similar to other approaches, physicians seek to convert roughly 300 patients. The practice then brings on either a junior physician or nurse practitioner. Patients who participate in the concierge model will continue to see their doctor. Those not participating will see the new physician and/or nurse practitioner.

With this approach, Jacobson says, it’s feasible for physicians to more than double their income while reducing their workload by 25%.

According to Garrison Bliss, MD, president of Qliance Medical Group and founder of the second monthly fee practice in the United States, concierge medicine offers physicians many benefits. However, he cautions against a major trap of the model.

“In the concierge world, there’s this fear that if you didn’t do a bunch of exotic testing, and you didn’t have a cool new medicine that you knew about that other people didn’t know about, that it would be hard for people to believe they were getting better care from you,” Bliss says.

Direct primary care model

Bliss envisioned an alternate membership-based approach to routine and preventive care called direct primary care (DPC), which he started in 1997.

“I decided to come up with a healthcare model, rather than a business model. And then, to figure out what the business model would have to look at if we were a monthly fee practice,” Bliss says.

With DPC, the monthly fee for patients is lower than in concierge medicine—often ranging from $50 to $150. The size of the practice is generally larger as a result—600 to 800 patients as compared with 300 to 400 in concierge practices.

“We stopped being focused on the issue of getting paid and started being focused on the issue of what do we have to do for people,” Bliss says.

Markets for DPC

DPC is a small but growing movement, says Thomas Charland, chief executive officer of healthcare consultancy for Merchant Medicine, LLC. The two primary markets include individuals who have high-deductible health plans and see the value in paying a low monthly fee for increased access to primary care.

The biggest potential, Charland says, is among employers who have given up on a traditional approach to primary care. Many firms recognize that physicians with large panel sizes don’t have the time to spend with patients and must refer anyone with complications to specialists. That, in turn, is causing costs to skyrocket.

 “If it takes off with employers it’s a game changer,” Charland says of DPC.

Building high-deductible insurance products that incorporate this model and that cover the services that direct pay practices don’t is an important step in moving this model forward. And it’s already happening.

“We’re involved in two instances of that in Washington State right now with, I think, more to come,” Bliss says.

Is Direct Pay right for your practice?

Experts offer these considerations when determining whether some form of direct pay model is right for your practice:

It must feel natural.

Physicians most likely to succeed using a direct-pay model are already operating as if they run one. “If you’re not already the guy who is taking the calls late at night, if you’re not the guy who is visiting your patients in the hospital…don’t do it because you will fail,” Jacobson says.

Carefully consider your monthly fee.

“I usually recommend that the doctor map out all of the fixed costs of his or her practice: facility rent and maintenance costs, utilities, equipment leases, staff salary, provider salary,” Bliss says.

Consider the size of your practice.

The next step is to consider how large a practice you want to operate. Once you’ve determined that, Bliss says, “divide the costs by the panel size and you have the annual fee you will have to get to make that work.”

Assess your patient pool.

Ask yourself how many of your patients will actually pay the fee. Jacobson’s firm employs a predictive model that relies on a range of information gleaned from a random sample of the patient population to determine the likelihood of success.

“If you don’t do that, you have absolutely no idea whether you’re going to succeed or not,” he says.

Connect with the community.

Charland says doctors should look for primary group companies operating in their area. In addition, they should become part of a community of practices and/or associations focusing on the type of model that they find most appealing.

Source: http://medicaleconomics.modernmedicine.com/medical-economics/news/direct-pay-medical-practices-could-diminish-payer-headaches?page=0,2#sthash.oGw1nNoT.dpuf