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May 2, 2014 - Concierge Medicine Today (CMT) would like your thoughts as physicians, patients, business leaders and others for your thoughts and comments on the recent MDVIP acquisition by Summit Partners.

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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

National Leader in Personalized Preventive Healthcare Continues Rapid Growth

Summit Partners to Acquire MDVIP — CEO says ““Summit Partners shares my vision for MDVIP – to continue growing as a national leader in primary care,” says Dan Hecht.

May 2, 2014 – Growth equity investor Summit Partners today announced that it has entered into an agreement to acquire MDVIP from The Procter & Gamble Company (NYSE:PG). The agreement is expected to close shortly subject to standard regulatory approvals. Additional terms of the investment are not being disclosed.

Founded in 2000, MDVIP is the nation’s largest national network of physicians and patients in personalized preventive healthcare. The company serves more than 700 MDVIP-affiliated primary care physicians with more than 200,000 patients nationally. MDVIP offers physicians and members an alternative to the traditional primary healthcare deliver model by enabling members to have an enhanced relationship with their primary care physician. MDVIP’s approach to primary care places the emphasis on “wellness” care, not just “sick” care.

Related: MDVIP and Summit Partners Case Study

Summit Partners originally invested in MDVIP in 2004 and sold the company to P&G in 2009. Patient membership in MDVIP practices has nearly doubled in the past four years and expanded across the United States. P&G said the sale of MDVIP is another step in its strategy to focus the company’s portfolio on core businesses where P&G can create the most value for consumers and shareowners.  The transaction creates value for P&G shareowners, and P&G is confident that Summit Partners will provide strong leadership as an investor to support the needs and advance the goals of the MDVIP national network.

Related: Physician Reaction To MDVIP, P&G Sale to Summit Partners — Share Your Thoughts On Our Facebook Page

Summit’s Mark deLaar, a Managing Director, will rejoin the MDVIP Board. “We know MDVIP very well and have witnessed its growth first-hand,” he said. ”This is an extraordinary company and we are very excited to pick up where we left off. Its patient-focused healthcare is second to none, and we look forward to partnering once again with its management team.” Summit’s Marty Mannion will also join the MDVIP Board.

MDVIP will continue to be run as a stand-alone company, and P&G’s Dan Hecht, who joined MDVIP in 2010, will transfer to the newly owned company as CEO. “Summit Partners shares my vision for MDVIP – to continue growing as a national leader in primary care,” said Hecht. “Amid all the complexity and uncertainty surrounding healthcare today, MDVIP is able to give patients what they want – a close relationship with a doctor who has the time to put them first and help them enjoy a healthier, longer life.”

About MDVIP

MDVIP is the national leader in affordable personalized healthcare.  With prevention at the center of its program, MDVIP has proven that its carefully chosen affiliated physicians provide exceptional care and achieve exceptional outcomes.  These results published in peer-reviewed medical journals include lower hospitalization rates which yield significant cost savings to patients, employers and the healthcare system.  MDVIP-affiliated physicians limit their practices to no more than 600 patients in order to provide a customized wellness and preventive care program.  There are currently over 700 MDVIP-affiliated physicians serving over 200,000 patients throughout the country.  MDVIP, Inc. was founded in 2000 and is headquartered in Boca Raton, Florida.  For more information, visit www.MDVIP.com, www.facebook.com/MDVIP, @mdvip on Twitter or http://www.mdvip.com/press.

About Summit Partners


The editor’s at Concierge Medicine Today (CMT) asked some of the industry’s leading physicians and business owners, ‘what are the traits of a concierge doctor [or direct-pay] physician business owner?’

About Procter & Gamble 

P&G serves approximately 4.8 billion people around the world with its brands. The Company has one of the strongest portfolios of trusted, quality, leadership brands, including Always®, Ambi Pur®, Ariel®, Bounty®, Charmin®, Crest®, Dawn®, Downy®, Duracell®, Fairy®, Febreze®, Gain®, Gillette®, Head & Shoulders®, Lenor®, Olay®, Oral-B®, Pampers®, Pantene®, SK-II®, Tide®, Vicks®, Wella® and Whisper®. The P&G community includes operations in approximately 70 countries worldwide. Please visit http://www.pg.com for the latest news and in-depth information about P&G and its brands.

In the United States of America, Summit Partners operates as an SEC-registered investment advisor. In the United Kingdom, this document is issued by Summit Partners LLP, a firm authorized and regulated by the Financial Conduct Authority. Summit Partners LLP is a limited liability partnership registered in England and Wales with registered number OC 388179 and its registered office is at 20–22 Bedford Row, London, WC1R 4JS, UK. This document is intended solely to provide information regarding Summit Partners’ potential financing capabilities for prospective portfolio companies.

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By Catherine Sykes, Publisher

J. Catherine Sykes serves as the Publisher and Managing Director of The Direct Primary Care Journal (DPCJ) and Concierge Medicine Today (CMT)

May 2, 2014 – Most retainer-based medical offices and cash-only clinics have 1 to 3 employees. Not only is hiring the wrong “essential” staff important, it can be expensive lesson if you make the wrong choice. For many of the concierge-style and direct-pay physicians we talk to each today, it seems harder than ever to find good employees who understand and believe it what you’re doing, have a solid work ethic who know how to deal with patients.

“Business is tough,” says one concierge physician in Fort Worth, TX. “If you are doing something just for the money, you are never going to enjoy it. You will be the hardest boss you have ever had. So, find people you enjoy working around that will support and assist you. Follow this advice and you will set yourself up for an enjoyable future in this field.”

We hear from doctors that the nurses, employees and administrative assistants they hire are frequently late, unmotivated or incapable of doing the tasks that are required. Many physicians tell us they DO NOT provide a written job description at the time they hire their employee(s) and the ones who do, are often to busy to reference it later to help grade the employees performance when it comes time for a performance review. Doctors have told me on several occasions, “Hiring one of my patients never works — and, if I do, they want to start in a management position.”

Related: Hiring Concierge/DPC Medical Staff Using Job Descriptions with Performance Standards For Measurement

When we reviewed more than a thousand prospective concierge medicine patient search inquiries at our site — nearly 30% of them said they are leaving one concierge doctor and seeking another because of staff. What’s wrong with this picture? While most concierge medical practices maintain a very high patient retention average of approximately 92%-94% (Source: Concierge Medicine Today, March 2010-2013), what’s happening inside the staff-to-patient interactions to those that are leaving and more importantly, what can you do about it?

To take it a step further, we asked them the question ‘What, if anything, could be improved or would you change regarding your previous concierge/direct medical practice?’ The findings may surprise you. I’ve listed them in order of importance according to the patient responses.

Related: The Top 5 Complaints Heard About Concierge Medicine: #1. Staff

“Find the bad apple (if you have one that is) and either reposition them to employment in the practice where direct patient interaction is not required or ask them to potentially move on to another place of employment. Every small medical practice, particularly in concierge medicine or direct care has its own culture. It doesn’t mean that all of your employees must think exactly the same way as you do.” — Related Story: Keeping your Staff Happy as Your Concierge Practice Grows

But there are simple ways to steer clear of hiring mishaps and avoid those expensive lessons. Here are four ways to find and retain the best employees for your medical practice. [1]

1. Start with your own employees. Ask your staff to refer highly-qualified friends for any open positions you might have in your practice. Provide a gift card reward for anyone who is subsequently hired and stays with the practice for more than 90 days.

Related: Instill Passion in Your Staff For Your “Concierge” Practice Model

2. Make it easy. Hiring expert Mel Kleiman says, “To hire the best, you’ve got to make it easy for the best people to apply.” If you only accept phone calls, résumés and applications during normal business hours, for instance, you’re discouraging the very people you should be trying to recruit.

3. Train and retain. Make retaining your present employees a top priority. Provide the kind of training that will make them more valuable both to the company and to themselves.

Related: Keeping your Staff Happy as Your Concierge Practice Grows

4. Cultivate a caring environment. Make sure your organizational values, company mission statement and employee orientation program support an environment that demonstrates how valuable employees are to your company.

One way to do this is to make it a point to remember your employees’ birthdays and host mini celebrations on a regular basis. Remember, for most people, the workplace is like a second family. Create an environment that feels like one.

Related: Concierge Medicine Today Launches Job Board For Physicians and Staff Seeking Career In Concierge Medicine and Direct Primary Care

[1.] Sources: Tom Borg, April 2014 http://www.entrepreneur.com)

By Sheri Porter

May 06, 2014 08:45 pm – Kansas City, Mo. – So, what’s the AAFP’s take on the DPC model?

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In 2013, the American Academy of Family Physicians (AAFP) issued its first-ever DPC policy statement. And currently, the Academy is scheduling a series of regional workshops aimed at giving family physicians all the information they need to know before they make decisions about transitioning to the DPC model of care. Interested physicians should mark their calendars for

• November 2014 in Phoenix,
• January 2015 in Wilmington, Del., and
• February 2015 in Atlanta.

More information about these events will be available soon.

Forrest noted that the invitation he received to speak at the AAFP’s 2014 ALF — an invitation that included two additional sessions on Saturday morning — illustrated that direct primary care is a hot topic.

“I’m here today, so the AAFP at least thinks this is worth talking about,” said Forrest. “This is good for family docs. You need to go back and tell doctors in your state that there is hope,” he added.

CONTINUE READING FULL STORY …

DPC Journal Physicians, residents, businesses and readers can SAVE $25 OFF their registration — PROMO CODE: “DPCJOURNAL”

Source: http://www.aafp.org/news/practice-professional-issues/20140506forrestdpctalk.html

Drs. Vicki and Scott Bralow thought there had to be a better way to practice medicine than the harried life of a general practitioner. So they’ve launched a startup they hope will create a new model for medical practices. Drs. Vicki and Scott Bralow PHOTO Credit: John George, UpStart By Business Journal

By John George, Philadelphia Business Journal

MAY 8, 2014 - Dr. Scott Bralow remembers the day his wife, a primary-care physician, came home near tears after a tough day at the office.

“She said she was spending more time at the computer (dealing with electronic medical records) than she was with her patients,” said Bralow, a nephrologist. “She said it wasn’t what she signed up for.”

Vicki Bralow, who said she was inspired as a child to become a doctor while watching Marcus Welby on television, confirmed her husband’s account.

“I always wanted to be a doctor,” she said, “but the way medicine is today, there are all these barriers between the doctor and the patient. By the time I get to see patients, they have already interacted with five other people. People getting their insurance information and other people taking their blood pressure and doing the initial screenings. I get in there and get to spend five minutes with them, then it’s on to the next patient.”

The married doctors thought there had to be a better way.

So, at the start of this year, they launched a new company called Affordable Care Options LLC. They provide workplace-based health services to employers. The companies pay a monthly fee and workers get access to care with no deductibles or co-payments.

CMT Launches “HSA Center,” a Digital Resource For Physicians, Patients and Businesses

All they need to practice site is about 300 to 400 square-feet of empty office space — with cable and phone hook-ups and an electric outlet — that can be converted into an exam room and small reception area. The company is responsible for any physical renovations, such as putting up walls, that are needed. Affordable Care Options brings in an exam table and any necessary medical equipment.

“We know how to run a medical practice,” she said. “It’s what we do for a living.”

The cost to a company varies by how many employees they have and how often they want a doctor on-site. The Bralows are open to creating one practice site in an office building or office park that would allow multiple companies to share the costs.

For a company with roughly 350 employees that wants a doctor on-site five days a week, the annual cost would be between $300,000 and $500,000.

Vicki Bralow said the fee pays for itself with increased productivity by workers who otherwise would have to leave the office for doctor appointments to get lab work done. In addition, she said, by making it easier for workers to access doctors and comply with follow-up care, a company’s employees are more likely to receive medical attention that can prevent a minor health ailment from becoming a major — and more costly — illness. Lowering the dollar amount of claims filed by employees, she said, can also help a company lower its health insurance premiums.

The current system is often much different. Employers are increasingly shifting more health-care costs to their employees, sometimes in the form of high-deductible plans that require more be paid out-of-pocket before the insurance coverage kicks in.

“Patients come in with $2,000 deductibles,” she said. “They have to pay (the full costs) for the office visit all the time because they have these big deductibles. They get annoyed.”

What often happens, Vicki Bralow said, is a patient will come in with a problem like high blood pressure. She’ll put them on medicine and ask them to come back in a month to see how they are reacting to the medicine. That means taking time off work and paying for another office visit. “They don’t come back,” she said.

The Bralows said they are not out to replace workers’ family physician, and will share test results and treatment decisions with them.

Scott Bralow said they first got the idea to start their company after reading about QuadMed, a Minneapolis company that provides office-based health care. QuadMed grew out of a single location inside Quad/Graphics, which decided to hire its own doctors who would provide care to the company’s 9,000 employees in a move to give the business more control over its rising health-care costs.

The Bralows attended a trade show on health-care consumerism in Las Vegas and came across another three companies that were providing workplace-based health services, and decided to join the trend.

Affordable Care Options isn’t the only Philadelphia-area company embracing the direct-care model, where services are provided directly to patients without a health insurance company serving as an intermediary. R-Health in Philadelphia and NewPath MD in Exton, Pa., are among the others.

The Bralows started their company in January and have spent the past few months talking with companies and groups representing employers. They have two proposals under review with potential clients.

Scott Bralow noted how decades ago manufacturing companies commonly employed company doctors to provide occupational health services to injured workers. What Affordable Care Options is looking to do, he said, is adopt that service to the 21st century to provide on-site primary care, population health and wellness services — all hallmarks of the Affordable Care Act.

“What we are doing is the company doctor 2.0,” he said. We’re not employees of the company. We are the subcontractors.”

Source: http://upstart.bizjournals.com/companies/startups/2014/05/05/affordable-care-options.html?page=all

The Concierge Medicine Research Collective has been studying consumer demand for concierge, direct care, cash-only and retainer-based medical models for years. They have found that the number of patients seeking concierge medical care is now far greater than the actual number of concierge doctors and practices available to serve them.

05/04/2014  - Although national media have reported increasing numbers of concierge, private-pay physicians in America, there are still not enough concierge-style physicians to meet current consumer demand. That’s the message from Michael Tetreault, Editor-In-Chief of Concierge Medicine Today and Executive Director of the Concierge Medicine Research Collective. According to Tetreault, search activity on his magazine’s concierge-style, direct care doctors search engine has increased tremendously since the 2012 election and January 2013. Even if you include all of the doctors who claim to be retainer-based or concierge-style practices, the supply still falls short.

Currently, only four states have sufficient active concierge or private-pay physicians in practice to meet consumer demand, according to the Concierge Medicine Research Collective. Florida, California, Pennsylvania and Virginia have significant numbers of people seeking concierge providers and sufficient concierge physicians already in place to serve them.

The fastest-growing “concierge medicine” cities

The Concierge Medicine Research Collective also determined the 10 fastest-growing cities for concierge medicine. It’s important to note that five of these cities (see bold type) are located in states where consumer demand for concierge care is being met by supply, according to the collective. The fastest growing cities are:

1. Los Angeles, CA
2. San Francisco, CA
3. New York, NY
4. Palm Beach, FL
5. Baltimore, MD
6. Washington, DC
7. Philadelphia, PA
8. Seattle, WA
9. Chicago, IL
10. San Diego, CA

Conversely, in predominantly rural states such as Idaho, Iowa, Louisiana, Mississippi, Alabama, North Dakota and South Dakota, the shortage of concierge practitioners is woefully apparent. Some have less than a half-dozen concierge practitioners serving the entire state. Obviously, their numbers need to increase to meet growing consumer demand.

Growing concierge healthcare to meet consumer demand

Between the Affordable Care Act, dealing with health insurance and the nation’s general economic woes, it’s not surprising that so many private practitioners are considering the switch to the more easily managed business model that concierge-style healthcare seems to represent. More physicians are realizing that variations of the concierge model can apply to more specialties than just primary care, family medicine and internal medicine. In fact, the care model has already moved into cardiology, dermatology, dentistry and pediatric medicine. And all indicators point to concierge care taking hold in other specialties such as ob/gyn and gastroenterology.

Concierge medical practices – whether they are called membership medicine, boutique medicine, retainer-based medicine, cash-only medicine, direct care, personalized healthcare, direct practice medicine or contract healthcare – share many similarities. Yet, they also differ greatly in their structure, payment requirements and business operation. The terminology of direct patient care describes many different business models where you have a direct, non-insurance-based financial relationship with your patients. Whichever model you choose, you’ll need transparent pricing, ready access, more affordable rates for your target patients and more personalized care.

Understand the new brand

Since its inception, concierge medicine has attracted some controversy. To many consumers, it seemed costly and elitist – medical care strictly for society’s rich. Terms such as “concierge” and “boutique” can easily be perceived that way. Today, however, more consumers, physicians and government legislators are realizing that this type of healthcare delivery can actually save money and improve patient care in our free-market system. And that makes it appealing to physicians who want to free themselves from the shackles of insurance-restricted care and simplify their businesses so they can focus more on patient care. It’s also appealing to patients who are tired of impersonal treatment and the insurance runaround.

In Part 2 of this two-part series, we’ll discuss concierge care from the patient’s perspective and reveal the reasons why patients choose concierge medicine.

If you already have a direct-care model in place and need help marketing your message to the right audience, talk to a healthcare marketing program consultant at Practice Builders. Call 800.679.1200 today.

Source: http://nsihealthcarerecruiter.com/demand-for-concierge-medicine-outpacing-supply-part-1-of-2/

FARMINGTON, CT (WFSB) - Concierge medicine is becoming more popular with people who want 24/7 access to their doctor.

Like so many people these days, J.R. Clisham is super busy. He owns a self-storage facility business, he’s always on the go and he didn’t have a lot of time to sit in a waiting room.

“I can see my doctor right away. There’s no waiting here. You come in and you have an appointment,” Clisham said. “That’s the appointment. You don’t show up and wait in the waiting room with a bunch of other people.”

Clisham said he now has a concierge doctor, and he’s guaranteed to be seen.

Doctors Paul Guardino and Thomas O’Connor own personal care physicians in Farmington.

“What people are really getting is accessibility when they need a physician,” O’Connor said.

“Whenever you need to talk to your doctor, you talk to your doctor, not to a nurse practitioner or something other than your doctor,” Clisham said.

CONTINUE READING FULL STORY …

Source: http://www.wfsb.com/story/25443356/concierge-doctors-promise-more-personalized-medical-care

“The Challenge For Concierge Medicine in The Years Ahead.”

Joel Bessmer, MD, FACP of Omaha, Nebraska’s own, Members.MD

“To those who say concierge doctors are hurting the system by diminishing the number of patients we can care for, my reply is: if you keep doing the same thing year after year, you are going to get the same results!” said Dr. Joel Bessmer of Members.MD based in Omaha, NE. “If we don’t focus on salvaging the doctor-patient relationship and allowing the appropriate time for each patient’s care and follow-up, patients will begin to feel their primary care is a waste of time.”

Concierge Medicine and Direct Care ‘By The Numbers’

By Michael Tetreault, Editor-In-Chief

MAY 7, 2014 – It’s time we take a serious look at the math behind concierge medicine, boutique practices and retail and direct-pay offices. These practices have been hammered in the media and press headlines over the years and riddled with nay-sayers bringing up tough topics such as patient abandonment, insurance participation and my favorite, ‘this is just wealth care.’

We talk to physicians and patients each day either looking for a doctor or considering a move into this industry. What I find is that most people either don’t understand or are not aware that the majority of concierge doctor’s offices operating today throughout the U.S. treat 500 to 750 “concierge medicine” patients AND have an insurance component [approx. 1,900 patients per practice on avg.] to their practice as well. Meaning, most concierge doctors accept and continue to participate in their HMO, PPO and managed care insurance contracts long after they have announced to a local community that they now offer a concierge medicine membership program to allow “more access to the doctor.”

A lot of doctors do this for several reasons. The most common, keeping the insured side of the practice acts as a safety net during start up and entry into the industry of membership-based medicine. Doctors say … ‘if this subscription plan doesn’t work out, at least I still have my insured side to fall back on.’

“One of the most difficult occurrences is when patients who does not understand the program or who philosophically disagrees with the membership fees (i.e. thinks this is for rich people) accuse the physician of abandoning them,” says one former Transition Manager in Arizona. “Sometimes patients can be very vocal about their opinion of this and at times, be quite rude. This is very disheartening to most doctors, at least in the early stages of the transition process. ‘Saying goodbye’ to some long-term patients is one of the reasons many Physicians are reluctant to convert [to a Hybrid model].”

Related: HYBRID CONCIERGE MEDICINE: Pros and Cons of Business Model

“The biggest mistake in my opinion is charging too low,” says Mike Permenter, Executive Vice President and Chief Development Officer at MedFirst Partners LLC. “Conversions [into this private-pay marketplace] will eventually be unnecessary as the public becomes more aware of the benefits of these types of memberships. The big challenge is continuing growth after the initial conversion. Customer service, as described by some physicians, is the number one way to grow [this type of] practice. Linking the service to local self-insured employers is a good way to grow but certainly requires expertise with regards to structuring the appropriate benefit, usually a high-deductible plan with an HSA plus a membership.”

Where patient abandonment discussions along with moral and ethical issues typically arise is when the doctor discontinues all insurance relationships in his/her practice and simply charges a cash fee for his/her services, thereby releasing 1,900 patients from the practice.

Understanding the insured component of a true concierge medicine practice, 2,500 patients do not typically leave the practice because a doctor isn’t able to treat them or keep them as part of his/her practice. Conservatively estimating that most traditional [non-concierge] primary care and family physicians have a patient panel of 2,500 patients. Let’s say 6.9% of 13,575 doctors convert to concierge medicine. This equates to about 950 doctors out of 13,575 transitioning their practice business model to concierge medicine. Thereby leaving 13,050 doctors to serve a population of roughly the same amount of insured patients.

“When I first heard about hybrid type models I was excited about a model that would allow some of the patients to become members of the concierge side of the practice while the rest were seen by a mid-level (Nurse Practitioner or Physician’s Assistant),” adds Permenter. “After all, this would eliminate having to part with those long-term patients. They could just remain in the practice and see the mid-level, and their insurance would be billed as always. It turned out not to be so attractive for both the patients and the Physician. With the right planning, a hybrid can be converted to a Direct Primary Care model. I predict there will be many hybrids converting to a Direct Primary Care model in the future.”

Related: BUSINESS: Should You Franchise Your Concierge Medicine Practice?

Where is the shortage?

If research says only 15% of concierge doctors do not participate in insurance, that means that 15% of 950 doctors will provide cash-only services to a patient base of roughly 600 patients each. Backing into the math, that means 143 [15% of 950 doctors] doctors will treat about 600 patients each equating to a serviced patient population of 85,800 [143 x 600]. If each of the 143 doctors had 2,500 patients, that means 271,700 patients no longer have a doctor that will accept insurance. Divide this patient population number [271,700] by the amount of doctors left who are still accepting insurance and choose to not participate in a concierge medicine practice whatsoever [13,050], that means each of the 13,050 doctor’s offices have the opportunity to welcome about 20 new patients into their practice. (5*)

Obviously the challenges are greater in rural or under-served areas. However, in the cities where concierge medicine is gaining ground, there should be enough physicians to service the patient-population seeking care.

The Merritt Hawkins data also states … it’s interesting to note here that physician practice “owners” are more likely to embrace concierge medicine than other types of physicians, presumably because they have an entrepreneurial mindset.

It is also important to mention that there are conflicting numbers regarding the actual growth each year of concierge medicine and private-pay healthcare offices touted by industry sources and media outlets. To date, key physician leaders in the industry tell Concierge Medicine Today that most crucial data compiled about this industry’s growth has come from The Merritt Hawkins Study, MDVIP and The Concierge Medicine Research Collective.

NEW RESOURCE to help guide you through the decision-making and buying process of selecting your next concierge doctor.

Concierge Medicine Today reported early in 2013 that there are currently four states that have a huge lead in the number of active concierge or private-pay physicians in practice as well as patients seeking their care. Florida, California, Pennsylvania and Virginia each have a significant number of people [most over age 50] seeking out concierge doctors and there is, fortunately, a sizeable number of concierge physicians to serve them. According to Dan Hecht, MDVIP has a high physician retention rate and the number of physicians who have left the MDVIP network over twelve years is very small. 2*

In late 2012, Concierge Medicine Today published a report from MDVIP and the American Journal of Managed Care. They stated that patients under the care of MDVIP-affiliated primary care physicians experience a dramatic decrease in hospitalizations versus comparable non-MDVIP patients, according to the study profiled in an article published in the peer-reviewed The American Journal of Managed Care (December 2012).  This first-ever, published study done on hospital utilization in the MDVIP personalized healthcare model found a 79% reduction in hospital admissions for Medicare patients and a 72% decrease for those with commercial insurance between the ages of 35-64 in MDVIP-affiliated practices.  As a result, MDVIP, the largest national network of primary care physicians, delivered to the healthcare system a one-year savings in excess of $300 million. 3*

The study also found decreased MDVIP hospital readmission rates for Medicare members when compared to the 2009 readmission rates for non-MDVIP Medicare patients, for such conditions as acute MI (heart attack), CHF (congestive heart failure) and pneumonia.  MDVIP readmission rates are below 2% for these conditions compared to the national averages that range from a low of 16% to a high of 24%. 4*

While the debate continues whether concierge medicine will exacerbate the doctor shortage, we can see that there is actually a proven, viable history that these types of healthcare practitioners are showing that primary care can be saved. I am sure this argument will keep the media and nay-sayers busy for the next couple of years. However, the marketplace consumer is the one who is showing all of us that we are a long way from seeing a concierge doctor in every neighborhood. We do need them and we need more of them.

No one is talking about the concierge physician shortage.

ONE YEAR PROFILE Sale ONLY $59.95/yr. (Reg. $99.95/yr)

“Despite what we hear in the media about the increase in concierge and private-pay physicians growing across America, there are simply not enough of these [concierge-style, direct care or membership medicine-style] physicians in the U.S. to meet the current demand,” says one concierge doctor in Dallas, TX.

Click on InfoGraphic to Learn More.

Rural Areas Hit Hardest.

Concierge Medicine Today reports that it is extremely difficult to find a concierge or cash-only physician in rural areas such as: Idaho; North Dakota; South Dakota; Louisiana; Mississippi and others. Oftentimes, less than half-a-dozen practitioners serve an entire state.

“Direct practices should be successful in most cities and states where there is an inadequate supply of primary care physicians,” says Dr. Chris Ewin, Founder and physician at 121MD in Fort Worth, TX. “This may be true in the country with the correct practice model. Most important, a physician needs to have social skills to sell him/herself and there new practice model to their patients and their community.”

According to CMT’s DOC FINDER, which receives thousands of unique patient visitors every month, California takes the lead with the most amount of prospective patient searches looking to connect with a doctor. ConciergeMedicineToday.com has become the leading digital resource for timely, trusted health news and concierge medical information and their DOC FINDER search engine is one of the most recognized, publicized and utilized physician search engine in the world.

“It’s about believability.  Would it work for me?  Could it work for me?” says Richard Doughty, CEO of Cypress Concierge Medicine, a Louisiana-based company helping doctors move into this industry. “Where physicians have taken an early leap of faith, if you build it they will come, overwhelmingly they have been satisfied.  As a result, physicians now have many examples of colleagues experiencing the benefits of concierge medicine for themselves and their patients.  In those areas, we see momentum continuing to build.”

What About The Doctor Shortage We Keep Hearing About … Will Concierge Medicine Really Make It Worse?

Simply answered, no;

The numbers of practicing concierge medicine and direct-pay doctors doesn’t matchup to media reports. First, in 2013, a national survey of physicians that Merritt Hawkins (*1) recently completed on behalf of The Physicians Foundation sheds some light on this question.  The survey garnered responses from some 14,000 physicians, who revealed a wide range of information regarding their morale, practice metrics and practice plans. Physicians were asked what changes they plan to make in their practices over the next one to three years. Close to seven percent of all primary care physicians indicated they plan to switch to a concierge practice.

RELATED STORY …
The Six Secrets of Self-Made Concierge Physicians >>

Sources:

1* http://www.merritthawkins.com/clients/BlogPostDetail.aspx?PostId=39491

2* http://www.rxeconsult.com/healthcare-articles/Is-MDVIP-Advancing-Physician-Practice-with-Personalized-Healthcare-383/#sthash.hqjM4ANk.dpuf

3* http://www.mdvip.com/study-proves-dramatic-reduction-in-hospitalizations-and-300-million-savings-for-mdvips-personalized-healthcare-model

4* http://www.reuters.com/article/2013/01/03/fl-mdvip-idUSnBw47Tk91a+110+BSW20130103

5* http://www.ConciergeMedicineToday.com

By Catherine Sykes, Publisher, The Direct Primary Care Journal

Use these 40 questions as your guide. Available now on Kindle, Nook and eBook editions — $3.95

MAY 9, 2014 – With almost half (approx.. 41%)[1] of all membership medicine and cash-only physician practices reporting a decrease in annual salary in 2013, how should you set fees or prices for your medical service(s) in your practice? Often the most terrifying question facing physicians entering and surviving in this marketplace is, “What do I charge my patients?”  Such a simple question, but for the new “Doc-Preneur” it’s often complicated and intimidating challenge.

As a medical service provider, pricing is often particularly subjective. You’re not selling a widget that can be easily bench-marked. You’re selling your training, expertise and time — a market value that isn’t necessarily easily defined. It takes quite a bit of time to figure out this “pricing conundrum” – but after countless discussions with physicians, hours of examination and a little investigation, here are five key things to consider.

Instead of Upselling: Offer Choices

Many membership 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.”

At The Direct Primary Care Journal, we recently learned that four out of every ten membership medicine and direct-pay 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.

Dr. Gamble, D.O. has consistently been recognized for her outstanding dedication to her patients, her commitment to continuity of care and her contributions to medical education.

“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].”

Some retainer-based and direct-pay medical practices are built around visible, low priced services aimed to bring people up to their service window and generate higher unit sales. Others offer more personal services and sprinkle in more relational ingredients into their business plan aimed at meeting a need at a higher price and communicating a message routinely to patients that keeps them coming back for more assistance. A problem with frequent low pricing is that your medical practice may wind up losing patients who assume your stable of services are not keeping pace with their needs.

Consider Raising Your Fee To Be Taken More Seriously.

Interviews with various physicians and industry sources indicate that the average patient or consumer of concierge medicine and direct primary care (DPC) services can withstand a small annual premium increase of about $25 to $160 per year. However, the problem with raising prices among concierge medicine and cash-only/direct-pay patients, especially in small medical offices is that it causes patients to reassess how much they value the relationship and how much then use the care throughout the year. Patients have a lot of other factors to consider such as their monthly or quarterly familial commitments, their health insurance premiums, recent experiences with the doctors’ staff, traffic and travel interruptions to your office and how often they truly utilize your services on an monthly or yearly basis.

“I don’t foresee any rate increases for 2015,” says Dr. Rob Nelson of Cumming, GA to one of his patients. “I don’t expect an increase in my costs for Lab or X-ray, so that component probably won’t be an issue. Unless my medical supply costs go up significantly, I don’t foresee any price increases for 2015.  For your peace of mind, I will guarantee that you can renew with no more than 5% increase.”

AVERAGE MONTHLY COST $$$ OF A CONCIERGE DOCTOR IN U.S.* (Source* The Collective, 2013)

• Less than $50/mo. – Eleven percent (11%) of surveyed concierge medical practices cost a patient less than $50 per month.
• $51-$100/mo. – Nearly fourteen percent (14%) of surveyed concierge medical practices cost a patient between $51-$100 per month.
• $101-$135/mo. – Nearly thirty-one percent (31%) of surveyed concierge medical practices cost a patient between $101-$135 per month.
• $135-$180/mo. – Less than nine percent (<9%) of surveyed concierge medical practices cost a patient between $135-$180 per month.
• $181-$225/mo. – Less than one percent (<1%) of surveyed concierge medical practices cost a patient between $181-$225 per month.
• $226-$00/mo. – Nearly thirty-five percent (35%) of surveyed concierge medical practices cost a patient more than $225 per month.

Price and transparency is the most powerful marketing message you have, beyond the doctor of course. What’s most important isn’t the high or low of it, but how it matches your strategy. When Concierge Medicine Today asked current patients of similar concierge-style medical practice, ‘what is the most common objection you have that influences your decision when choosing a private, concierge doctor is …’ 34% said price is biggest concern/objection they have, followed closely by insurance compatibility at 29%. (Source: The Concierge Medicine Research Collective 2010-2014)

There’s No National Benchmark, But There Is An “Acceptable” Range.

As you may already know, the national average annual fee for membership medicine and cash-only services is between $1,200-$1,700 per patient per year. Large networks of concierge medicine and direct primary care doctors have claimed a significant portion of the concierge doctor market share and thus help to keep prices from inflating too high in major metropolitan markets. We have also found that some independent concierge and DPC doctors, those not affiliated with the larger franchise consulting companies, who are not part of a large group may charge higher rates, $2,500 and up.

According to industry physicians and business leaders currently operating in this market space, this price difference is primarily due to the fact that franchise concierge medicine practices are better supported during the initial launch period and do a better job of educating patients about what services will be included for the fee. Therefore, more patients sign-up by start-up. Meanwhile, independent physicians setting out to transition their private medical practice into a viable business model are at times, struggling to acquire the necessary amount of patients to support operational activities, thus, many are charging more per month for their services because they have less patients and less start-up support to help them with strategic planning, messaging and growth.

Know Your Competition.

The research, discussions and analysis of annual fees we’ve compiled over the years related to this pricing conundrum tell us that fees are coming down due to direct primary care and direct-pay physician competition in certain metropolitan markets. But direct-pay physicians are not your only competition. As the demographic of patient for both concierge and direct pay is getting younger and younger, retail medical clinics, Urgent Care’s and the ACA (Affordable Care Act) are increasingly more competitive in this niche space. Additionally, as more physicians move into straight cash-only, direct-pay practices with no insurance contracts, they are trying to keep their fees under $100 to meet financial and operational annual goals. In doing so, they are seeing more patients. The problem DPC physicians with cash-only, membership fees priced under $100 per month is that physicians lack enough patients to sustain a viable practice. We hear of a new DPC practice going under about once a week. DPC practices with have no insurance component have to see more patients and lose the true connection and meaning behind why they moved into this model in the first place because they’re prices are either too low and they’re seeing too many patients OR they’re not in a market that can support it.

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

“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.

This is what we’re hearing on “Mainstreet” from the cash-only and membership medicine physicians and staff we talk to each day. We coach and mentor physicians based on our expertise and recommend that if you raise your rates, do it slowly. Patients will vote with their feet or their wallet. You’ll know very quickly the answer to the “Pricing Conundrum.”

“The first thing to decide is whether you want to continue billing insurance,” ,” says Mike Permenter, Executive Vice President and Chief Development Officer at MedFirst Partners LLC. “If so, then there are specific legal issues to address with regards to the structure. If you are opting out of insurance there are a number of options. The biggest mistake in my opinion is charging too low. Conversions [into this private-pay marketplace] will eventually be unnecessary as the public becomes more aware of the benefits of these types of memberships. The big challenge is continuing growth after the initial conversion. Customer service, as described by some physicians, is the number one way to grow [this type of] practice. Linking the service to local self-insured employers is a good way to grow but certainly requires expertise with regards to structuring the appropriate benefit, usually a high-deductible plan with an HSA plus a membership.

Should you decide to revise your pricing every six months, make sure you reflect that in your sales forecast, research your competitors (not just the local direct-pay docs – they’re not your biggest competition as I stated above). While you may think the marketplace can bear a higher retainer/annual fee for your service, be cautious and take small steps before taking big ones.

[1] Concierge Medicine Today, April 2014

Jani, Haley team up for another Doc & Chef presentation May 19 — Full house expected At Fish On in Lewes

MILTON, DE — This is a free series, but a $10 donation to Haley’s Global Delaware Fund will be accepted at the door. Space is limited and this event will fill up quickly.

MAY 9, 2014 - Local physician Dr. Uday Jani and chef/restaurateur Matt Haley are once again teaming up to present the next installment of the Doc & Chef series, which focuses on healthy, simple to prepare food. The free cooking demonstration and educational seminar is scheduled for Monday, May 19, beginning at 6:30 p.m., at Fish On in the Villages of Five Points in Lewes.

“Matt and I want to thank the 150 people that came out to the last talk we did, and we hope to get even more people this time. This talk is going to focus on a meal that definitely gets overlooked too often – breakfast,” says Jani, a longtime area physician, who has recently added a personalized concierge practice focusing on wellness. “It’s so easy and so necessary to get your day started with a healthy breakfast, yet so many people skip it in the interest of saving a few minutes in the mornings.”

“We hope that all the people on the waiting list from the last talk make it to this one because once again, we want to focus on healthy, local eating,” says Haley, who owns eight coastal restaurants. “We are coming into the time of year when local fruits like blueberries ans strawberries are going to start popping up at farmers markets all throughout the area. We want to show you how quick and easy and energizing breakfast can be using products almost entirely grown in our region”

In addition to breakfast, Jani and Haley will also focus on the myriad of vegetables that will soon be becoming abundant. “With the severe weather we had this winter, everything is late blooming.” adds Haley. “However, spring is definitely here and very very soon we’re going to start seeing asparagus, radishes, and artichokes everywhere. These veggies are nutritional powerhouses, and we’ll help you make room for them in your family dinners.”

Dr. Uday Jani of Milton, Delaware

The doc and the chef will also give consumers insight into how to navigate the vast sea of produce that is available. “Although we encourage people to shop in local farmers markets whenever possible, we fully understand that it’s not always feasible.” says Jani. “We will show you not only how to select the best produce available but also how to decipher a lot of the signage in the bigger box grocery stores.”

For more information and to register, call Lisa Wheeler at 302-644-1200. This is a free series, but a $10 donation to Haley’s Global Delaware Fund will be accepted at the door. Space is limited and this event will fill up quickly.

Source: http://capegazette.villagesoup.com/p/jani-haley-team-up-for-another-doc-chef-presentation-may-19/1178456

By Elaine Thompson TELEGRAM & GAZETTE STAFF

Dr. Stephen Hoffmann, left, is seen with one of his patients, Ronald B. Cohen of Hopkinton, in his Framingham office. Dr. Hoffmann is now a concierge physician. (T&G Staff/PAUL KAPTEYN)

MAY 12, 2014 - Sitting at his desk all day at work, Peter E. Recklet of Hudson packed on a few extra pounds, though he was by no means considered fat.

Two years ago, his doctor determined that he was heading toward becoming diabetic unless some life style changes were made. Mr. Recklet dropped 20 pounds, increased his exercise with his personal trainer and now the 70-year-old is in better health than some people 20 years younger. He recently went on a group “field trip” with his doctor to a local grocery store to learn how to eat healthfully and to keep the weight off.

Robert Bodio of Milford and his wife, Ann, who has several chronic health conditions, sometimes would sit in a waiting room for two hours to see a doctor. Or, they would just come back another day. Now, there is no waiting and they have 24/7 access to their doctor, via cellphone and email.

Ron Cohen of Hopkinton was in Boca Raton, Fla., recently visiting his elderly parents. His 92-year-old father wasn’t feeling well so his doctor came to his home to visit him.

All of these are great, personalized medical services that most Americans don’t have. The innovative type of medical practice is known by several names, including concierge, retainer, boutique and direct care medicine. The primary care physicians are able to give more time and care to patients because they have much smaller practices — up to 600 patients, compared with an average of 2,500 for traditional practices.

But, of course, all that comes with a price.

The best-selling book in “concierge medicine” … Concierge medicine has always had somewhat of a “brand/identity” problem in the media, amongst patients and in the widely discussed health care debate. But in general, the term concierge medicine is used to describe a modern-day relationship with a doctor in which the patient pays an affordable fee for access and cost effective care with their primary care of family physician. ON SALE NOW … $9.95

The Cohens, Bodios and Recklets are patients of Dr. Stephen A. Hoffmann of Framingham, a concierge physician with the Florida-based MDVIP network. Each pays Dr. Hoffmann a $1,650 annual membership fee — which can be paid quarterly, semi-annually or annually — to get the preferential treatment. This type of medical care began in Seattle in the late 1990s. MDVIP (VIP stands for Value in Prevention) was founded in 2000 and now has more than 700 physicians throughout the country with more than 215,000 patients.

Only 17 of these physicians are in Massachusetts, none in Worcester County.

The annual membership fee provides patients with several attractive amenities, including unhurried and longer office visits, no waiting to see the doctor, 24/7 availability to the doctor via email and cellphone, ability to see a MDVIP physician in another state the same day of an emergency, and patients’ children ages 16-26 have access to the physician without an annual membership fee.

One of the most important features is a comprehensive wellness program that includes an extensive annual physical and personal wellness plan aimed at identifying health risks and preventing conditions and diseases before they can occur.

The MDVIP annual wellness exam includes screenings for vascular disease, hearing, vision, depression, mental health status, sleep disorders, sexual function, pulmonary function, body composition, meal planning, nutritional life style analysis, exercise, a proprietary women’s and men’s health panel, diabetes, inflammation and online modification program.

“Quite candidly, I’ve been stunned at how many different threats to health in the making I’ve been able to help patients ward off — heart disease, stroke, cancer, diabetic complications,” said Dr. Hoffman, a Harvard-trained internist.

He said he changed to a concierge practice less than two years ago because it became increasingly clear to him that he wasn’t able to indulge in his passion for preventive medicine. Before he was seeing on average 20 patients a day. Now he sees about half that number. He has patients from 20 years of age to the mid-90s. Most patients are from nearby communities, but some are from as far away as Cape Cod and Sturbridge.

“My day is just as long now, if not longer. But, I’m spending a lot more time with all of my patients. In between visits, I’m on the phone checking on people at home. It’s a different type of busy.”

Representatives of the Massachusetts and Worcester District medical societies, did not offer a position for or against the concierge concept. But, because of the price tag for patients, they said, it’s exclusive.

“There’s a socio-economic bias in my opinion,” said Dr. Ronald W. Dunlap, president of the MMS “With concierge, you’re cherry picking the best patients. It’s like being in the (auto) insurance industry and saying you’re not going to insure someone’s car because they live in the south end of Roxbury. But, you will if they live in Dover. That’s cherry picking: taking people who pay well and their risk is lower.”

Dan Hecht, CEO of MDVIP, disagreed. He said it’s more a matter of a person’s priority. He pointed out that, while some concierge doctors may charge an annual membership fee of $10,000, the $1,650 fee charged by Dr. Hoffmann and other MDVIP doctors amounts to about $135 per month.

“That’s a price that many Americans can prioritize and make the choice to have,” he said. “I’ve heard the story where a patient has said, ‘Look, I smoke two packs of cigarettes a day. I’m giving up one for you.’ That more than pays for the membership fee. Those are choices that people make every day about a cup of coffee … about cable television or about a night out.”

Dr. Michael P. Hirsh, immediate past president of the Worcester District Medical Society, said none of the society’s more than 1,500 physicians have concierge practices. His first experience of talking with a concierge doctor was with Dr. Connie Mariano, a former White House physician from Arizona, who was fielding calls from patients while a guest at a dinner at the home of Michael F. Collins, chancellor of UMass Medical School two years ago. He said from that he learned that concierge medicine is so demanding that it’s for a select few who have the right frame of mind.

Every 20 minutes or so during the dinner, Dr. Mariano received a page, and at one point she asked to use a computer to look at an X-ray, he said.

Just Released! On Sale Now $9.95

“You can imagine if every single sniffle, ache and pain generates unlimited access to you, it takes the right kind of personality to be able to deal with as many calls as you would get,” he said. “Physicians who completely immerse themselves in their practice only let other areas of life suffer: health, marriage, raising their own children. I don’t imagine this kind of practice is going to promote that kind of work-life balance.”

Mr. Bodio, a 69-year-old retired banker from Milford, said the access to Dr. Hoffmann is phenomenal now compared to what it was before he switched to concierge medicine. He said that’s particularly important since his wife suffers with severe asthma and cardiac problems.

“He had so many patients before that some days it was impossible to see him if something was serious,” he said. “His access is tremendous now. We have 24/7 access almost instantly.”

Mr. Cohen said since his elderly parents winter in Florida, they were happy that Dr. Hoffmann set them up with an MDVIP doctor in that area.

“They collaborate. They talk and share files. It’s almost seamless,” he said.

Mr. Recklet said by helping him to prevent getting diabetes, he feels that Dr. Hoffmann’s care is extending his life and giving him a much better quality of life. That is well worth the annual membership fees he and his wife, Elaine, pay, he said.

“My personal trainer is amazed that at my age I’m in so much better shape than some of his clients who are 15-20 years younger,” said Mr. Recklet, who retired from the biotech industry six years ago. “My feeling at this point is whatever I’m investing up front now to maintain my health and well being, I think is going to end up saving society as a whole the end-of-life expenses too many people bring upon themselves.”

Contact Elaine Thompson at ethompson@telegram.com.

Source: http://www.telegram.com/article/20140508/NEWS/305089479/1246

By Michael Tetreault, Editor

MAY 13, 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.

Initially, Concierge Medicine and Direct-Pay doctors were mostly operating in primary care and family practice. The latest data from Concierge Medicine Today (CMT) reports that there are an estimated 12,000 Concierge Medicine and Direct-Pay practices nationwide in 2014. While these figures differ somewhat from analysis touted in the media and quoted by other organizations, CMT’s number represents primary care and family physicians plus a wide range of Concierge Medicine and Direct-Pay healthcare specialty practices in the U.S.

In 2011, there started to be a growing number that practice in secondary Concierge Medicine specialties including: pediatrics; general surgery; psychiatry; spine surgery; gynecology; dentistry; cardiology; addiction medicine; dermatology; oncology and more. These specialty practices usually offer the same immediate access, longer appointments, and a proactive health focus similar to primary care concierge practices. Some also offer home visits. Specialists usually limit their practices to a smaller number of patients –150-300 compared to the more typical 300-750 patients for primary care. They also tend to have patients who have chronic conditions.

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

Recent industry changes along with the implementation of the Affordable Care Act bringing a sudden influx of recently insured lower-income patients to the doctor’s offices. Primary care and family medicine doctors are listing their prices in menu-like fashion and offering affordable healthcare services and discounts on laboratory tests and examinations for a fraction of the cost seen in most traditional, insurance-based, managed care medical offices. CMT finds that approximately two-thirds charge less than $135 a month on average. This figure includes primary care, family medicine, osteopath and various specialty physician practices.

“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

J. Catherine Sykes serves as the Publisher and Managing Director of The Direct Primary Care Journal (DPCJ) and Concierge Medicine Today (CMT)

“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.

At ACAM in Palm Springs, CA. 2013 — Photo Credit: Shira Miller, MD — 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.”

Dr. Alexa Faraday – Office: 855.372.5392

“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

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

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.

May 15, 2014 - As an internist, Dr. Carl DeMars specializes in solving puzzling diagnostic problems. For the last three years, as the medical director of Mid Coast Health Services’ Accountable Care Organization, he’s been practicing that skill in the arena of health care policy as an advocate for a new approach to primary care known as the “patient-centered medical home.”

“I see the patient-centered model as the very foundation of our health-care system,” he says. “Too often we’ve relied on waiting for sick patients to show up at the door and sending them out with their prescriptions. The patient-centered medical home is all about treating patients proactively. It’s about making decisions together with our patients, talking with them about the positives and negatives and the costs of the different treatment options.”

It’s time to fix the system from the ground up, he says, pointing to the $11 million investment Mid Coast Health is making to create primary-care clinics in Topsham and Bath that were designed from top-to-bottom to facilitate a team approach to primary care. Together with a clinic in downtown Brunswick, the three medical homes will be supported by coordinated teams of physicians, nurse care managers and behavioral health specialists — all having the mission of helping people to stay healthy, rather than simply treating them when they’re sick.

DeMars and his Mid Coast colleagues are not alone in their embrace of the new PCMH direction.

Of the roughly 500 primary care practices in the state, upwards of 175 have begun implementing the new PCMH approach, according to figures provided by Maine Quality Counts, an independent collaborative aiming to improve health care. They extend into every corner of Maine: 75 are enrolled in the pilot program launched in 2010 by Maine Quality Counts, the Dirigo Health Agency’s Maine Quality Forum and the Maine Health Management Coalition; another 100 or more were added in the Health Homes initiative overseen by MaineCare and the Maine Department of Health and Human Services.

Because almost 40% of emergency room visits and between 10% and 17% of inpatient hospitalization costs are estimated to be preventable, according to an April 10 commentary in the Journal of the American Medical Association, primary care has emerged at the forefront of local, state and national health care initiatives to reduce costs.

DeMars says patient-centered medical homes offer the right prescription for achieving the “triple aims” of improving people’s health, improving the quality and experience of their care and reducing per-capita health-care costs for the 30 communities served by Mid Coast Health Services.

But he also acknowledges that revenues at the 92-bed Mid Coast Hospital in Brunswick could take a hit if the three medical homes achieve those goals and help reduce unnecessary ER visits, hospital admissions and readmissions.

“That’s the meat of the matter,” he says, not only for hospitals but also for the primary-care practices that traditionally have been paid on a fee-for-service basis. “With our current health care system, the better job we do, the less money we get. The challenge we face is: How do we flip this system around so we reward quality and improved outcomes instead?”

Statewide pilot program

PHOTo / Tim Greenway
Dr. Carl DeMars, ACO medical director for Mid Coast Health Services, says the new Topsham medical home is designed with patients in mind.

Dr. Lisa Letourneau, Maine Quality Counts’ executive director, says the emerging patient-centered medical home trend is driven by primary-care providers “finally coming together saying, ‘What we do is important, we could be doing it better and we should be getting paid appropriately.’” Frustrated by what she characterizes as a “wacky payment model” based primarily on volume rather than quality of care, Letourneau says the 75 primary-care practices involved in the five-year pilot program have signed on to achieving 10 core expectations, including:

• Practicing a team-based approach to care

• Including patients and families in the implementation of the patient-centered model

• Improved management of patients with severe chronic health problems

• Reducing unnecessary health-care spending

• Integrating health information technology to improve communication with patients.

At the same time, she says, payers for health care — both public and private, as well as patients who increasingly are hit with higher deductible and co-pay costs — are all seeking to curb their rising costs. Out of that convergence of stakeholders — patients, providers and payers — came the 2010 pilot program that initially was to last three years. In January 2012, she says, Maine was one of just eight states selected to participate in the three-year Multi-Payer Advanced Primary Care Practice demonstration project testing the effectiveness of the new approach. Funded by the federal Centers for Medicare and Medicaid Services, it provided enough additional money to keep the pilot program going through the end of 2014.

Letourneau says the 75 primary care practices in the PCMH pilot are providing care to 360,000 patients — or almost 25% of the state’s 1.3 million people. The additional 100 Health Home practices joining MaineCare’s pilot last year will be open also to qualified pediatric practices and will be focusing on patients with asthma, diabetes, heart disease, hypertension, obesity, chronic obstructive pulmonary disease and other chronic illnesses.

“I think it’s impressive that we’ve been able to get as much traction as we have in this state,” she says. “We’ve got 175 practices doing it in a climate where the payment incentives are very mixed. We picked people who were committed and willing to make these changes with everyone else watching them. That’s the kind of leadership we need. The challenges are real. It’s not easy to make any big change.”

A work in progress

Letourneau says statistics for the latest progress report haven’t been compiled yet. But at the half-way point, she says all of the participating practices had achieved national medical home recognition from the National Committee for Quality Assurance based on a “must pass” checklist of core expectations practices need to meet in order to be certified.

Accountability is built into the checklist, she says, which includes as goals: Patients having same-day access to their provider; proactively identifying patients who are “at risk for adverse outcomes” and creating a care plan that will help them reduce those risks; identifying one to three initiatives to reduce avoidable hospitalizations, emergency room visits and expensive procedures that aren’t “evidence-based.”

Anecdotally, she says, some practices in Maine have reported success in reducing emergency room visits by up to 50%. Under the federal CMS demonstration project, she adds, pilot participants are expected to achieve 6% to 7% decreases in avoidable inpatient admissions and 5% decreases in avoidable ER visits, specialty consultations and unnecessary use of imaging and other expensive procedures.

Nationally, she says, the early reports show mixed results. An article in the Journal of the American Medical Association in late February, based on a three-year survey of 32 pilot practices in Pennsylvania, concluded that despite achieving NCQA certification as medical homes, the surveyed practices showed “limited improvements in quality” and did not experience “reductions in utilization of hospital, emergency department, or ambulatory care services or total costs over three years. These findings suggest that medical home interventions may need further refinement.”

A much broader national study published in January by the Patient-Centered Primary Care Collaborative shows mixed results. A few examples:

• Colorado: 15% fewer ER visits (compared to 4% fewer in control group), 18% fewer inpatient admission (vs. 18% increase in control group).

• New York: 11% fewer ER visits for adults, 17% lower for children; lower rates of inappropriate antibiotic use.

• Connecticut: 22.8% fewer monthly ER visits, 20.7% fewer specialty care visits; 75% increase in primary care visits; modest improvements in adherence to prescribed medications for heart disease, blood pressure, cholesterol and diabetes.

• New Jersey: Pilot in Monmouth County shows 33% increase in colorectal screenings (vs. 10% increase in non-PCMHs) and 23% increase in breast cancer screenings (vs. 3% increase in non-PCMHs).

“There’s a lot of learning going on,” Letourneau says. “We’re all working hard on the basic question of ‘What do you need to do to ensure accountability?’”

Reports from the field

Paula Eaton, practice administrator for the Martin’s Point clinic in Bangor, says being selected as a pilot site has given her opportunities to learn best practices from peers during monthly check-in meetings. Taking it one step further, she just created a patient advisory committee that will meet monthly to offer suggestions on improving “the patient experience” at her clinic, which sees 3,400 patients a year.

Along with eight other Martin’s Point clinics in Maine and one in New Hampshire, Eaton says, her clinic has integrated a behavioral health component into its services to help patients with depression, anxiety, substance abuse and addiction issues. “Many patients don’t understand the impact mental health has on chronic illness,” she says.

Among the agenda items Eaton plans to present to her newly empaneled patient committee is the “Choosing Wisely” initiative of the ABIM Foundation — which she sees a perfect complement to the PCMH pilot program because it encourages patients and physicians to talk about tests and procedures that might be recommended as part of their care.

“Choosing Wisely does a great job of making the questions understandable,” she says. “That’s another awareness the pilot has brought forward: The cost of care and the need to educate patients about their care … We’ve seen, since January, when a lot of people began to see higher deductibles, that people are now asking, ‘How much is this going to cost me?’”

For Laurie Kane-Lewis, CEO of DFD Russell Medical Center, a federally qualified community health center, the additional per-member per-month fees from payers that include commercial insurers such as Anthem, Aetna and Harvard Pilgrim enabled her to hire case managers for her clinics in Leeds, Turner and Monmouth. That additional staffing, she says, has been key to being able to focus more closely on the health care needs of chronically ill patients.

“That improves outcomes and reduces costs,” she says.

With the pilot program’s funding ending at the end of this year, Kane-Lewis says she’s pleased that at least one insurer, the nonprofit Maine Community Health Options, has already indicated it will continue paying a per-member, per-month fee to support the PCMH value-based approach to primary care at her medical centers. She’s hoping the other payers will do likewise, largely because the new approach already is proving effective in improving health and lowering costs.

“That’s the elephant in the room,” Martin Point’s Eaton agrees. “A quality-based system can work, but with a fee-for-service payment structure, you don’t get paid for those follow-up phone calls. Those all take time, and that takes money. The fee-for-service model has really outlived its usefulness. We need to restructure the reimbursement so that it’s based on quality.”

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Dr. Barbara Crowley, executive vice president at MaineGeneral Health and Maine General Medical Center, says there’s no question that hospitals large and small will be challenged if the PCMH model achieves its goals of reducing hospital admissions and readmissions, particularly unnecessary emergency room visits, thereby reducing their revenue streams. But, she says, MaineGeneral’s new $312 million, 192-bed hospital in Augusta embraces that challenge and was designed with a greater emphasis on wellness that’s reflected in a wing devoted to an array of outpatient services.

“We feel quite strongly about that,” she says. “We built fewer beds than we previously were licensed for. Our intention is to do everything we can to keep people out of those beds.”

Crowley also serves as president of Kennebec Region Health Alliance, a coalition of 28 primary-care practices partnering with MaineGeneral in a “physician-hospital organization” that contracts with insurance providers and other payers. Of those, she says, 10 are participating in the PCMH pilot program and 20 are recognized by the NCQA as a patient-centered medical home.

Both Crowley and DeMars say commercial insurers and the state and federal payers are increasingly receptive to payment models that will be based on quality measurements. “If you are seen as a high-value health care system, more patients will come under your tent,” DeMars says, noting that pharmacies and insurance companies are also likely to offer lower rates to the patients covered by those providers.

And if it means fewer ER visits, hospital admissions and readmissions, Lois Skillings, president and CEO of Mid Coast Health Services, is OK with that.

“Health care is changing and we’re choosing to be part of the change that’s going to happen,” she says. “Yes, we have to run it like a business, but our mission is not a business. It’s to improve the health of the community. Hospitals need to see themselves as only one component of health care. In today’s environment, my role is to be a leader of the entire health-care system, not just of the hospital.”

Source: http://www.mainebiz.biz/article/20140505/CURRENTEDITION/305019993

Name of Contact Person: George C Win

Email: office@unitedmulticare.com

Website: http://www.unitedmulticare.com

Employment Contact Info. (Tel, Address, Email, Fax, Etc.):

United Multi-Care Health Center
2630 San Gabriel Blvd., #200
Rosemead, CA 91770
TEL: 626-280-9968

Job Title: Primary Care/General Practice

Please email to office@unitedmulticare.com or fax back your resume to 877-400-0565.

Date Posted: 05/06/2014 Job Location: Los Angeles Area

Duties/Responsibilities/Job Description: Do you want to have a private practice without any insurance headache? How about no weekends and night hours! Do you feels like you are not happy with the way how Obamacare is going? How about able to take home up as much as you make of your production collection and majority is cash base practice. Do you feel that you are stuck and you know you can do better? How about provide true healthcare and not work for insurance company. If you say yes to all the above questions, we have the perfect proposition and solution for you – Concierge Medicine!

An Integrated Multi-Discipline Healthcare Center is looking for a MD/DO to join us and start a venture. We are looking for long term relationship with opportunity to become part of the ownership. We are one of the most active Multi-discipline Groups in Los Angeles San Gabriel Valley Area. We have two locations. If you just graduate or want to get out of HMO insurance dependent practice and hospital and interested in true freedom of private practice, we have the perfect place for you. You need to be open minded and willing to work with other healthcare professional such as Functional Medicine, Chiropractic and Acupuncture. Can start as Part Time and become full Time if desire. Please apply if you want to challenge yourself and have a strong passion for entrepreneur and help people.

Affordable direct care doctors are the long-term health care solution

Josh Umbehr, MD | Physician | DPC Journal and Concierge Medicine Today Contributor

May 10, 2014 -  In 2010, I started practicing direct care in Wichita, KS. I steadily built a full roster of subscribers who pay between $10 and $100 per month to see me whenever they need to, for as long as they need to, however they want to (at their home, in my office, or via the Internet), all with zero co-pay.

Recently, a patient of mine developed ongoing shoulder pain. He’s middle-aged, insured, in good health overall, and as expected, refused to get an MRI.

Dr. Josh Umbehr is founder, Atlas.md.

As a direct care practitioner, I act as my patients’ family doctor (routine checkups, consultation, etc.) and as their personal urgent care physician (lacerations, broken bones, earaches, and stomach flus) I can handle all of this at no extra cost.

I write and fill their prescriptions, some as low as pennies per pill. Patients do pay for their labs and panels, but our wholesale rates come out lower than the copay of most insurance plans.

I even have someone who helps them find super affordable wraparound insurance plans in case of major trauma.

Just last week this same patient called me up first thing in the morning: He was in severe pain.

“Dr. Josh, I’m ready for that MRI.”

So I immediately made the call to a local lab technician, because I wasn’t fifteen minutes behind my third appointment scheduled for the first hour of my day like most doctors working within the traditional fee-for-service model.

Because of the relationship I’ve built with the lab, my patient owed only $400 for the MRI, instead of the out-of-pocket cost of $1,500 that’s billed standard.

Within 45 minutes, my ailing patient was leaving the lab. Within a few hours, I was reviewing the results.

But critics are probably shaking their head, wondering why this man would want direct care when he’s currently insured.

Well, the thing about insurance is that in almost all cases, patients need to meet their deductible in order for insurance to cover things like MRIs. An Obamacare silver plan comes with a $3,000 deductible – twice the amount due! If they went to the same lab and used their insurance, they would owe $1,100 more out-of-pocket.

And they would still owe that monthly insurance premium that’s really only there in case of major trauma.

And they would risk having to go to an overpriced ER if they had any trouble late at night or on the weekend.

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It’s worth remembering that insurance is a business and they sell their benefits like every other company. Major medical plans will typically offer “free preventative care” in effect saying, “as long as you see an overworked doctor of our choosing, you pay nothing.”

Except you do pay. You pay by waiting 18 days to get an appointment. You pay when doctors talk to you for 7 minutes and have to look down at your chart to remember your name. You pay when these doctors refer you to the same lab for the same MRI and you’re indebted $1,500 because you haven’t met your deductible yet.

That’s why it baffles me when people have knee-jerk reactions to paying cash for medical services.

“Oh, cash-only medicine, that’s only for the rich,” said an associate of mine while we were in Los Angeles years ago. She went on to manage patient experience for a prestigious medical center, a place even the insured might only dream of receiving care.

Then there are critics who say things like, “You doctors seeing fewer patients will reduce access to primary care.”

Or our favorite gripe, “You’re going to create two-tiered health care.”

As a direct care practitioner I take offense to these attacks because they lack perspective. Do critics of an affordable option that delivers real value want health care without any tiers? And what would this tier look like? Millions losing existing coverage, rising premiums for small businesses, cheap Obamacare plans sneaking in absurd drug costs …

To me, this sounds like a universal health care system that equally fails all people of all socioeconomic backgrounds.

Why would someone criticize me when I tell people, I’m happy doing what I’m doing, I’m happy to consult other doctors in doing similar work, and I’m happy to motivate students to choose family medicine instead of a specialty?

Critics see affordable cash-only doctors as the root of our doctor shortage. I see us as a viable long-term solution. When students begin to perceive the financial and emotional benefits of practicing family medicine — two things I can personally vouch for their attainability — then this doctor shortage might actually be addressed.

And when critics want to examine the chip on their shoulder, I’ll be glad to negotiate for them.

Josh Umbehr is founder, Atlas.md.

Source: http://www.kevinmd.com/blog/2014/05/affordable-direct-care-doctors-longterm-health-care-solution.html

Name of Contact Person: Clark Eddy

Email: clarkeddy@gmail.com

Employment Contact Info. (Tel, Address, Email, Fax, Etc.):

ProPartnersMD Direct
Tel: 913-451-4776
Fax: 913-451-4770

Web Site:  ProPartnersMDDirect.com

Please email clarkeddy@gmail.com if interested.

Job Title: Physician

Date Posted: 5/8/14

Job Type: Full Time

Job Location: Leawood, KS

Duties/Responsibilities/Job Description: Direct Primary Care clinic for Men would like to partner with physician interested in doing DPC for women and children. At this time we are looking to either hire on or partner with someone to see women/kids (likely candidate would be family practice physician).