By Tommy Prewitt, MD | Policy | April 5, 2015 | KevinMD

As the CMS Innovation Center rolls out the Next Generation ACO Model, I wonder what doctors are thinking. The Next Generation ACO model ups the ante on risk and reward and is the next delivery model iteration as CMS marches on to 30 percent at risk Medicare in 2016. Some of the docs will generally acknowledge that medicine is changing, but there is often no corresponding change in behavior. Other docs will simply ignore what is being played out right before their very eyes, expressing the same willful blindness that some of my breast patients would, presenting with huge, fungating cancers.

It is understandable that doctors would want to hang on to a health care belief system that they embraced in medical school. But many of the beliefs of years past do not work today; try not to believe everything you think. Consider these five examples.

1. I am too busy to learn how to improve. Actually, you can’t afford to not learn. As we have discussed multiple times in these pages, our current system of health care finance is unsustainable. We are broke. For that reason, fee-for-service is going away. This means you will be at financial risk for populations of patients. You can’t just change one day. You need to learn how to improve quality and reduce costs. This requires new skills.

2. I make a lot of money, and that means I am really smart. Yeah, right. Like that failed limited partnership that cost you $500,000? Or how about both of those alimony checks that go out every month, regardless of your income? We know folks who have had stellar careers who still work in some capacity because they squandered their money. Anybody can learn how to do a colonoscopy or fix a hernia, so don’t get on a high horse because you have been blessed to have a good income. The future comes with significant uncertainty. Be a good steward and be grateful. If you think that you can win going against the forces that be, it could be disastrous.

ATLANTA, GA — JULY 31-AUG 1, 2015

3. My hospital loves me because I make them tons of money. Really? How do you know that? You would be surprised. I have a friend who was bragging about how much money he made for the hospital doing MRIs. It turns out that they lost $150 every time they turned the machine on. Or what about the $46M service line that cost $48M to run? I guess they will make it up on volume, right?

4. My performance benchmarks are OK, so that means my quality is good. You are two clicks to the green side of the benchmark, but that doesn’t mean you have good quality. It just means you are better than 52 percent of your peers. Plenty of people will stay there at 48 percent. Time to go to #1 above and learn how to get better outcomes, and in the process, you will also reduce costs. Your patients deserve it.

5. I will always have my choice in where I work. Don’t bet on it. Everyone is replaceable. You need to protect your career. Embrace team concepts of care. Develop leadership skills. I recommend that you start thinking now about how your work will change when you and your hospital or clinics take on more financial risk. Remember that lower costs of care are becoming indicators of higher quality. Don’t be the jerk that gets fired.

July 31-Aug 1, 2015  … The Concierge Medicine Assembly is a two-day educational format event (Atlanta, GA) — Click here to learn more…

EXL/CMT “Concierge Medicine Assembly” | July 31 – Aug. 1, 2015 | Atlanta, GA

• Organizers: EXL Pharma/EXL Events/CMT
• To Advertise, Call: 1 (866) 207-6528 — (Be sure to Mention CMT referred you for special rates)
• REGISTER Online: Click Here
• Registration@exlevents.com
• Call: 1 (866) 207-6528
• A two-day educational setting, learn from doctors and industry leaders alike as they address topics such as the principles doctors have utilized when facing challenges like acquiring new patients; how to notify patients about your new business model; PPACA obstacles, including maintaining a healthy staff culture; how to work with your local businesses and mid-size employers; the process of accepting insurance; and much more.

By Christopher Johnson, MD | Policy | May 27, 2015

‘So we conclude that this is a characteristic of a profession that’s torn between the artisan, the single Marcus Welby who knows everything, versus the idea of doctors who adapt to clinical evidence and who may drop procedures that have been shown not to be effective.’ ~Jonathan Skinner, a researcher who works with the group at the renowned Dartmouth Atlas of Health Care

Some months back I read an interesting interview with Jonathan Skinner, a researcher who works with the group at the renowned Dartmouth Atlas of Health Care. More than anyone else I can think of, the people at the Dartmouth Atlas have studied and tried both to understand and to explain the amazing variations we see in how medicine is practiced in various parts of the country. It turns out that specific conditions are treated in quite different ways depending upon where you live. Atul Gawande documented a detailed example of the phenomenon in an excellent New Yorker article.

A major determinant appears to be local physician culture, how we doctors “do things here.” The disturbing observation is that patient outcomes aren’t much different, just cost. Of course, it’s more than cost. Doing more things to patients also increases risk, and adding risk without benefit is not what we want to be doing.

Skinner is interested in something else, a phenomenon he calls “cowboy doctors.” By this, he means physicians who are individual outliers, who go against the grain by substituting their own individual judgments for those of the majority of their peers. In theory, such lone wolf practitioners could go both ways. They could do less than the norm, but almost invariably they do more — more tests, more treatments, more procedures. Such physicians not only may put their patients at higher risk, they also add to medical costs. I have met physicians like that and have usually found them to be defiant in their nonconformity. A few revel in it. They maintain they are doing it for the good of their patients, but there is more than a little of that old physician ego involved. There is also the subtext of what many physicians feel these days, especially old codgers like me who have been practicing for 35 years: It is the tension between older notions of medicine as an art, a craft, and newer evidence-based, team driven practice.

Skinner describes it this way:

It’s the individual craftsman versus the member of a team. And you could say, “Well, but these are the pioneers.” But they’re less likely to be board-certified; there’s no evidence that what they’re doing is leading to better outcomes. So we conclude that this is a characteristic of a profession that’s torn between the artisan, the single Marcus Welby who knows everything, versus the idea of doctors who adapt to clinical evidence and who may drop procedures that have been shown not to be effective.

Leaving aside outcomes and moving on to costs, Skinner and his colleagues were quite surprised to discover how much these self-styled cowboys were adding to the nation’s medical bills. They found that such physicians accounted for around 17 percent of the variability in regional health care costs. To put that in dollars, it amounts to a half-trillion dollars. That is an astounding number.

So what we are looking at here is a dichotomous explanation for the huge regional variations in medical costs. On the one hand, we have physicians who conform to the local culture, stay members of the herd and go along with the group, even if the group does things in a much more expensive way that confers no additional benefit to patients. On the other hand, we have self-styled mavericks who scorn the herd and believe they have special insight into what is best, even if all the research shows they’re wrong.

I think what is coming from all this cost and outcome research is that best practice, evidence-based medicine (when we have that — often we don’t for many diseases) will be enforced by the people who pay the bills and professional organizations. Yes, some will bemoan this as the loss of physician autonomy and the reduction of medical practice to cookbooks and protocols. I sympathize with that viewpoint a little, especially since I am the son and grandson of physicians whose practice experience goes back to 1903. But really, there are many things we used to do that we know now are useless or even harmful. An old professor of mine had a favorite saying for overeager residents: “Don’t just do something — stand there!”

Here is the actual research paper from the National Bureau of Economic Research describing this.

Christopher Johnson is a pediatric intensive care physician and author of Keeping Your Kids Out of the Emergency Room: A Guide to Childhood Injuries and Illnesses, Your Critically Ill Child: Life and Death Choices Parents Must Face, How to Talk to Your Child’s Doctor: A Handbook for Parents, and How Your Child Heals: An Inside Look At Common Childhood Ailments. He blogs at his self-titled site, Christopher Johnson, MD.

SOURCE: http://www.kevinmd.com/blog/2015/05/the-problem-with-cowboy-doctors-in-health-care.html

Champagne with your Cialis? It’s the pharmacy for the 1% — Personalized care comes to Upper East Side—for those willing to pay for it.

Crain’s New York Business, Health Pulse is a subscription-only website focused on the business of health care.

Updated 05/18/2015 | Crain’s New York Business – Add one more entry to the ever-growing list of businesses trying to siphon money from America’s wealthiest citizens: An Upper East Side pharmacy is betting that residents of the tony Manhattan neighborhood will pay a sizable premium for personalized care.

RELATED STORY

INDUSTRY-FOCUS: New York sees exponential growth in concierge medicine clinics from 2008-2014.

For $2,500 to $6,500 a month, Cedra Pharmacy on Second Avenue and East 63rd Street is offering concierge services, such as weekly consultations with a pharmacist and unlimited door-to-door limo rides to doctors’ appointments.

RELATED STORY

SPOTLIGHT on NEW YORK: “You don’t have to be rich to have a concierge physician,” notes Dr. Kaplan. In fact, fees are typically lower than most insurance deductibles. And patients love being seen by the doctor personally every time.

“This is a niche program,” said Mazen Karnaby, 37, who opened Cedra this past December. “It’s only for people who would like to get pampered and make sure that they’re getting the best service there is when it comes to the pharmacy world. We will be there right next to their doctor.”

CONTINUE READING FULL & COMPLETE STORY from CRAIN’S NY BUSINESS HERE …

A version of this article appears in the May 18, 2015, print issue of Crain’s New York Business.

SOURCE: http://www.crainsnewyork.com/article/20150517/HEALTH_CARE/150519888/champagne-with-your-cialis-its-the-pharmacy-for-the-1

* Editor’s Note:

“It is important to note that industry physician surveys, investment analysts and industry experts tell The DPC Journal’s research arm, The Concierge Medicine Research Collective, that they believe there are an additional 6,000 physicians who practice some form of Membership Medical Care (MMC) — i.e. albeit Concierge Medical Care or DPC, across the U.S. at this time (December 2014) equating to a total of approximately 12,000 MMCs operating in the U.S. — representing a total of just less than 6% of all licensed primary care physicians in the U.S. Another way to to look these numbers in perspective … is these 12,000 MMCs represent just over 1% of all licensed physicians in the U.S. across multiple specialties. According to the most accurate observers and news reports in recent past, we caution that exact numbers (<300 DPC; 5-6k up to 12k Concierge Care) are hard to track. The shift by physicians, despite hype, has been gradual. However, the positive data coming out of the MMC marketplace, usage and acceptance by consumers is growing at a moderate rate.” ~DPC Journal 2015 Annual Report and Market Trends Summary

By Catherine Sykes, Publisher, DPC Journal, Concierge Medicine Today, DocPreneur Press

Catherine Sykes, DPC Journal Publisher and Managing Director

JUNE 22, 2015 – Today, attitudes towards both Concierge Medicine and its demographically diverse and very different familial companion, Direct Primary Care, have undergone significant changes since the signature of the Affordable Care Act in 2010.

Even according to a June 2015 article written by the LAS VEGAS REVIEW-JOURNAL an interview with Editor, Michael Tetreault of Concierge Medicine Today stated … “Concierge Medicine [and DPC] has evolved, and no longer is the practice limited to well-heeled patients. Even people on fixed incomes and modest means seek the extra attention and access doctors provide.”

RELATED STORY
“Be Proud to call yourself DPC: If you are a Direct Primary Care (direct care) doctor … own it, be proud of it, brand it your own … because your fellow colleagues (nearly 300, Source; The DPC Journal 2015 Annual Report, June 2015) certainly are also.“

Membership Medicine has become more accepted and DPC clinics today are now more diverse in their customer base, provide low-cost monthly memberships and are progressively building a large following among savvy employers, Gen. Xers, Millenials and capturing some very impressive employers in certain markets across the U.S.

READ MORE … The Four Modern-Day Distinctions of Direct Primary Care In America, (C) 2014-2015. The Direct Primary Care Journal

But while the era of the high-priced, high-end, Concierge Doctor stigma in the minds of many Americans has changed and is changing, Direct Primary Care is the next brand invited to the stage … showing doctors in small towns and suburban metropolitan areas that the personality and patient make-up can be as diverse and unique as the doctors offering it.

The Greatest Challenge The Industry Is About To Take On …

Policy aside, today, the free market medicine community of physicians (including both Concierge Care providers and Direct Primary Care doctors) have a faithful patient following that faces a new challenge. Sadly, it’s a chronic condition ailing millions of people across the country. Education. Admittedly, it may just be the most formidable obstacle doctors have yet faced.

As we monitor the chatter on social media, read the story threads written by thousands of opinionated people about free market healthcare delivery solutions used across America, we are beginning to see a growing community of people that believe doctors, particularly primary care and family medicine physicians, are the problem. Concerns around private-pay clinics — which typically bundle physician access with uninsured services for a monthly, quarterly or annual membership fee — are soon going to be center stage fodder for ‘the queue-jumping patient’ in the coming years ahead.

JULY 31-Aug 1, 2015 — ATLANTA, GA

For example, a reader just last week wrote a letter to the editor and said … Source: Tampa Bay Times (Letters, June 2015): ‘This artfully worded gibberish describes an arrangement under which people contract directly with a doctor to self-pay their charges. Insurance — that pesky “third-party payer system” — is not accepted. Does this sound like a good idea for expanding health care to Floridians? What it sounds like to me is an excellent “innovation” for Florida legislators instead of their current insurance coverage provided largely by the taxpayers.’

The educational obstacles and discussions you will have in the coming years ahead will probably challenge your spirit, frustrate you, humble you and, at times, defy logic. So what are we to do? What are the questions you as a physician need to know the answer to when asked by your patients, new patients, school administrators, local businesses and even the media?

The answer can be found in a recent call we had with a DPC doctor in Missouri a few weeks ago.

RELATED STORY/EVENT (ATLANTA, GA — Friday, JULY 31, 2015)
B2MD: Working with Employers and Local Businesses (ATLANTA, JULY 31, 2015) — Addressing How DPC and Concierge Care Practices Work for/with Employers; Study a Snapshot of Who Is Currently Doing It; Creating a Profile of an Ideal Employer; What Are Employers Looking for? A Profile of Receptive Employers; Determine Your Unique Selling Points; Uncover Objections You Need to Be Prepared for; How to Find Employers in Your Area and more. Speakers: Catherine Sykes, CEO/Publisher, Concierge Medicine Today and The Direct Primary Care Journal and William “Bill” Bennett, CFP, CFCI, Chairman, WORKsiteRx.

She said … “You (The DPC Journal) are the only ones who told me that patients will actually be angry and upset that our practice is changing to a DPC monthly subscription payment model.”

Another story came to us by way of email from a doctor in Colorado. He informed us that a new patient walked in their door with a page ripped right out our 2015 DPC Consumer Guide. It was the page titled “The 40 Questions You Should Ask your DPC Doctor Before You Join.”

The physician writes … “At first, I was impressed. Then, 25 minutes later and 15-questions in, I was starting to get annoyed. Ten minutes later and 4 more questions, the patient left, no membership received. The next day, her entire family of 5 walked in the office and signed up! I was impressed and over joyed. What I learned from that encounter was that my staff and I had some real work to do in overcoming some common objections and serious questions that our community of new patients want answers to. We went back to the drawing board as a team/staff and went thru the “40-Questions Checklist” and we are now very confident we can provide the answers to the questions our patients need and want to know.”

2015 EDITION — Available Now — On Sale $8.95

It is no secret that there are thousands of people across America who benefit from old-fashioned, modern-day healthcare delivery solutions such as those used inside Direct Primary Care and Concierge Medicine practices.

However, the reverse is true as well.

There are millions of people across America who do not agree with free market healthcare delivery models. Mainly those used in Membership Medicine (Concierge Medicine, Direct Primary Care practice’s, etc.) and inside Convenient Care Clinics (Walgreens, Minute Clinics, CVS) Urgent Care Centers, etc.

It doesn’t matter what name your adopted practice model is entitled or what flavorful language you put into the FAQs on your web site … there are simply some people strongly believe that not only should healthcare be a ‘right’, but that everyone should also be allowed to use their health insurance cards as yet another form of credit in a debtor enabling society. Be prepared to answer their questions like the examples above did.

The Voices Against Free Market Healthcare Will Only Get Louder In The Years Ahead. So, Be Ready.

Free, WHITE PAPER — Media Training Guide

Comments about subscription healthcare, retail medicine, Direct Primary Care and even Concierge Care will defy logic. Opinions will be loud, boisterous and at times truthful. Usually these opinionated comments and stories will center around their guiding principle that what you are doing in your practice just simply isn’t right.

RELATED STORY
December Is National Direct Primary Care Awareness Month

“We’ve got a big divide here,” said one Texas-based Concierge Doctor. “This is about changing the culture that has taken hold … one that believes [primary care] doctors are greedy and uncaring. Our country is divided on healthcare affordability and who should pay for it. We’ve got some very difficult conversations ahead of us amongst those who practice in DPC and Concierge Medicine business models. We want to win all people’s hearts and minds with incredible care and great customer service. But, I’m going to have a tough time making a living assuming the best in people. I’ve got to be willing to engage in some difficult conversations with strangers, some of my new patients and a few of my current patients who strongly disagree with how I should get paid. I will show as much grace and understanding as I possibly can. That’s my job. Sometimes however, we have to pay a price for our principles and ethics … but we either pay for them or with them.”

What’s interesting as we watch these discussions unfold in social media and across the online atmosphere is that many of the same objections people had with Concierge Medicine ten years ago are now the same objections people are raising with Direct Primary Care. More important however, is the long-term educational strategy and discussion doctors must begin using in the years ahead to combat this chronic illness that ails our country. Consumers need to be educated on the realities and benefits of Membership Medicine. Mainstream media cannot be relied upon as the voice for this movement.

NEW RELEASE — now available! It took nearly 3 years to write … The Doctor’s Guide to Concierge Medicine (nearly 400 pages of industry insight plus, over two dozen physician contributions compiled in one book) — On Sale $129.95  (Reg. $189.95)

To learn how you can be a voice, contact The DPC Journal or Concierge Medicine Today for more information and helpful talking points and tips. Direct: 770-455-1650 or editor@directcarejournal.com.

RELATED STORY

CMT CANADA: Alberta called weak on rules for private clinics

“If you think we have it bad …” said one Texas physician to Concierge Medicine Canada.

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Copeman Healthcare Centre Setting Standard for Private Clinic In Canada.

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ALBERTA, CANADA: ‘Under a new standard of practice rule, physicians cannot promise or provide preferential access to insured services to patients who are already paying them fees for uninsured medical services.’

By Janet Palcko

NEW RELEASE — now available! It took nearly 3 years to write … The Doctor’s Guide to Concierge Medicine (nearly 400 pages of industry insight plus, over two dozen physician contributions compiled in one book) — On Sale $129.95 (Reg. $189.95)

Nov 25, 2014 –  As “concierge medicine” gains popularity, we are getting a lot of inquiries as to whether such fees can be reimbursed from a Health FSA or HSA.  The answer is not always clear.

What is Concierge Medicine?

Concierge medical practices provide a personalized focus to healthcare.   Patients may experience longer visits, an emphasis on preventive care, greater access to their physician, more patient education, and insurance management services.  Patient loads are less than in traditional medical practices.  The patient pays an additional fee for these “concierge services”; fees vary widely, but average $1,000-1,800 annually for a Family.

RELATED STORY

Why Doing an FSA Makes More Sense Than Ever

Can Concierge Fees be reimbursed from a Health FSA or HSA?

A quick rule of thumb is if the expense is directly related to a qualified medical service that has been provided, it is reimbursable.  If it is only for access to services, or the right to “get in the door,” then it is not a qualified medical expense for HSA/FSA reimbursement purposes.

Who decides whether an expense is reimbursable under a health FSA or an HSA?

Not the claims administrator and certainly not the doctor. It depends on whether it meets the IRS definition of a qualified medical expense and whether it is a permitted expense under the employer’s plan.

RELATED STORY

HSAs, the Affordable Care Act and Concierge Medicine

VIEW OUR LIBRARY of MP3s … Click Here … Download

In practical terms, to determine whether an expense is for medical care, an administrator (NEO) must ask: what, who, when, and why?

• What is the expense for? The expense must fall within the legal definition of medical care as defined in Code §213(d) and be permitted under the employer’s plan. The expense must be for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body. It must primarily be to alleviate or prevent a physical or mental defect or illness. This is the basis for all eligible medical expenses.
• Who is the expense for? The expense must be for the participant, his or her spouse, a tax dependent, or a child who has not attained age 27 as of the end of the taxable year.
• When was the expense incurred? It must be within the Plan Year (for a health FSA) or after the account was established (for an HSA).
• Why was the expense incurred? It must be primarily for a medical purpose (e.g., generally not for cosmetic purposes).

About the Author

Janet Palcko is a partner at NEO Administration Company, a benefits consulting firm that provides FSA, HRA, HSA and COBRA administration and compliance services to area employers. As managing partner, she is responsible for all aspects of NEO’s business, from fiscal planning to practice development, compliance, and client services. Ms. Palcko is a member of the National Association of Professional Benefit Administrators (NAPBA) and the Employer’s Council on Flexible Compensation (ECFC)in Washington DC and is one of a select number of practitioners in the U.S. who have earned the designation of Certified in Flexible Compensation (CFC) from ECFC’s Academy of Professional Standards & Ethics. The CFC designation is the highest professional certification available for practitioners in flexible compensation. Janet is also certified in FSA, HRA, HSA and COBRA administration.

Editor-In-Chief, Michael Tetreault | The DPC Journal, ConciergeMedicineToday.com

By Michael Tetreault, Editor-In-Chief

Last Updated, JUNE 1, 2015 – When launching a direct primary care (DPC) medical practice, many “Doc-Preneurs” grapple with how to structure their practice and which business model to choose. Here are the pros and cons of each practice model commonly used by direct primary care doctors and retainer-based medical physicians.

Related: DPC EDITOR: Successful “Docpreneurs” Know These 6 Things

Dr. David Tusek, MD, is a Board Certified family doctor and diplomate of the American Academy of Family Physicians.

“Direct Primary Care (DPC) is not insurance,” says Dr. David Z. Tusek of Nextera Healthcare based in Colorado. “It does not strive to replace health insurance, nor is it adversarial to it. On the contrary, many DPC practices are eager to work with insurance carriers to co-create blended plans which integrate DPC with high-deductible insurance and ultimately correct the perverse incentives which are rife in the traditional fee-for-service system.”

Summary of Models In Direct Primary Care

• #1. DPC Lifestyle Model — “In my experience, there are two types of DPC models,” said Mike Permenter, a consultant at Private Practice Direct based in Atlanta, GA. “Lifestyle models where physicians reduce the size of the practice and maintain minimal staffing, and offer a variety of services for a membership fee. We strongly urge all physicians not to have a fee less than $100 per month.”
• #2. DPC Growth Model — “Then there is the Growth Models for physicians who don’t mind the longer hours but want to solidify income through growth,” notes Permenter. “These models can include one or more mid-levels or additional physicians to provide services when the practice grows. But there is NO insurance billing. Instead of trying to manage two types of practices under one roof, and trying to accommodate Medicare rules regarding the structure of such entities, the DPC model is a partnership where all providers offer the service as a team. You are either a government doctor or a private doctor. Trying to have it both ways is a great way for a company to take advantage of selling things to your practice, but as has been shown frequently, a disservice to both doctor and members in our opinion.”

In a recent White Paper published by the American Academy of Family Physicians (AAFP), they ask what’s the difference between DPC practice models?

The answer they (AAFP) wrote was: The variance between DPC practices is often found in the breadth of primary care services covered by their retainer contract fee structure. Some DPC practices have retainer fees that cover the entirety of primary care services, including care management and care coordination, as well as services involving external organizations such as off-site diagnostic facilities. This means that patients do not have to pay out of pocket for any services delivered to them through their DPC practice beyond the monthly retainer fee. Other DPC practices cover a far more limited scope of services and collect service fees from patients at the time of care to cover costs occurred in the visits. This is because these DPC practices continue to participate in traditional FFS contracts with third-party insurance carriers but utilize the retainer fees to supplement their contracts. Typically, these retainer fee structures only cover services that would otherwise go un-reimbursed under those insurance network contracts.

The Fee For Care (FFC) Model

Usually a monthly, quarterly or annual fee model, where a patient pays a monthly fee, quarterly or annual retainer fee to the physician. There is typically no long-term contract or obligation between the physician-patient in this model. The fee covers most services provided by the physician in his/her office. Often, vaccinations, lab work, x-rays and other services are excluded and charged for separately.

Benefits and services typically included in the contract between the physician and patient may include: same day access to your doctor; immediate cell phone and text messaging to your doctor; unlimited office visits with no co-pay; little or no waiting time in the office; focus on preventive care; unhurried atmosphere; free cell phone, text message and online consultations, prescription refills; convenient appointment scheduling and more.

Related: Insurance, HSAs and DPC — How They Work Together

Many FFC or Retainer plans may be purchased with pre-tax dollars utilizing HSA and/or FSA accounts attached to patients’ insurance plans. Please note, these programs are not an insurance company or product. Each patient should check with their physician to find out what services are included in their individual membership. These are only examples of some of the typical services provided.

The Fee For Non-Covered Services Model

Many doctors have chosen to partner with large franchise concierge medicine businesses to help with the startup and transition needs necessary to open their concierge medicine practice. However, more than half of all concierge physicians have opted to use accountants, attorney’s, practice managers and business consultants to navigate their way into the new practice model. As more and more doctors begin to analyze and potentially move into concierge medical practices, independent physicians choosing not to be a part of a large franchise operation instead are transitioning with a smaller consultant should examine their fee structure and price them competitively.

“The first thing to decide is whether you want to continue billing insurance,” says Permenter. “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.”

Most doctors currently practicing concierge medicine as a career choice fall into one of two intelligence-gathering categories when they first opened. First, they used a franchise concierge company to help them with the details or they opted to do it themselves and surround themselves with a local team that would provide counsel in starting this practice model.

The DocPreneur Institute, an educational industry resource — offers a wide-array of mp3’s, recommended reading guides, professional access to DPC industry mentors and coaches and more … without a sales pitch from a consultancy. Click here to learn more …

“I perform a thorough analysis of the practice and determine areas where expenses will be reduced,” says Permenter. “After a survey of the physicians patients, we conduct a 12-16 week conversion. Our fees are collected during the transition only. Once a successful conversion has been completed, we help train the physician staff to provide membership services. If customer service is maintained, we know the practice will continue growing without a need for further services.”

The Concierge Medicine Research Collective (“The Collective”) found over the past four years that concierge doctors operating under the direction of a large franchise concierge company or consultancy will price services, on average, between $1,200 and $1,800 per patient and opening with a patient load between 300-750 patients. This helps the practice compete with local retail clinics, pharmacy chains, primary care doc-in-a-box practices and attract, en masse, the demographic that practice needs in order to succeed in their local market. The Collective also found that many independent concierge doctors who chose not to operate under the guidance of a franchise business model were charging much more for their services, between $2,500 – $5,000 per patient, and opening with a patient load of 75-180 patients under their care.

The premise of most franchise concierge medicine business models, termed “Fee For Non-Covered Services Model,” reduces the size of a medical practice to a more manageable patient load and these patients agree to pay a fee for more time with their physician, an annual physical, and more personalized access and service. Emphasis is on a healthier lifestyle, both for the members and the physician. According to a national poll of concierge doctors from 2010-2012 by Concierge Medicine Today (CMT), approximately 80% of these practices accept most major insurance plans and participate in Medicare.

The “Fee For Non-Covered Services Model” allows for Medicare and private insurance to be billed by the physician for routine visits and procedures. To date, this model comprises the largest segment of the market, approximately 46 states, although Direct Primary Care (Fee For Care Model), is rapidly catching up in select markets, according to The Collective.

Distinct advantages for selecting the “FNCS” model are:

• Physicians who are looking to slow down without affecting their current income levels will find this model attractive. These types of models offer an enhanced physical (or some enhanced procedure or procedures not covered by Medicare), on an annual basis, which is the basis for the entire fee. Fees for these models usually range from $1,200 – $2,000. It is critical that physician converting to this business model are able to reduce expenses to accommodate this type of practice.
• There is typically a maximum number of patients allowed to join the practice, usually around 600. Industry sources tell CMT that they have not seen too many of these concierge medicine practices reach the 600 patient-member level, but that most are satisfied at the 400 patient-member level.
• Contrary to what people think, this model is not just for the rich as the vast majority of patients make less than $100K, according to industry surveys. The concierge medicine industry has been touted by the media and television for years as an expensive way to see the doctor you’ve known for years. At the inception of the movement in the early to mid-’90’s, this was factually true. What’s not truthful is that nearly two decades later, the majority of concierge medicine and direct primary care clinics cost their patients between $50 – $135 per month.
• Family Practice Physicians typically offer a family plan where dependent children up to a certain age are covered free. Internal Medicine Physicians may offer a similar program but typically for dependent children between the ages of 16 and 25. Therefore there are many single moms joining these practices.
• There are many development teams and implementation companies that are helping physicians to convert to these more price transparent business models. They have every base covered with regards to ensuring a successful launch. There is nobody in this industry that does it better. There is a very high failure rate for physicians trying to transition to this type of model on their own. The conversion process is intense and every transition has its own unique challenges.

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Distinct disadvantages for selecting the “FNCS” model are:

• The FNCS business model works very well when implemented appropriately. Although a medical practice is considerably smaller and much easier to manage, there are still existing issues with regards to billing Medicare and insurance companies, collecting co-pays, checking patients in and out, etc. This not only increases operational costs, but most of the problems surround billing insurance. Alternatively, in other concierge and direct primary business models, operational costs are much lower because the physicians/practice do not participate in Medicare or insurance plans. We will write more about the pros and cons of this in Part 2 of our follow-up article:
• FNCS Business Models require that the services paid for by members are not Medicare covered services. Accordingly, it is critical to have legal input with regard to structuring this model. Because Medicare regulations are likely to change frequently, especially with the ACA, ongoing legal monitoring is necessary in this type of model.

According to a recent 2013 Physicians Practice Survey (2013 Staff Salary Survey) respondents in practices of six-to-10 physicians reported practicing in a concierge/membership practice. Here are some more specific findings from the survey:

• Solo practices: 2 percent are in concierge/membership practices.
• Two- to five-physician practices: 2 percent are in concierge/membership practices.
• Six- to 10-physician practices: 5 percent are in concierge/membership practices.
• 11- to 20-physician practices: No respondents are concierge/membership practices.
• 20-plus physician practices:  1 percent of respondents are concierge/membership practices.

It’s likely that more physicians, especially physicians in smaller practices, will begin transitioning to concierge, membership, and even direct care practices in the coming years. Physicians who favor independent practice will likely view these alternative reimbursement models as a way to retain their independence, spend more time with patients, and combat declining reimbursement.

In Part 2 of  “Concierge/DPC Practice Models: What Model Is Best For Me?” we will look at the pros and cons of converting to a Hybrid or Segmented Business Model and in Part 3, look at the pros and cons of operating a Direct Primary Care practice.

Pros and Cons of Hybrid/Segmented Medical Practice Business Model

The business and day-to-day operation of any medical practice is challenging. Concierge and Direct Practice physicians will tell you the same challenges exist in their business model as well. In Part 2 of our series entitled “Concierge/DPC Practice Models: What Model Is Best For Me?” we are going to look at how some physicians are operating their medical practices in what is called a “Hybrid” or “Segmented” business model. “Hybrid” concierge medicine practice is where physicians charge a monthly, quarterly or annual retainer or membership fee for services that Medicare and insurers don’t pay for. Under this model, practices and physicians will bill Medicare and insurance companies for patient visits and services covered by the plans. They also offer a traditional model of healthcare which is generally staffed by a Nurse Practitioner (NP) or a Physicians’ Assistant (PA). These two-levels of service are offered under the same roof but have very different payment models.

What Does This Look Like Practically?

Simply stated, the medical practice has two businesses under one roof, Business ‘A’ and Business ‘B.’ Under Business ‘A’ those patients wishing to be treated by the physician will likely pay a monthly, quarterly or annual fee to the practice and receive services such as: quick appointments; email access; phone consultations; newsletters; an annual physical, prolonged visits and comprehensive wellness and evaluations plans. Business ‘A’ will bill Medicare and the patients’ insurance company for visits and services covered by the plans and services not listed in the Membership Service Agreement (MSA). Business ‘B’ however, is where the patients schedule an appointment to see a Nurse Practitioner or a PA and that care is overseen by the Physician in the practice. Business ‘B’ will bill Medicare and the patients insurance company for visits and services covered by the plan, accept co-pays, deductibles, etc. If patients on Side ‘B’ must see the overseeing doctor, it’s very likely they will see him.

So Why Join Business ‘A’ of the Physician’s Practice?

Services inside a “Hybrid” concierge medicine practice on Business ‘A’ may include: quick appointments; email access; phone consultations; newsletters; annual physical, prolonged visits and comprehensive wellness and evaluations plans. Each patient should check with their Physician to find out what services are included in their Membership Service Agreement (MSA). These are only examples of some of the typical services provided. Services vary by state, physician and specialty. These services, along with ensuring they will maintain an ongoing relationship with their Physician, on the outset, can be very attractive to patients.

Advantages To Physicians Operating Under The “Hybrid” Concierge Medicine Practice Model

• Physicians who operate in a “hybrid” concierge medicine business model typically see 6-15 patients per day.
• Proven track-record. According to CMT’s (www.askthecollective.org) The Research Collective, over 80% of concierge medicine practices in the U.S. accept insurance and Medicare patients.
• Spend more than 30-minutes per visit with each of their patients, allowing doctors to get to know their patients better.
• Increased annual reimbursement compared to traditional, managed care and insurance-driven primary care practices.
• More time to research valuable, cost saving treatment options and drugs for your patients.
• Provides a safety net for you in the transition process as this dual model approach initially has less disenfranchised patients and less stress and anxiety throughout the transition process as patients continue to participate in the insured, non-concierge side of your practice.
• More time to spend with your family.

The “Hybrid” Challenge

Such as life, nothing good ever comes easy. The transition to a “Hybrid” concierge medicine model or “Fee-for-Non-Covered-Service Model” has its challenges. When a physician chooses the “Hybrid” business model, he/she must first carefully interview either a Physician Assistant (PA), a Nurse Practitioner (NP) or Physician partner that will replace you and your time under Business ‘B’ of the practice while you migrate and start Business ‘A.’ Most physicians will likely hire a PA or NP for cost reasons. Once this is accomplished, a physician needs to spend some time explaining reasons why he is opening up Business ‘A’ of his practice and taking on a more formal ‘observational’ role of Business ‘B’ of the practice.

Sometimes, transition consultants who assist doctors in establishing a “Hybrid” concierge medical practice will train a temporary transition manager whose job it is to mirror the physician’s schedule. That Transition Manager will also be available to meet with patients as they come through the office on their regular visits, explain the benefits of joining Business ‘A’ of the practice and what the cost, features and benefits might be. All the while, informing patients that they can still see visit this location and see an NP or PA for their regular care, if they choose to do so and not join Business ‘A’.

“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].”

There are some distinct implementation and management challenges to the “Hybrid” model. Physicians are strongly encouraged to establish a team of trusted advisors, which may include:

• a “Hybrid” medical practice consultant;
• a Transition Manager;
• an attorney;
• a supportive spouse;
• and an accountant … to name a few.

“Patients are educated, possibly more than ever, as a result of the changes to our healthcare system,” adds Richard Doughty, CEO of Cypress Concierge Medicine based in Louisiana. “Patients are looking for answers and options and taking more initiative in their overall health. Following their doctor into concierge medicine for many patients is exactly the vehicle that meets their needs. In addition, knowing others who have benefitted from that relationship with their concierge doctor confirms the value as their doctor makes this change.”

Some of the other challenges to overcome include:

• The average membership is typically much lower than other models because a lot of patients are given to option to stay with the practice, as they always have, and continue to see a PA or NP under their insurance. Patients understand that the NP or the PA has to be overseen by the Physician and if they need their doctor, it’s likely they will request to and be able to see him/her.

• There are great NPs and PAs. But not a lot of them will jump on the doctors hamster wheel and see 30 to 40 patients per day while they see their overseeing physician treat 6-10 patients per day. There is likely to be high turnover of NPs and PAs as well as burnout among staff and other support members. Frequently the Physician will decide to work both sides of the practice in order to help the Nurse Practitioner (or Physician Assistant, PA). Once this occurs, members have been known to leave the practice as they see no differentiation, or at least not enough to pay a fee.
• The staff that is helping the NP or PA is as busy trying to manage the chaos as they have been in the past. Support staff is crucial to highlighting the doctors Business ‘A’ of the practice. Customer service is key. There is likely to be high turnover among these team members. If you share staff, this can create its own set of dilemmas. If part of the time some staff are frantically moving patients through Business ‘B’ of the practice to see the PA or NP and then are relied upon to switch hats and be a strong advocate and customer service representative, some things are going to be forgotten and this message will ultimately be communicated to patients on both sides of the practice. If there is a lack of customer service the patients have been found to leave the practice entirely.
• The most important challenge to the model is trying to keep it profitable. Typically, in addition to a lower number of members, there is also a significant number of patients that will leave the practice altogether, choosing not to participate in either Business ‘A’ or Business ‘B.’ Frequently, the Physician is made to believe that his/her membership fees produce additional revenues added to the revenues of his/her original practice, and that he or she is likely to earn $300k – $500k more with this type of medical business model. Additionally, because there are no decreases in the size of the overall practice, and Business ‘B’ of the practice requires billing support, it is very difficult to reduce expenses in these types of “hybrid” concierge medical business models.

“With the right planning, a hybrid can be converted to a Direct Primary Care model,” says Mike Permenter, industry expert and consultant to physicians. “I predict there will be many hybrids converting to a Direct [Primary] Care model in the future.”

MDVIP, the country’s largest concierge medical group, has contracts with around 640 practices and operates in nearly every state across the contiguous U.S. They have been operating and helping physicians enter into concierge medicine business models for over a decade.

ON THE SIDE: “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),” notes 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.”

All in all, “Hybrid” concierge medicine programs can be successful if the transition is done appropriately. There are a few companies that specialize in these transitions. CMT has a list of those companies on www.ConciergeMedicineToday.com – Click on INNOVATORS PANEL or feel free to email us at editor@conciergemedicinetoday.com for a list of trusted consultants and advisors you might want to consider adding to your team to help you start a career in “Hybrid” concierge medicine.

Brief And Abridged History Of Concierge Medicine And The DPC Healthcare Marketplace.

Last Updated: June 1, 2015 | Source: Concierge Medicine Today; The Direct Primary Care Journal; Concierge Medicine Research Collective; AAPP (formerly, SIMPD); MD2; MDVIP, and DPCC. Edited By Michael Tetreault, Editor in Chief, Concierge Medicine Today

What Is Concierge Medicine?

Concierge Medicine is a form of “Membership Medicine” in which doctors provide medical care to Patients generally providing 24/7 access, a cell phone number to connect directly with their physician, same-day appointments, visits that last as long as it takes to address their needs and varying other amenities. In exchange for this enhanced access and personal attention, the Concierge Doctor receives a fee (most fees average between $135-$150/mo., Source: AskTheCollective.org; 2014) which enables them to increase the amount of time they spend with Patients.

“We are a family of mom, dad, and 10 year old daughter,” says a mother in Marietta, GA. “Dad’s retirement from his job means leaving his insurance plan. We are healthy and looking for affordable medical care.”  A Concierge Doctor becomes the source for all things medical. Essentially, you become a trusted friend, advocate and stand fully prepared to help your Patients navigate the complex healthcare system. In the event of emergencies, hospital care is closely monitored, and specialists are often personally briefed and debriefed by you on behalf of your Patients.  “Even if you (a Patient) have insurance, you still do not have access to care,” says Dr. Chris Ewin or 121MD in Dallas/Fort Worth, TX. “You can have all the insurance you want. You still cannot get in to see the doctor.”  This is why thousands of people are now actively searching for a Concierge Doctor or a DPC physician. They also discover that out-of-pocket costs to this type of doctor can actually save them thousands of dollars a year. At the same time, they can have their doctors cell phone on speed dial.

• Business Models Used …Part 1, 2, 3 and beyond year one.
  • PART 1: DPC and Concierge Medicine Models: What’s Best For Me?
  • PART 2: Pros and Cons of Converting to a Hybrid/Segmented Concierge Medicine Business Model
  • PART 3: A Simple Look at the Best Corporate Structure for Your DPC Practice
  • Concierge Medicine Market Research and Feasibility Study: 8 Great Resources.
  • BUSINESS: Should You Franchise Your Concierge Medicine Practice?
• Typical Services Offered …
• Recent Data & Statistics …
• Direct Primary Care 
  • Defining Direct Primary Care (DPC): What Is It?
  • DPC Scope of Practice: Typical Services Offered
  • BUSINESS: A Simple Look at the Best Corporate Structure for Your DPC Practice
  • FAQs: Insurance, Medicare, HSAs and More …

Learning From The Past …

1996:     Dr. Howard Maron and Scott Hall, FACP established MD2 (pronounced MD squared) located in Seattle, Bellevue, WA and Oregon. They charged an annual retainer fee of $13,200 and $20,000 per family.

1999:     Medical Professionalism Project-consisting of members of the internal medicine community, including representatives of ACP and the American Board of Internal Medicine, set out to draft a charter that could serve as a framework for understanding professionalism.

1999:     Institute of Medicine releases the now famous report of medical errors, Patient safety, and professional integrity that caused further probing in physician exam rooms.

2000:     Virginia Mason Medical Center in Seattle, WA began operating concierge medical services within its facilities and used some of the profits from the 5 physician practice to subsidize other programs and indigent care services.

2000:     MDVIP, founded by Dr. Robert Colton and Bernard Kaminetsky, in Boca Raton, FL. A brand of Concierge Medicine practice and management firm which has set-up more than 700 concierge medical practices with offices in almost every State across the U.S. Update: In April 2014, Procter & Gamble announced the sale of MDVIP to a private equity firm, Summit Partners.

2001:     American Medical Association writes concierge physician guidelines: PRINCIPLES OF MEDICAL ETHICS.

2002:     ACB Foundation , ABIM Foundation and the European Federation of Internal Medicine defines ethical principles and responsibilities contracts between Patient and physician, which is in a language that suggests both parties have equality, mutual interest and autonomy.

2002:     Medicare addresses Concierge Medicine and retainer fees.

2002:     Centers for Medicare and Medicaid, CMS, outlined its position on concierge care in a March 2002 memorandum. The memorandum states that physicians may enter into retainer agreements with their Patients as long as these agreements do not violate any Medicare requirements.

2002:     Pinnacle Care establishes Patient care with a one-time membership fee for access to VIP service.

2002:     The AMA counsel on medical services issued a report in June 2002 on Special Physician-Patient contracts. It concluded that retainer medicine was a very small phenomenon.

2003:     American Society of Concierge Physicians was founded by Dr. John Blanchard. The association later changed its name to SIMPD, Society for Innovative Practice Design.

2003: AMA issued guidelines for boutique practices in June ‘03.

2003:     Department of Health and Human Services rules the concierge medical practices are not illegal and the federal government the OIG, Office of the Inspector General, takes a decidedly hands off approach.

2003:     American College of Physicians writes doctors struggle to balance professionalism with the pressures of everyday practice.

2003:     June 2003 the AMA Council on Ethical and Judicial Affairs outlines guidelines for “contracted medical services”. The AMA House of Delegates approves these guidelines.

2004:     GAO, General Accountability Office writes 146 concierge physicians in the U.S.

2004:     Harvard University study finds that 55% of the respondents are dissatisfied with their health care, and 40% of that 55% agreed that the quality of care had worsened in the previous five years.

2005:     The AOA, American Osteopathic Association adopts not to recommend and an official policy on concierge care.

2006:     MDVIP, a concierge physician practice management firm, reports that 130 physicians within their network treat up to 40,000 Patients worldwide.

2007:     Concierge Medicine Today, a concierge medical news agency opens its doors to be an advocate for news pertaining to the Concierge Medicine, retainer-based, boutique, private medicine and direct care industry.

2007:     The term “direct practice” was first used in legislation in Washington in 2007 that clarified these practices were not insurance companies under state law-but they do provide basic, preventive medical care.

2008:     Boasting an estimated 35 concierge physician practices, Orange County, CA appeared to be a leading hub of Concierge Medicine.

“We recognized back in 2000 that health care was moving from personal to a more institutionalized form, and it was not what we wanted to do. We felt we needed to have time with our Patients, to have the excellence to have the time with Patients. Health care has been cutting reimbursement to doctors, which has forced doctors to see more Patients, so the time doctors have with their Patients has declined. The average time today with Patients for most doctors is only 10 minutes.”

Dr. John Blanchard of Premier Private Physicians,
Troy and Clarkston, Michigan

2008:     Concierge Physician of Orange County (CPOC)– a non-profit group of existing concierge physicians was founded.

2009:     Concierge Medicine Today, announces the formation of The Concierge Medicine Research Collective.

2009:     Concierge Medicine Today, reveals that concierge medical practices across the U.S. are thriving in a recession.

2009:     Procter & Gamble Acquired MDVIP in 2009 – No less a respected corporation than Procter & Gamble (NYSE: PG) has staked out a major presence in Concierge Medicine. In 2007, P&G acquired a 48% stake in MDVIP, a Concierge Medicine company that was formed in 2000. Then, in December 2009, Procter & Gamble acquired 100% ownership in MDVIP for an undisclosed sum.         This acquisition was reported by Dark Daily. (See “Boutique Medicine Venture Generates Marketing Intelligence for Procter & Gamble,” April 5, 2010.)

2010:     SIMPD reorganizes, expands its vision, and rebrands itself the American Academy of Private Physicians (AAPP).

2010:     Concierge Medicine Today, reveals the affordability of concierge medical and private medicine practices across the U.S. stating that over 62% of the programs offered to Patients cost less than $135/mo.

2010:     American Academy of Private Physicians (AAPP) forms first local chapter in Orange County, California called AAPP,OC (formerly CPOC)

2010:     According to a 2010 American Academy of Family Physicians survey, three percent of respondents practice in a cash-only, direct care, concierge, boutique, or retainer medical practice.

“When you think of Andy Griffith-style medicine, the doctor had a clinic in the local town.
It’d be strange for him to say, ‘What kind of insurance does Opie have?’”

Michael Tetreault, editor in chief, Concierge Medicine Today, Comstock’s Magazine, April 1, 2014

Dr. Chris Ewin, a Texas-based concierge advocate, bristles at the notion that he only serves the rich. He says many of his patients are unemployed or blue-collar workers and that, in some ways, his services can prove more affordable than other alternatives. “I have a patient who had a Vicodin addiction, and he spent $50 a day on his drug habit and he worked at Taco Bell,” he says. “Now his addiction is gone, and I only charge him $5 a day. I had someone come in — an immigrant — who mows lawns for a living. He has diabetes. He looked at me and said, ‘Wait, all I have to do is mow two lawns a month, and I can call the doctor all I want?’”

Concierge medicine may prove fiscally responsible as well. A study from MDVIP, a network of private physicians, found a 72-percent reduction in hospital admissions for concierge patients and a savings of more than $2,000 a year for each concierge patient. Doctors who engage in this practice can save the economy billions of dollars, according to Dr. Zwelling, by working with their patients on preventative care, staving off serious ailments and trips to the ER.

Is it worth it?

Since concierge medicine is not insurance (it wouldn’t cover a trip to the hospital) many patients combine it with a high-deductible plan. Tetreault suggests that consumers think of health insurance more like auto insurance or fire insurance; it should be used for emergencies, not the day-to-day. You wouldn’t use car insurance to change your oil, rotate the tires or buy wiper blades. In the best-case scenario, the sum of the concierge fee ($150/month, for example) plus the bare-bones premiums for a high-deductible plan ($110-ish, theoretically) would pencil out to less than $328 per month, or what the Department of Health and Human Services cites as the “average” cost of health care.

Comstock’s Magazine, April 1, 2014

2012:     December 2012 – Study Proves Dramatic Reduction in Hospitalizations & $300 Million Savings for MDVIP’s Personalized Healthcare Model

2013:     Three Year Analysis of Concierge and Direct Care Medicine Shows Encouraging Signs For Boosting Primary Care In U.S. Economy. Data collected from Concierge Medicine and DPC doctors show encouraging signs across the U.S. from December of 2009 to December of 2012.

2013:     New Data on Concierge Medicine Physician and DPC (DPC) Clinician Salaries and Released by Concierge Medicine Today. Data also looks at career satisfaction among Concierge/DPC physicians.

2013:     On August 2, 2013, the Dare Center, Seattle, WA, invited concierge physicians, hospital administrators and medical center executives from across the country to participate in a roundtable discussion. This inaugural event took place at the Washington Athletic Club in Seattle.

2013:     Family Physicians, Patients Embrace DPC … AAFP Recognizes Benefits, Creates DPC Policy

2013:     The DPC Trade Journal Launched. The DPC Journal works directly and indirectly with physicians, businesses and leaders, journalists and the media in the healthcare marketplace to help promote the distribution of news and information, policy initiatives and to reach out to physicians throughout the United States. www.DirectPrimaryCare.com.

2013:     First National Gathering Focused On DPC (DPC) Held In St. Louis: October 11-12, 2013.

2014: New Association Formed, American College of Private Physicians (ACPP): Group to Focus on Credentialing Doctors, Advocacy to Employers, Unions, Government and the like to benefit industry nationwide.

2014: P&G sells concierge medicine unit: P&G CEO — ‘Since returning as CEO last year, A.G. Lafley has said P&G will exit ventures that won’t help it grow.’

2014: MDVIP to be Acquired by Summit Partners — ‘MDVIP will continue to be run as a stand-alone company …’ [May 2, 2014]

2014: IRS asked to clarify HSA rules in letter: On June 17, 2014, Members of Congress wrote Commissioner of Internal Revenue John Koskinen asking for clarification on how the Internal Revenue Service (IRS) treats DPC Medical Homes with regard to Health Savings Accounts (HSAs). Senator Maria Cantwell (D-WA), who authored ACA Sec. 1301 (a) (3), allowing DPC practices to participate in health exchanges with Qualified Health Plans, took the lead on the letter and was joined by Senate Budget Committee Chairman Patty Murray (D-WA) and Rep. Jim McDermott, MD (D-WA), ranking member of the Ways and Means Subcommittee on Health. The three WA state lawmakers point out that The ACA rules on the Establishment of Exchanges and Qualified Health Plans Part I (CMS-9989-F) promulgated by HHS, clearly state that DPC is not health insurance, and that the law has its roots in a provision in WA state law (48.150RCW) defining DPC as a health benefit outside insurance. IRS Continues to give guidance that DPC plans are considered health plans under Sec. 223 (c) of the Internal Revenue Code (IRC), which prohibits HSA account holders with high deductible health plans from having a second “health plan.” DPC members have met with officials in the Department of the Treasury and continue to work with the administration and Congress to change the IRS definition so that DPC fees are qualified medical expenses under Sec. 213 (d) of the IRC and can be offered as a benefit complimenting Health Savings Accounts (HSAs) paired with high deducible health plans.

2014:     Second National Gathering Focused On DPC (DPC) Held In Wash., DC., June 2014.

2014: DPC United, a new DPC Physician Association, launched by Dr. Samir Qamar of MedLion announces that it will provide resources for DPC physicians and consumers. Dr. Josh Umbehr, a DPC United Board Member and founder of Kansas-based Atlas MD, says, “DPC has finally found traction with patients, physicians, employers, and insurance companies alike. However, DPC is still in its adolescence and it’s vital, now more than ever, that we have unity and clear leadership to guide the movement in the right direction.”

2014: Michigan DPC Bill Introduced as Louisiana Passes Law: On September 9, 2014, Michigan State Senator Patrick Colbeck (R-Canton) introduced S.B. 1033, a bill to amend the MI state insurance code to clarify that a DPC agreement is not subject to state insurance regulation. DPCC has provided resourced to Sen. Colbeck, and we are watching developments in state legislatures around the country as they prepare for the coming sessions.     This summer, Gov. Bobby Jindal (R-LA) signed similar legislation; Senate Bill No. 516, making Louisiana the latest state to create law to define DPC practices correctly outside the scope of insurance regulation.   Stay tuned for further updates as the legislative sessions kick off in this coming January.

2014:     DPCC member Iora health recently announced an exciting new partnership with Humana to treat Medicare Advantage patients in Washington and Arizona.   According to the Iora release, “The partnership launches Iora’s unique health care model in Arizona and Washington where Iora Health will open four new primary care practices – two in Phoenix and two in Seattle – under the Iora Primary Care brand. The primary care practices are designed exclusively for Humana’s Medicare Advantage members and will provide members access to affordable, quality care.”

2014: New Study Conducted by Optum and MDVIP Finds Personalized Preventive Care Significantly Reduces Healthcare Expenditures Among Medicare Advantage Beneficiaries

2014:     September 2014, American Academy of Private Physicians (AAPP) Course Corrects Physician Association, citing that the industry’s association is focusing on five key areas. Those include: legal compliance for doctors, innovative learning tracks at national meetings, physician networking, legislative and lobbying initiatives and staying up to date on new and emerging technologies..

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2014:   In October 2014, at the AAFP Assembly, a DPC Track is added to the agenda in Washington, D.C. It was called the “Health is Primary” initiative, a key business model for success touted by the AAFP (American Academy of Family Physicians).

2014: Washington State OIC issued DPC Outlook in Washington State. The OIC report insinuated that DPC is losing ground in terms of patients and that our monthly fees have been climbing (presumably as we head toward concierge medicine pricing).

2014: In reply, The DPC Journal assimilated a DPC leadership response to the Washington State OIC Report publishing for legislators, payers, physicians and the like: ‘DPC Leadership Response To Washington State OIC Report: ‘Outlook for DPC is bright throughout U.S.’

2014: The DPC Journal releases its industry-wide definition of DPC, the 5-Minute Guide: What Makes DPC Different From Concierge Medicine. Also releases 2-Year analysis of DPC marketplace data.

2015: Michigan State Sen. Pat Colbeck, R-Canton, believes the path to providing Michigan citizens with access to higher quality, lower cost health care has been cleared following Gov. Rick Snyder’s signature into law of Colbeck’s SB 1033 (Public Act 522 of 2014). The new law in Michigan assures physicians who adopt a direct primary care service business model that the administrative burden associated with insurance regulations will not interfere with their treatment of patients. Physicians who offer direct primary care services provide specified services for a monthly subscription fee that usually vary between $50 and $125 per month.

States with DPC Laws: Source: DPCare.org; Current as of January 22, 2015: Washington – 48-150 RCW; Utah – UT 31A-4-106.5; Oregon – ORS 735.500; West Virginia- WV-16-2J-1; Arizona – S.B. 1404; Louisiana – S.B. 516; Michigan – S.B. 1033

2014: Specialdocs, a pioneer and leading Concierge Medicine consulting firm says ‘Cardiology, Endocrinology, Pulmonology, Pediatrics and OB GYN Practices Can Benefit from Conversion to Concierge Model.’

2015: The United Hospital Fund Releases A Report, Convenient Care: Retail Clinics and Urgent Care Centers In New York State.

This report is relevant to Concierge Care and the DPC healthcare space because: Although based on a small sample from a single group practice in Minnesota, the study found that patients who visited retail clinics had lower total costs than matched patients who visited the acute care clinic (Rohrer, Angstman, and Bartel 2009). A more recent study of adult primary care patients, also in Minnesota, found that the odds of return visits for treatment of sinusitis were the same whether patients received care at a retail clinic or in a regular office visit (Rohrer, Angstman, and Garrison 2012).

Perhaps more telling, a larger study of spending patterns of CVS Caremark employees found a significantly lower total cost of care in the year following a first visit to a retail clinic compared to costs incurred by propensity score-matched individuals who received care in other settings. In total, retail clinic users spent $262 less than their counterparts, with savings stemming primarily from lower medical expenses at physicians’ offices ($77 savings) and reduced spending for hospital inpatient care ($121 savings). Retail clinic users also had 12 percent fewer emergency department visits than their counterparts (Sussman et al. 2013). The UHF saw nothing analogous on the impact of urgent care centers on total costs, but one study found that initial use of an urgent care center significantly reduced emergency department visits without increasing patient hospitalizations (Merritt, Naamon, and Morris 2000). Those results should be cautiously interpreted, however, given the study’s design limitations.

Conversely, in September 2014, the MDVIP model also was shown to have saved some $3.7 million in reduced medical utilization for the 2,300 MDVIP Medicare Advantage patients over two years. Savings were $86.68 per patient per month in year one, and $47.03 per patient per month in year two, compared with patients who did not join an MDVIP practice. The two-year study explored preventive healthcare’s ability to improve outcomes by creating a closer, personalized physician-patient relationship and focusing on disease prevention for Medicare Advantage.

2015: PinnacleCare, a leading health advisory firm, studied the impact of an expert second opinion on medical outcomes.

Researchers collected data on 1,000 cases over a three‐year period and found that almost 77 percent of medical interventions led to changes in diagnosis, treatment, and/or treating physician. PinnacleCare gathered data on patient outcomes from their interventions over a three‐year period. In a sampling of 1,000 cases with known outcomes from 2012‐2014, 41% resulted in transfer of care to a COE or expert provider with 34% resulting in a change in diagnosis, treatment, and/or course of care. A total of 18 patients were able to avoid unnecessary surgery as a result of a PinnacleCare intervention.

The data demonstrates the potential for health advisory services and second opinions to optimize outcomes and avoid needless expense. One of the persistent challenges in health care today is access to expert physicians. With consumer directed health care plans, the value of health advisory services becomes even more evident as consumers struggle with vetting appropriate providers and treatment options for their complex conditions while seeking timely access to the care that they need. PinnacleCare is committed to providing objective, concierge‐ level support with the expert resources and access needed to help consumers tackle these complex challenges.

ATLANTA, GA — JULY 31-AUG 1, 2015

2015: The DPC Journal to release its 2015 Annual Report and Market Trends Analyses In The Summer of 2015

2015: The DPC Journal releases physician insight gathered in a 2015 Industry Guidelines Proposal To Insurers and Legislators, Third Quarter 2015

“There are no insurance codes for ‘cure,’” says Dr. Garrison Bliss of Qliance, based in Seattle, WA.

By Lora-Marie Bernard

JUNE 1, 2015 – FOUR bills sponsored by Galveston County legislators, including one hailed as an innovative patient care model, were signed into law by state governor Greg Abbott early on Friday morning.

State representative Greg Bonnen, right, sponsored house bill 1945, which received praise from direct primary-care physicians who had been straddled under insurance-company and government bureaucracy. It has become law.
The law, dubbed “direct primary care”, is hailed as an innovative model for delivering and purchasing health-care services. It gives physicians and their patients an alternative to the third-party fee-for-service system.

In most instances, patients will pay a flat fee to have unlimited access to their doctor – in person and by phone or e-mail – for a full range of comprehensive primary-care services.

The law allows patients to pay frontline primary-care physicians a fixed monthly fee, like a gym membership.
The byzantine health-insurance programs used now pay physicians a certain amount for each test, diagnosis and procedure, which drives up cost and encourages overtreatment.

The law allows for the fixed fee to operate outside Texas’ insurance regulations. It receives support from Texas Academy Of Family Physicians and Texas Public Policy Foundation Center For Health Care Policy.

Senate b 455 authored by senator Brandon Creighton creates a three-panel judicial court to hear matters of statewide policy at the petition of the attorney general.

By 2020 the fiscal impact is expected to be $158,000 to the general-revenue fund. The law amends the state’s government code. Upon bill enactment, the attorney general will be able to petition the chief justice of the state’s supreme court to form a special three-judge court to hear certain cases.

Under the arrangement, the ad-hoc court will preside over lawsuits involving any claim challenging the finances and operations of the Texas public-school system and any claim involving the apportionment of districts for the Texas house of representatives, senate, congress, education board or state judicial districts.

Upon enactment, the bill will require consolidation of all related pending cases in another district or inferior court in Texas with the cause of action before the three-judge court.

Senator Larry Taylor’s SB 498 windstorm bill will allow more homes coverage under the Texas Windstorm Insurance Association.

Upon enactment, the bill will repeal a provision in the state’s insurance code that has prohibited TWIA from covering structures that did not meet local building codes in certain circumstances. The bill also removes the December 31 expiration date for other homes that don’t meet certain inspection requirements for TWIA coverage.

Finally, Taylor’s coastal-barrier-study-committee bill was also signed. It extends the joint interim committee, comprised of certain members of the senate and house of representatives, to study the feasibility and desirability of creating and maintaining a coastal barrier system.

Upon bill enactment, the committee will be empowered to report its findings and recommendation before December 1, 2016.

SOURCE: http://thepostnewspaper.net/tag/lora-marie-bernard/

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125 Inspirational Quotes for “DocPreneurs” and Concierge Care Industry Influencers

By Michael Tetreault, Editor-In-Chief, CMT

JULY 13, 2015 – Our mission is to communicate news and relevant educational information about the growing industry’s of concierge medicine and direct-pay, primary care. The two business models, now distinguished by their engagement with patients through transparent pricing and their disconnection or loose connection with insurance, are increasingly gaining the attention of consumers, employers and the media.

We (our trade publications and resources) serve as a public relations advocate and educational resource for the media, consumers (i.e. patients/prospective patients), curious physicians and industry practitioners. As we continue our public relations, news and keep developing more educational resources for these markets, we are at this time, pleased to have such great friends and colleagues in these evolving healthcare industry’s that work with us each day to help us educate, influence and guide outsiders about what these two very different healthcare delivery models are all about. At this time, we’d like to say ‘thank you’ to many of these industry-influencers and innovative physicians by highlighting some of their most popular quotes that have educate, persuade and guide others to a more satisfying career in medicine and helped thousands of our readers better understand how-to achieve better patient-physician outcomes in a difficult and at times, political economy.

NEW RELEASE! Text Book On Sale $129.95 Until June 1 (Reg. $189.95)

Disclaimer:

In no event shall the authors, publishers, distributors and its related, affiliated or subsidiary companies, be liable for any direct, indirect, special, incidental or consequential damages arising out of the use of the information herein.

The information is given with the understanding that the authors, publishers, distributors and its related, affiliated or subsidiary companies, are not engaging in or rendering legal, accounting or other professional advice. The authors, publishers, distributors and its related, affiliated or subsidiary companies, stress that since the details of an individual’s personal situation are fact-dependent, you should seek the additional services of a competent professional for legal, accounting and business advice for your individual practice.

It is your responsibility to evaluate the accuracy, completeness and usefulness of any opinions, advice, services or other information provided as it pertains to your practice. All information contained is distributed with the understanding that the authors, publishers, distributors and its related, affiliated or subsidiary companies, are not rendering legal, accounting or other professional advice or opinions on specific facts or matters, and accordingly assume no liability whatsoever in connection with its use. Consult your own legal or tax advisor with respect to your personal situation.

125 Inspirational Quotes From Doctors and Industry Influencers:

“In some respects, our well-heeled patient population and their inherent and unique needs is our specialty. We are fortunate to have interesting and distinguished patients; I cherish the relationships deeply,” said MD² founder Dr. Howard Maron.

C.J. Miles, MBAHCM, MSA Research Analyst at the AMAC Foundation writes ... ‘Any type of healthcare and health insurance-related issue is going to have legal and ethical issues that everyone will not agree on. The bottom line with concierge medicine is that it is quickly growing, presumably due to physicians and patients fed up with the current state of America’s healthcare system and where it could be going due to The Affordable Care Act. In fact, even with the growing number of concierge physicians, “the number of patients who are seeking concierge medical care in the past 24 months is far greater than the actual number of primary care and family practice concierge physicians available to service them” (CMT, 2014b, para. 22). Only time will tell how this will pan out, but for now, it looks like this is where our country is heading.’

“I became a concierge physician for the same reason I became a doctor – I want to help people. With this model, I can continue to help people even when traditional medicine changes significantly. When a patient has a “one more thing, Doctor…,” the last thing I want to do is to cut the patient off. Patients deserve to be involved in their care and receive the valuable service of planning for optimal health with the guidance of a family physician who is dedicated to the care of the patient.” ~Dr. Brian Nadolne, MD, Marietta, GA

Dr. Garrison Bliss, Qliance based in Seattle, WA.

“There are no insurance codes for ‘cure,’” says Dr. Garrison Bliss of Qliance, based in Seattle, WA.

“Some have said, ‘We’re in the Golden Age of technology but Dark Ages of delivery.’ We have resources but no time to utilize them to their highest & best use.” ~Dr Andrea Klemes, physician and MDVIP Medical Director, says to Medical Economics.

“The past year has been one of big changes. We are continuing to grow the practice in numbers, but we are also working to improve our quality.  There’s a lot to be done still! We added immunizations. At the present time we are doing adult immunizations, but are soon to move fully into pediatric immunizations. We continue to work on improving our quality, collecting information and reaching out to people who are needing care. Our goal is to continue to improve the quality of care from where we are now.” ~Rob Lamberts, MD, Augusta, GA

“Being a good physician is not just about knowing how to diagnose and treat disease. Honestly…that’s what books and studying is for. Being a good doctor entails earning the trust of your patients by being honest and forthcoming. It means knowing how to communicate effectively while still remaining sympathetic. It requires you, first and foremost, to be a human being. It honestly bothers me that young doctors feel like they have to “know everything” to be a great physician. Put down the damn book and go talk to your patient. Be a friggin human being. Be a friend. Its really that simple.” ~ Tiffany Sizemore-Ruiz, D.O. of Choice Physicians of South Florida.

“My vision is to cultivate a personal Patient – doctor relationship amidst a bustling urban community where impersonal professional relationships are the norm. Our practice strives to deliver quality medical care with an emphasis on evidence based medicine, open communication, easy accessibility, and a focus on customer service. These benefits can lead to an overall improvement in how healthcare is delivered and may ultimately improve outcomes.”  ~Dr. Edward Espinosa Buckhead Concierge Internal Medicine, Atlanta, GA

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

~“Running on the discount-insurance based hamster wheel is fatally destructive to doctor morale, patient care and the entire health system,” ~Dr. Thomas LaGrelius, Torrance, CALIF.

Dr. Anglyn, a concierge physician based in McDonough, GA.

“I’m 60 years old now and I had to figure out how I could continue to practice medicine, enjoy it and enjoy my life at the same time. This is something I decided to try and see if it works, and so far, it’s working,” said Dr. Derrell W. Anglyn, Jr. of Anglyn Family Medical Center in McDonough, GA

“The existing system is built around diagnosing and treating complex cases. It rewards expensive, invasive and complicated solutions. But patients don’t want to be complex cases,” Bliss says. She cites a famous study by the Institute of Medicine that estimated that 30% of each health care dollar is wasted in the U.S. While reformers struggle to “bend the curve” of rising costs by squeezing out the waste, “we just lop it off,” says Dr. Erika Bliss of Qliance.

“I have negotiated lower prices for certain tests and one-third of the cost for lab values from what they charge when they go through insurance companies. People will be spending less, and what they do spend will be spent on their own care instead of the care for two other people,” ~Dr. Donald F. Condon, a Spokane, WA-based direct primary care physician

“DPC allows me to have the time to care for patients rather than third party payers,” writes Dr. Eric Potter to The DPC Journal. Dr. Potter is a DPC physician at Sanctuary Medical Care which services the Middle Tennessee-Nashville region and Northeast Tennessee/Southwest Virginia. “Many more doctors turn over a new leaf with DPC.”

“If you are thinking about staying in your fee-for-service practice because DPC is shrinking, I suggest that you rethink that decision,” concludes Garrison. “This movement is gathering steam and you may not want to wait until everyone else makes the transition. All you have to lose is that massive headache from fee-for-service insurance billing with its inevitable corruption and destruction of the American health care system.” ~Internist Garrison Bliss, MD, a movement pioneer, sits on the board of the Direct Primary Care Coalition and is Founder and Chief Medical Officer of Seattle-based Qliance Medical Management

“According to industry analysis and national data summaries to be released in early 2015 by The Direct Primary Care Journal (The DPC Journal), the independent trade journal and news reporting publication observing and reporting on the national scope of the DPC industry, 90% of the interviews, surveys and DPC physician polling indicates that these practices are doing better financially than over one year ago, whereas, only 10% said they were doing worse nationwide.” ~Michael Tetreault, Editor-In-Chief, The DPC Journal, January 2015

“To be able to practice in this fashion, the patient roster is limited to a maximum of 600 patients. Each patient enjoys a 90- to 120-minute annual wellness visit similar to an executive style physical. This includes an exam, review and coaching for every patient. Follow up visits last 30 minutes. Under this calculation, doctors see eight to 12 patients a day.  Physicians benefit on multiple fronts. We enjoy financial stability in this uncertain time. We regain the freedom to practice the way we were trained.  Our time, tools and technology improve our abilities and make us even more valuable to our patients than we were before.  Partnering with a consultant or an organization who provides the resources to transition successfully to this model is critical particularly to ensure that your practice is compliant with all federal and state laws.  The model even improves national outcomes. Hospitalizations are down – by 79% in Medicare patients in one year and 72% in commercial patients. Readmission rates for common problems (Acute MI, CHF and pneumonia) are all under 2%, as compared to the national averages that range from 15% to 21%. Control of chronic conditions is better against all benchmarks and together, these saved the healthcare system over $300 million a year.  The patient benefits of a smaller size practice include same-day appointments, 24-hour availability, no waiting and a higher level of coordination of care. As a result, patient satisfaction tops 94%, with nine in 10 patients renewing annually. Moreover, physician satisfaction is over 95%.  With the right tools and model, we get to practice medicine the way we had been trained. We find the time to talk. We tease out buried details, identify issues, and become the hands-on healers we once were. For their part, patients become more accountable and see real results.” ~Dr. Andrea Klemes is the Chief Medical Officer of MDVIP. 

“In terms of Patient discounts, I try to negotiate discounted cash pricing  for my Patients whenever possible. Whether it is for blood testing, radiology,  or supplements/medications – I would rather they keep their money for my know-how/concierge fees. And a lot of times cash-pricing makes their life easier,  because they do not have to wonder or worry about whether or  not insurance will cover, etc.,” said Shira Miller, MD of Sherman Oaks, CA.

“While it is true, as the AP reported, that more and more patients are joining our practices nationwide, the number of patients is not just in the thousands already but in the millions. While it is true that concierge practice is exponentially on the rise, the current number of such doctors is not just in the hundreds but in the thousands, perhaps tens of thousands. Most are below the radar. They work quietly and are never counted by bureaucrats. ” ~  Thomas W. LaGrelius, MD, Daily Breeze, Calif.

“I suspect that employers will be the major reason for direct primary care membership/retainer-based practice growth in the coming years as they will essentially demand that level of service for their employees — and in so doing they will be reducing their company health care costs as a result of high quality primary care.  The exact number of physicians in DPC practices is unclear but an estimate by Concierge Medicine Today in early 2014 pegs the known number at about 4,000 with about 8,000 others doing so but without fanfare [so in total, approximately 12,000].  More doctors will convert once the general population understands the advantages and begins to ask for it. There are many good reasons for an individual to connect with a direct primary care physician: better quality care, a return to relationship medicine and often a significant cost savings despite the fee.” ~Dr. Stephen C. Schimpff is a quasi-retired internist, professor of medicine and public policy, former CEO of the University of Maryland Medical Center, senior advisor to Sage Growth Partners and is the author of The Future of Health-Care Delivery: Why It Must Change and How It Will Affect You

“This transition is getting harder and harder the closer I get [to my ‘all-in’ date],” states one DPC physician in a December 2014 interview with The DPC Journal. “There’s a lot of rejection from patients I’ve cared for and thought would join. It’s difficult to hear.”

“My overhead is a phone, an electronic medical record, internet access, rent for office space and one medical assistant. The clinic is built lean because we don’t have to deal with the insurance companies. The revenue that is generated through the monthly fee of $39 to $89 per month is where 
we get the money to pay our overhead and the doctor’s salary. We don’t need to make a profit on anything else.” ~Dr. Chris Larson is a family physician and can be reached at Austin Osteopathic Family Medicine.

“Not all direct primary care practices are concierge practices, and not all concierge practices are direct primary care practices. The terms are not synonymous, and even the basic fundamentals of either model do not overlap. The key to differentiation is whether or not a third party payer is involved. If not, then the model is a direct pay, or direct primary care model, no matter what the fees.” ~Samir Qamar is CEO, MedLion

“In both Concierge Care and DPC, people have inherent, not ascribed value. There’s no class order … no first class or second class, just people for whom doctors serve each day. They’ve built clinics for children, families and people who are sick … and it is these visioneering physicians who are drawing attention to the cost of healthcare across the country and designing ways for it to be available and affordable for anyone. But there are significant differences between the two categories or sectors in healthcare and it’s time we learn what they are.” ~Michael Tetreault, Editor, The DPC Journal

MD² CEO, Peter Hoedemaker

MD² CEO, Peter Hoedemaker says “Time is just so critical. By limiting their total number of families they have the ability to accompany patients to specialist visits, navigate their care through hospital stays and truly research every ache and pain. It’s like having a physician as part of your inner circle, as if they’re a member of your own family.”

“For the past 2 1/2 years, Dr. Rob Marsh, 58, [Middlebrook, VA] also has reached out to another medically neglected population: the truck drivers who spend their days on the interstate, many never home long enough to find a primary-care physician. At the TA Petro truck stop here, where Marsh opened his clinic in July 2012, drivers wander the stores killing time, looking at chrome for their trucks, hunting gear and fried strawberry-rhubarb pies in wax-paper packets. They can get an oil change, work out, take a shower. And now they can get a U.S. Department of Transportation-mandated physical, a flu shot or treatment for a sore back.” ~Written by Susan Svrluga, Jan. 19, 2015

“Direct Primary Care is a growing point of light in the darkness. I encourage those who are facing these high deductibles to look for Direct Primary Care which can save them money on doctor visits, urgent care visits, prescription costs, lab costs, and help avoid some ER visits. People will be surprised at the value they get for their healthcare dollar.” ~Dr. Eric Potter is a DPC physician at Sanctuary Medical Care

“Many of my patients, including those with insurance, save more money on these ancillary services (versus traditional prices) than they pay for their membership each month. And they get unlimited visits with their personal physician without copays.  With improving technology, scalable models and use of physician extenders, I believe DPC membership prices can and will continue to trend even lower. What level of DPC pricing would be low enough to deem it universally affordable? I rarely hear critics give an acceptable dollar figure. I recognize some people may struggle to afford even $10 per month, but does this sad reality invalidate the entire concept of DPC?” ~Dr. W. Ryan Neuhofel is a family physician and owner, NeuCare Family Medicine

Dr. Carrie Bordinko states “Gain some customer service experience– try a service industry job as these skills are not taught in med school. Moving into Concierge Medicine is not solely about providing excellent medical care without the restraints of insurance industry mandates. You have to also appreciate the lost art of customer service so long ago forgotten when visiting a healthcare institution. Many times my clients (notice I do not use the word “Patients”) have noted why they refer their friends to my practice. It is the attention to detail, always delivering exactly what is promised and then some, and keeping their unique needs positioned first with a flexibility to offer new programs or meet needs as quickly as they are identified. This is the cornerstone of customer service.”

“Direct Primary Care (DPC) is quickly becoming an important contributor to the transformation of our nation’s healthcare system.” ~ Dr. Erika Bliss, a Family Physician at Qliance Medical Group of WA and President/CEO of Qliance Medical Management Inc.

“I believe one of the keys to the continuing growth of Direct Primary Care (DPC) is integrating it within the employer sponsored health plans,” says Mason Reiner, CEO of R-Health, “which remain the primary means for paying for healthcare for the majority of Americans. However, for DPC to be a viable option for employers, there needs to be a critical mass of physicians offering it as an option in the employer’s geographic area. That is why we have focused over the past year on expanding our panel of affiliated physicians offering DPC in the Philadelphia region to nearly 100 (and growing), including Family Physicians, Internal Medicine Physicians and Pediatricians. The strong geographic coverage we have in the region has been a critical factor for the employer groups we have added as clients.”

“I didn’t become a doctor to bankrupt my patients …” ~Dr. Jordan Grumet

“Your basic family physicians will either be in concierge medicine or ‘God help you medicine.’” ~ Mike Huckabee said in his keynote speech Tuesday at the 2014 Benefits Selling Expo.

Dr. Chris Ewin of Fort Worth has run a concierge practice for nearly a decade. Ewin says, “I don’t have to go through a bean counter, insurance and the government. Therefore I get the cost down.”

“Business is tough,” says Dr. Chris Ewin of 121MD 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 something you love and pursue it. Follow this advice and you will set yourself up for an enjoyable future in medicine.”

“The outlook for DPC is much brighter throughout the U.S. than what one report may conclude,” says Michael Tetreault, The DPC Journal’s Editor-In-Chief. “No industry is full of sunshine and roses all the time and every industry needs data to benchmark success. The mission of DPC is to reduce the healthcare expenses on the individual while improving the physician-patient care service relationship — and it’s working. Data coming forth from a wide variety of industry sources in the past several months validates that it works. WeCare Clinics, Iora Health, Qliance Medical Management, MDVIP, and OneMedical have all reported reductions for total healthcare costs for their patients of 15% or more versus population norms*. However, more [DPC] doctors need to get out in front of their local employers, media and patients and talk about their own DPC data in relevant ways in the months ahead.”

“The claim that MDs who go into concierge and become millionaires is rarely true,” says Wayne Lipton of Concierge Choice in a commentary related to a Forbes article. “As someone who has been working with MDs for more than 30 years and talks to hundreds of doctors a year, I can tell you that most improve their economic and professional situations, and many do it just to survive. The goal of nearly all concierge physicians is to keep their practices independent and viable for their staff and patients. Additionally, for a physician with an established practice and a sound plan, financing a concierge practice conversion is a non-issue. If they align with a company that has experience with practice conversions, the costs to the practice are minimal. The risks are far greater if they attempt to build a concierge program from scratch, in which case they will more likely need a bankruptcy attorney. The other benefit to aligning with an experienced concierge care company is that it handles business development, allowing the physician and his staff to focus on doing what they do best—providing superior care to their patients.”

“The challenges of medical center concierge-style programs are very different than those experienced by concierge physicians in private practice.  All hospitals/medical centers have special perks and usually enhanced access to specialists for their donors and patrons, often a special number they can call.  Most have an informal “private banking” approach where there is no established fee, just an expected level of donation.   Despite the proliferation of individual concierge practices and now organized networks, concierge medicine programs INSIDE medical centers are quite unusual – there may be only 20-25 in the entire country.” ~ John Kirkpatrick, MD Seattle, WA

“The “don’ts” can be just as important as the “dos” when it comes to financing your concierge medicine practice or direct primary care clinic. Here are three pieces of advice on the subject. First, don’t invest all your time in trying to raise money. There have been so many good business concepts that go south because the person has committed everything to raising money and puts the concept on hold. Second, ideas are great but execution is everything. Don’t pursue financing if you don’t have a working concept. Lastly, don’t get hung up on the interest rate. If someone is offering you $50,000 at 12 percent and someone else is offering you $30,000 at 8 percent, the loan with the higher interest rate may be the way to go if that is the capital you need and this may prevent you from spending more than you need.” ~Michael Tetreault, Editor, Concierge Medicine Today

Garrison Bliss MD of Qliance and Chairman of the Direct Primary Care Coalition (DPCC), will hold its Washington, D.C. Fly-In March 4-6, 2014.

“The people who can pull this off are often people who already have long-term existing practices,” says Internist Garrison Bliss, MD, a movement pioneer, sits on the board of the Direct Primary Care Coalition and is Founder and Chief Medical Officer of Seattle-based Qliance Medical Management, the nation’s first direct primary care practice. “You need to have 10-15 years in practice, so you have an established base of patients who trust and like you. It also matters if you have people with chronic illnesses, or who are older, who just don’t want to go through the heartbreak and complexity of finding another doctor,” he continues. “And it depends on whether you really do provide extraordinary service already. The practices that do great work, have large patient populations, have been around for a long time, and have great reputations can often make this transition without difficulty.”

“It’s notable that growth in the DPC industry according to physician interviews across the U.S. throughout the past 12-24-months is largely supported by consumers motivated by price and transparency,” says Catherine Sykes, Publisher and Managing Director of The DPC Journal. “We also find that most DPC patients have [and pay for] insurance and they want to use it. The questions consumers have most when approached with the value proposition of DPC is how does it work with my insurance? and how much does this cost? It is important to communicate that DPC is not insurance. If a doctors program is not properly paired with high-deductible health plan policy or a wrap-around insurance product of some kind, those low price points [and monthly premiums] compete with a lot of other expenses — which we [The DPC Journal] have found represents 14% of patients throughout the country who use DPC earn less than $49,000 per year [combined annual HH income].”

Dr. Josh Umbehr of AtlasMD in Wichita, KS writes: “We routinely tell doctors that once you are up and running, the ideal overhead of a lean office is approximately 30% of $360,000 or roughly $120,000 per year (This average gross income is based on a doctor seeing 600 Patients at $50/mo. + expected tests/labs/prescriptions). Our overhead is based on ~$10,000 per month with staff, half going to rent/utilities, the other half allotted for miscellaneous expenses (office supplies, insurance, prescription cost, machine maintenance, and advertising). However, this expense is higher than what it needs to be because we have done much more advertising than your practice might actually need to operate at a profit.”

CAP has been working in the concierge physician space for quite some time. For the last 10 years CAP has been tracking the benefits, losses and business practices of concierge [and direct primary care] physicians. Starting in 2013, CAP started offering discounts to concierge physicians. CAP reviewed records of concierge physicians over the past 10 years and concierge physicians have fewer claims than regular physicians – they can get up to a 45% discount. “When they become concierge physicians their loss experience improves [by losses, CAP means medical liability claims],” says Cindy Belcher, Senior Vice President of Corporate Strategy and Business Development at CAP. “When one becomes a concierge physicians they [most likely] go from high volume practice to a low volume practice [have fewer patients]. We are aware that concierge physicians really do understand that their staff is vital to having satisfied patients. What makes us different from other carriers is our longevity in the marketplace and our Risk Management Institute — educational modules designed specifically for solo and small group office staff that provide a lot of information in a short period of time to help office staff/office management processes and reduce risk.”

“I made the switch many years ago into concierge medicine, or at least a form of it, and I couldn’t be happier. I can provide better care and build a strong relationship with my patients. It definitely can be challenging since I make myself available 24/7, however if you can develop a good support structure of other like-minded MDs you can maintain a successful business with less stress than a traditional practice.” ~Las Vegas Urgent Care Doctor, Facebook.com/24HourVegasDoctor

“Instead of viewing the status quo PCP model as the center of the universe. Maybe we should take some plays from the Retail Clinic playbook  before we become obsolete.” ~Direct-Pay Physician, Dr. Robert Nelson of Cumming, GA.

Here is what Dr. Timothy J. Murray of Solstice Health [Wisconsin] says about his private practice philosophy: “I believe every individual is unique and deserves the best, most affordable personal care possible.”

“It’s common for physicians, particularly those with long-standing patients, to significantly underestimate ‘ramp-up time’ – how long it takes to get new people enrolled,” said Helen Hadley, Founder and CEO of VantagePoint Healthcare Advisors in Hamden, CT.

“Insurance is the business of risk management via coverage for rare, expensive events. Nearly every industry in this country uses insurance in this manner — except health care. In health care, in addition to covering for rare events like surgeries and accidents, insurance is also used to cover common medical events as routinely encountered in primary care. Whenever insurance is used to cover common events, premiums go up due to claims being filed more frequently. Unfortunately, routine primary care is expensive in the current state, and society is forced to seek health insurance for this as well. This drives up health care costs across the board.  Direct Primary Care is able to make primary care relatively affordable, and thus eliminate the need for costly insurance. Health insurance is reserved for rare, expensive events, like in all other industries. By removing the need for insurance from primary care, which is a significant portion of health care, costs are driven down.” ~Samir Qamar, MD, MedLion, Founder

“Why does a successful transition need outside funding at all?” asks N. Scott Borden of www.DirectPayConsulting.com. “With the new wave of affordable DPC practices that almost anyone can afford, patients are not expecting first class facilities. They value physician access above scenic views. By educating patients about DPC friendly health insurance plans, more patients will join the new practice. Our goal is to make DPC affordable for both physicians and patients.”

According to The DPC Journal analysis and national data summaries to be released in January 2015, on average, 68% of fees inside most DPC practices cost between $25 to $85 a month. Approximately 45% of DPC Medical Offices average between $51-$85 per month. (Source: DPC Journal Industry Summary to be released in January 2015)

“I have decided to adopt a blended model of concierge medicine. My current patients may continue their medical care at our clinic, and a well-trained and capable nurse practitioner under my supervision will be seeing them. When necessary, I will be brought in with the nurse practitioner to discuss and formulate the medical management plan. Those patients who sign up for the concierge service be seen by me and get to enjoy extended appointment time during their visits, have access to me via telephone 24 hour/7 days a week, same day appointments, and get detailed in-depth yearly physical that focuses on disease prevention and wellness. My motto is “Preventive Healthcare, A Smart Approach to Healthy Life”. I believe that a healthy body and stable mind gives the opportunity to live an enjoyable and rewarding life.” ~Dr. Mary Thomas, Baton Rouge, LA

A little advice from DPC Patients … A large number of Consumers (I.e. current patients and prospective patients) who read our DPC Journal and books have some advice for DPC doctors … “If I’m paying any amount of a monthly subscription to see my doctor, you better know my name when I arrive and I sure shouldn’t have to tap on the glass when I walk-in. And please, move the phone to the back of the office so I don’t have to hear your staff calling in prescriptions or making specialist referral calls.”

Dr. John Blanchard

“We recognized back in 2000 that health care was moving from personal to a more institutionalized form, and it wasn’t what we wanted to do,” said Dr. John Blanchard of Premier Private Physicians, a concierge medicine practice with offices in Troy and Clarkston. “We felt we needed to have time with our patients, to have the excellence to have the time with patients. Health care has been cutting reimbursement to doctors, which has forced doctors to see more patients, so the time doctors have with their patients have declined. The average time today with patients for most doctors is only 10 minutes.”

“Don’t apologize to your patients for the business changes you’re making. This new process will help them. Inform them that this is a positive change and will help you maintain more secure patient-physician communication on a timely basis and offers them a much more affordable payment system with routine and convenient access to their doctor.” ~Mike Permenter

“We ask people to do really hard things: gluten and dairy free diets, mold remediation, massive amounts of targeted vitamin and mineral supplementation based on labs, calorie counting and exercise logs, meditation. When they are willing to do these things they usually get better. When they don’t, they are wasting our time and their money. We coach them with a lifestyle coach included in their membership, we follow up with them via snail mail cards, phone and email, and we do everything to give them tools for success but if they are not willing to make the changes, we tell them that the relationship is not working and they need to seek another doctor.” ~Dr. Ellie Campbell of Campbell Family Medicine in Cumming, GA

“Today, everyone has to have health insurance and for all of us, it’s now the law of the land under Affordable Care Act (ACA). The $100 or less price point is very important to DPC moving forward, a line in the sand. Anything more than that [$100/mo.] you’re probably not going to get federal subsidies, managed care operations and other people that would provide wrap-around insurance to pay much more than that, particularly because they’re probably not paying more than $40 for primary care right now.” says Jay Keese, DPCC (Direct Primary Care Coalition) lobbyist. “As we move forward into the employer and individual responsibility of the ACA kicking in, people will have to have insurance. You can’t simply say ‘I don’t need to be insured because I have a DPC doctor.’ That is not a viable policy option under the ACA moving forward. What is a viable option is to have a low-cost, DPC plan [i.e. less than $100/mo] with a high-deductible insurance or a wrap around plan that could make that level of insurance fit under confines of Section 1301 A3 under the ACA a viable product. This could work with employers, Medicaid, Medicare Advantage and private insurance. I think that’s where the model makes a lot of sense.”

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

“When doctors talk about concierge medicine being “the oldest, new form of medicine,” they’re not speaking figuratively—they are trying to reframe the identity of their practice and an over-worked industry.” ~Catherine Sykes, Author, Publisher, Speaker

“Concierge medicine is, at its most basic, a return to the age when doctors made house calls and were paid directly by the patients they treated.”~Paul Sisson, UT San Diego

“The concierge model is a great option for physicians seeking more control over their time, their professional lives, and their ability to care for patients. But it is by no means a financial cure-all. My life is so much better now.   It’s a big improvement. I’m enjoying the benefit of more time for my family and my kids, more time to do administrative stuff during the workday rather than after-hours. But it’s not like my financial woes suddenly disappeared, especially during the first year.” ~Marcela Dominquez, MD,  family physician in Mission Vejo, CA

“We’ve helped nearly 40 clinics launch in 2014 with more slated to enter DPC next year. We’ve heard from employers and insurance carriers in various states like Kansas and Pennsylvania. They are interested in how DPC can help them save money and lower premiums. Our own clinic [AtlasMD in Wichita, KS] has grown each month since we opened 4 years ago. We’ll may even have to have a waiting list for new patients soon or employ more physicians. The AAFP is openly supporting the direct care model and their DPC programs are very well received.  I think 2015 is the year that DPC will move ever closer to becoming the mainstream model for primary care physicians because its better for the patients, physicians, employers, insurance companies and the public.” ~Josh Umbehr, MD, Founder of AtlasMD

“Happier doctors usually have happier patients and tend to be more successful by many measures including reputation and patient retention, which leads usually to better financial reward in the end,” says Dr. Robert Nelson, MD, a Direct Primary Care Physician and Advocate for free-market healthcare. “If focus is on good care and good business practices, reward will follow.”

“This primary care business model [direct primary care] gives these type of providers the time to deliver more personalized care to their patients and pursue a comprehensive medical home approach,” said Norm Wu, CEO of Qliance Medical Management based in Seattle, Washington. “One in which the provider’s incentives are fully aligned with the patient’s incentives.”

Tiffany Sizemore-Ruiz, D.O. of Choice Physicians of South Florida

“I received a phone call the other day from a physician in Winter Park Florida,” says Tiffany Sizemore-Ruiz, D.O. of Choice Physicians of South Florida. “She was calling just to thank me for answering her questions about [this industry] a few months ago, and encouraging her to start her own practice. Today, her practice is thriving and she said that ‘she is happy with her schedule, her life, and being able to practice medicine that way it is meant to be practiced.’ I was so happy to hear that I helped a fellow physician and colleague, and even more happy to hear that she was doing so well!”

“This primary care business model [DPC] gives these types of providers the time to deliver more personalized care to their patients and pursue a comprehensive medical home approach,” said a spokesperson at Qliance Medical Management based in Seattle, Washington. “… In which the provider’s incentives are fully aligned with the patient’s incentives.”

“Direct Primary Care (DPC) is not insurance, does not strive to replace health insurance, nor is it adversarial to it. On the contrary, many DPC practices are eager to work with insurance carriers to co-create blended plans which integrate DPC with high-deductible insurance and ultimately correct the perverse incentives which are rife in the traditional fee-for-service system.” ~Dr. David Z. Tusek, Nextera Healthcare, Colorado

“I love my job! Unfortunately, very few family physicians and internists  can say that. To save our profession from extinction given the exodus of medical students to subspecialties, we must offer a physician in a primary care specialty the ability to love their job.”  ~Charles Whitney, M.D. Washington Crossing, PA | Revolutionary Health Services

“Every visit is on time; you are not waiting. If you are ill and come in the morning, you are always able to be seen the same day. And I don’t mean ‘squeezed in.’ I mean seen in a relaxing comfortable visit. You are not seen for five minutes with a practitioner saying, ‘Tell me your problem,’” but is rushed because five more people are waiting. When patients call at 10 o’clock on a Saturday night, they get their doctor on his cell phone — not an answering service, not a doctor who is covering for the weekend. It is their own doctor. He knows them. He doesn’t have to go back to a computer and say, ‘I see here that three years ago, you had pneumonia and we prescribed Cipro.’  When you have that number of patients,” says Roberta Greenspan of Specialdocs. ”You know your patients.”

“The biggest reason he was able to transition so quickly is because he is a very popular physician with a large number of loyal Patients.” ~Scott Borden, Consultant, HSA Advisor, Consultant

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

“The anti-aging and medical home delivery model fits well inside a concierge medicine [and direct care] practice. 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.” ~Michael Tetreault, Editor, CMT, The DPC Journal

“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.”

“Because this is such an innovative model, and because of the high level of disruption that DPC entails, we would expect the first practices out there to have the hardest time as they get a feel for the new landscape and encounter the first, big problems.  What we are seeing now is that our customers who are the second and third waves of DPC practices are becoming more comfortable with the model and also more savvy partnering with employers to secure large groups of patients with longer contracts. This makes them less susceptible to consumer whims.  Finally, I do not know the politics of the situation, but you always have to understand the motives of the government agency putting these reports out. There are a lot of stakeholders who are very comfortable with the status quo. And those people likely have a lot more money and influence than individual DPC doctors.” ~ Blaine W. Lindsey, JD, MPH, CEO of GetHealthy, Inc., a technology operator in the DPC industry providing an evidence-based health and wellness platform that develops unique solutions and services to the DPC marketplace.

“There is no substitute for a doctor who one knows and trusts, and who acts exclusively on behalf of one’s own needs and interests. Fortunately, many people can have this type of care. For people who are enrolled in high deductible insurance plans, they can apply their annual retainer fee toward their deductible. For people who have flexible spending accounts, they can use the money from that account toward the annual retainer fee. My fee is less than the cost of a daily sandwich lunch or a monthly cable contract. I think if more of the public were aware of how affordable this care can be, more people would be clamoring for it. Access 24/7, prompt appointments, same or next day sick visits, unhurried visits, health care coaching, continuity and advocacy. What is there not to recommend this model of care?” ~Alexa Faraday, M.D., Greater Baltimore Medical Center, Baltimore, MD

“With the right planning, a hybrid can be converted to a Direct Primary Care model,” says Mike Permenter, industry expert and consultant to physicians. “I predict there will be many hybrids converting to a Direct [Primary] Care model in the future.”

Marcy Zwelling-Aamot, M.D. is a respected member of the California medical community and a prominent voice in the crusade to improve the broken healthcare system. Dr. Marcy Zwelling is part of a growing trend, physicians who work on a cash only basis. Her Los Alamitos concierge practice is off the insurance grid in an effort to combat regulators and government involvement.

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

“We keep all unearned membership fees in an escrow account, so if they have pre-paid, they are refunded for any unused days of service. If the relationship is not working, dismiss the patient. Use proper dismissal letters, adequate notice and names of other docs in the community, but don’t spin your wheels on folks who don’t value you.” ~Dr. Ellie Campbell of Campbell Family Medicine in Cumming, GA

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

“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.”

“The first thing to decide is whether you want to continue billing insurance,” says Mike Permenter, long-time industry consultant and physician advisor. “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. Most doctors currently practicing concierge medicine as a career choice fall into one of two intelligence-gathering categories when they first opened. First, they used a franchise concierge company to help them with the details or they opted to do it themselves and surround themselves with a local team that would provide counsel in starting this practice model. I perform a thorough analysis of the practice and determine areas where expenses will be reduced. After a survey of the physicians patients, we conduct a 12-16 week conversion. Our fees are collected during the transition only. Once a successful conversion has been completed, we help train the physician staff to provide membership services. If customer service is maintained, we know the practice will continue growing without a need for further services.” ~Mike Permenter, long-time industry consultant and physician advisor.

Dr. James Pinckney, II of Diamond Physicians based in Dallas, TX writes … “Preventative medicine is now our top priority. The upfront costs associated with genetic testing, inflammatory testing, etc. pales in comparison to the cost of treating chronic disease. Stakeholders are realizing that it is more important to invest in technologies that detect disease at an earlier stage when it is less challenging to treat effectively. Spending capital now on tailored treatment plans for individuals will save billions in the future.”

Dr. Knope is a board-certified internist, speaker, author and sports medicine expert.

“Young doctors are refusing to go into primary care medicine,” notes Dr. Steven Knope of Tucson, Arizona in his writings about The Myths of Concierge Medicine. “This is due to the fact that practicing primary care medicine in our current broken system, seeing 30 patients per day, making only one-third to one-fourth of what a specialist makes, have created an understandable shortage of doctors willing to practice primary care medicine. Over the long run, the only way to increase the number of qualified primary care doctors is to make the profession more attractive, both from a professional and financial perspective. It is our current broken system that has caused a shortage of primary care doctors; and if we stay on the old path, it will only get worse.”

“Doctors carrying a medical bag and coming into a patient’s home was standard into the late 1960s. Look at The Andy Griffith Show. That’s what our grandparents did. Medicine became government regulated and that started to end. It came in for a reason — there did need to be some amount of administration. But now regulation and administrative tasks have frustrated doctors. Be intentional with your excellence, don’t be normal.”~Michael Tetreault, Editor, Author, Speaker, Concierge Medicine Today

“If things are going well, not need to worry. In 18 months, I have only had one patient leave after 3 months and then she re-joined 3 months later when her finances improved. I have not even come close to firing anyone; nor have I had any card denials on recurring payments.” ~Dr. Robert Nelson, Cumming, GA

“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].”

“The language of strategy rather than the delivery of platitudes is more informative and effective with physicians when talking to them about how concierge medicine will benefit their practice, patients and bottom-line. For consultants to sail and compete in the concierge medicine ocean over the next two to four years, the company that will repeatedly give its physician clients something that feels refreshingly new and solves their problems in a way no existing consultant has done will exit the red ocean and begin trawling in blue waters.” ~Michael Tetreault, Editor-in-Chief, Concierge Medicine Today and The DPC Journal

“On my side, it is not really any different than terminating in an insurance environment – actually easier in that I have no contract with the insurance company which often dictate terms of dismissal. STEP ONE: The standard is a certified letter indicating the patient needs to find another doctor within a specified period (30, 60 or 90 days usually), which also outlines what services will and will not be provided during that interval of transition. STEP TWO: Make sure they have enough medication to hold them over until the end of the transition period. STEP THREE: Stop taking their money.” ~Dr. Robert Nelson, Cumming, GA

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

“Slow and steady growth is ideal in this type of practice because it allows you to offer patients a personalized experience,” says Joel Bessmer, MD, FACP of Omaha, Nebraska’s Members.MD. “I’ve found that the word-of-mouth aspect (vs. a billboard advertising approach) has been the most consistent factor in building my practice.  I consistently have patients recommending their family members and friends. Getting word of mouth referrals based on high quality care, staff service and patient satisfaction has been a much more effective tool than traditional marketing. And the slow and steady approach ensures that staff can keep up with new patients, as opposed to getting a rush of new caseloads that would be more difficult to manage all at once.”

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

“With concierge medicine, the impact for patients and physicians is phenomenal,” says Richard Doughty, CEO in a recent article on Baton Rouge’s The Advocate. The article states … ‘In a typical concierge practice, the management firm gets one-third of the membership fees patients pay, Doughty said. Most contracts are for five years, and the fee structure remains the same over the life of the contract. If a practice has 600 members and the members pay $1,500 a year, the management firm’s share is $300,000 a year. Over a five-year contract, that adds up to $1.5 million. But most of the heavy lifting is done during the first 18 months of moving the practice to the concierge model, Doughty said. After that, if the management firm has done a good job, there’s not nearly as much work required.In a typical concierge practice, the management firm gets one-third of the membership fees patients pay, Doughty said. Most contracts are for five years, and the fee structure remains the same over the life of the contract. If a practice has 600 members and the members pay $1,500 a year, the management firm’s share is $300,000 a year. Over a five-year contract, that adds up to $1.5 million. But most of the heavy lifting is done during the first 18 months of moving the practice to the concierge model, Doughty said. After that, if the management firm has done a good job, there’s not nearly as much work required.’

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

“The road was much more difficult than I expected, but also much more satisfying. I spent much of my time learning what doesn’t work, but in the end learned that most good ideas grow out of the remains of a hundred bad ones that didn’t survive.” ~Rob Lamberts, MD, Augusta, GA

“I remember when I started my direct-access, home-based primary care practice (www.MetroMedicalDirect.com) in 2009,” says Raymond Zakhari, NP and CEO of Metro Medical Direct. “Patients were skeptical and reluctant because of how accessible and convenient the service was. They expected to be kept waiting on hold. Some seemed puzzled by the fact that when they called I answered the phone and knew who they were. One patient even inquired as to how come they only had one form to fill out. Direct-access primary care patients who have been referred post hospital discharge, have not been readmitted to the hospital in the last 4 years because I can see them without delay or red tape. In NYC, despite the high number of physicians per patient, particularly on the upper east side of Manhattan, direct-access primary care can still be a viable practice solution for patients and providers. It helps patients cut through the red tape that has become expected in accessing health care.”

“Some doctors would say this is easy, especially the successful ones,” says Matthew Priddy, MD, who operates in a thriving concierge medicine practice based in Indianapolis, IN. “But there are also doctors who failed, gave up, and went back and worked for hospitals. Those folks are out there too, and they would probably tell you that it’s impossible. It can be a little bit of a selection bias when you talk to the doctors who are oft-quoted in the media or who are involved in national organizations. But that is more the exception than the norm.”

“There are downsides to a hybrid practice,” said Michael Tetreault in an interview with Medscape in late 2014. “Number one is that a lot of patients will get into a wait-and-see mode. They will say, ‘I can still see my doctor. I’m just going to file through insurance. I might have to wait longer to get an appointment, but that’s fine.’”

“Do not be afraid to try something new. If we do not try to do things differently, primary care will continue to languish and we will have a harder and harder time attracting people into the field and ensuring that primary care survives for us, our children, and our grandchildren.  You do not have to do it all at once, though – a lot of practices are trying to develop a hybrid model, gradually moving more and more of their Patients to the DPC model.  It is challenging to do this if you are caring for large numbers of Patients, but practices are finding ways to do it.” ~Dr. Erika Bliss of Qliance.

Dr. Alexa Faraday – Office: 855.372.5392

“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.” ~Dr. Alexa Faraday

“The biggest mistake in my opinion is charging too low,” says Mike Permenter, industry consultant. “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.”

Neil Chesanow with Medscape writes … Only a fraction of your traditional patients will typically join you in a retainer medicine practice, experts caution. It’s not unusual for a traditional primary care practice with 5000 patients to have trouble attracting the 300-600 patients needed for a full concierge practice, or the 1000 or so patients needed for a full direct primary care practice. Doctors who open with half-full practices court financial collapse.  “Unrealistic expectations are what I hear in many doctors’ comments,” Tetreault reports. “Doctors set themselves up for hard times over the next 12-24 months by underestimating the market. We’ve seen physicians fail because of lack of capital. They think, ‘My patients love me. There’s no way they’re not going to continue to use me after I transition. I’m affordable. How can they not choose this? This is great!’”  One family doctor, who left a primary care group practice to open a solo concierge practice in 2003 — without a single patient going in (a restrictive covenant prevented him from taking practice patients with him) — told Medscape that he wiped out his entire savings keeping the practice afloat, and that he finally earned $100,000 in 2012, 9 years after he left traditional practice.

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

“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.”

“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.”

“We believe that Direct Primary Care (DPC) Models reaffirm the central role of the physician-patient relationship which lies at the heart of an effective health care delivery system,” said Laurence Bauer, MSW, Med, CEO of FMEC. “Direct Primary Care incentivizes the physician to respond effectively to the needs of his/her patients.”

“We try to make it fit into your lifestyle instead of disrupt it,” said Iowa physician, Dr. Ingram. “You call the office, you call my cellphone, you text me, email me and we set something up.”

Neil Chesanow with Medscape writes … Most concierge and some direct primary care practices promise patients 24/7 cell phone access to their physicians. Is it tantamount to being on call 24/7 as a lifestyle?  “The question I’m most often asked in regard to patients is: Does private medicine attract the type of needy patients who feel like they’re paying money so they can boss you around?” says Dr. Matthew Priddy. “Will they call me in the middle of the night because they have a hangnail? Do they demand that you do unreasonable things, like get them an MRI in 5 minutes?”  The answer, he says, is generally no.  In fact, this was Priddy’s biggest fear before he made the transition: that patients who paid a fee to be a member of the practice would act like prima donnas. “I didn’t want to be someone’s butler,” he says. “I was worried that there would be a sense of entitlement among our patients — that we’re paying you X amount of money a year, and if I want that antibiotic, you’re going to give it to me. And if I want those pain meds, you’re going to write those scripts for me. Or I’ll quit.  “We absolutely have people who sign up with that attitude, and we tell them they can quit,” he says. “I’m not going to write you a script for Vicodin® just because you write me a check. That’s not how it works.”  But demanding patients have been the exception, not the rule. “Ninety-five percent of our patients are fantastic,” Priddy says. “Five percent aren’t. That’s just life.”

“The conversion process is not an easy one,” said Jeffrey S. Gorodetsky, M.D. of Stuart, FL. “My staff and I are cognizant of the fact that we must consistently communicate the benefits of this choice in care, with the challenge to increase my [memberships] numbers and convert other patients.”

“Patients value speed and low cost most of all for most minor complaints,” notes Dr. Ellie Campbell of Cumming, GA. “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.”

“Becoming a concierge physician is an opportunity to give my patients the special personal touch that they like, need, and desire! The concierge practice will afford me the opportunity to engage my patients about all aspects of their healthcare: preventative, social, family, fitness & wellness, as well as nutrition, and all the while spending a good deal of quality time with them. For physicians, concierge practice is our chance to practice medicine the way it was before insurance companies started dictating healthcare. I am very excited about the opportunity for my patients as well as myself.” ~Dr. Eddie Richardson, Eatonton, GA

Dr. David Tusek, MD

“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.”

“Typically, there’s a period after start-up when income goes way down as patients decide whether to stay,” said Allison McCarthy, a senior consultant in the northeast office of Corporate Health Group, a national consulting firm. “It often takes a good two years to bring the patient level up to where it should be.” At that point, physicians do better financially. In the interim, they are likely to struggle, particularly with those large start-up costs, which range from $50,000 to over $300,000.

“As an integrative physician, my goal is to help people focus on health and wellness. I prefer to teach patients self-help skills and provide them tools to transform their life rather than prescribing them medication. If I could, I’d love to hand a patient a pair of running shoes and a tasty plate of vegetables instead of constantly scribbling out prescriptions. Pills are not always the answer. Your body often has the ability to heal and take care of itself if you are willing to make the lifestyle changes.” ~Dr. Jameelah Gater, MD

“Consumers buy what they understand. It has taken years for the industry to educate consumers about the basic components of concierge medicine. Build upon that existing knowledge base and take the time to further educate them on how your practice uses labs, technology and other tools that will elevate their health.” ~Sonja Horner, President at Private Medical Partners, CMT Contributor

“Becoming a concierge physician opens up that time to practice medicine this way. It truly permits me to become a partner in my patient’s lives. In the past year, I’ve started to explore the science of anti-aging medicine. I have wanted to have a better understanding of why some patients age more quickly than others. I’m excited about the cutting edge knowledge and products that I am able to bring back to my practice.” ~Dr. William Adcox, Peachtree City, GA

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

“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.”

“Direct Primary Care (DPC) allows doctors to provide better care, more often, at a fraction of the cost to patients, while increasing their income and offering greater satisfaction … why would anyone stay in a broken insurance-based model?” ~Doug Nunamaker, M.D.

C.J. Miles, MBAHCM, MSA Research Analyst at the AMAC Foundation writes … ‘The four states with a very large lead in the number of concierge physicians in practices, as well as consumers seeking their care, are Florida, California, Pennsylvania, and Virginia. In these areas, the franchise concierge fees are increasing and the independent concierge doctor fees are decreasing due to competition (Tetreault, 2014). However, the number of patients seeking concierge medicine far outweigh the number of available physicians, especially in rural areas. According to Concierge Medicine Today (CMT, 2014b), states with high demand but very few concierge physicians include Hawaii, Idaho, Iowa, Mississippi, Maine, New Hampshire, South Dakota, North Dakota, Louisiana, and Alaska. The most common specialty for these types of practices is obviously primary care with family medicine a close second. The next top two specialties are cardiology and pediatrics (CMT, 2014a). In 2011, specialists were growing in numbers in concierge medicine, which include general surgery, psychiatry, spine surgery, gynecology, dentistry, addiction medicine, dermatology, oncology, and the cardiology and pediatric specialties already mentioned. Specialists offer the same increased access and patient attention as the primary care concierge doctors and tend to have patients with chronic conditions. The main difference is that the primary care concierge physicians tend to have a patient load of 300-750, whereas the specialists tend to have a patient load of 150-300 (CMT, 2014b).’

“Patients are educated, possibly more than ever, as a result of the changes to our healthcare system,” adds Richard Doughty, CEO of Cypress Concierge Medicine based in Louisiana. “Patients are looking for answers and options and taking more initiative in their overall health. Following their doctor into concierge medicine for many patients is exactly the vehicle that meets their needs. In addition, knowing others who have benefitted from that relationship with their concierge doctor confirms the value as their doctor makes this change.”

“You will never regret being a doctor IF you work only for patients. But if you don’t work only for patients, you will regret your decision in the end.” ~Dr. Thomas LaGrelius, California

“My real joy is spending time with patients and trying to help them improve their health. In many practices, the high volume of patients that must be seen reduces the time clinicians can spend with each patient. Our model increases the time available for each patient encounter. I spend about 30 minutes with a patient during our average visit. This is the main reason that most patients give for returning to our practice. People are willing to spend money on something they value, and they value time with the doctor.” ~ Dr. Brian Forrest, Apex, NC

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

“The ‘concierge’ term gets people to imply high value, which is good. We want them to feel like they’re coming to a high-quality place,” says Dr. Josh Umbehr of Atlas MD in Wichita, KS. “But it also gets them to assume high cost. That’s OK, though, because I can show you my costs are affordable.”

“This new practice has been truly liberating. I am working harder than ever getting it of the ground but my time with patients is wonderful. And I get to be creative again in how I develop the practice, something that was lost from my previous office.” ~Dr. Alicia Cunningham, Vermont

“Personalized medicine provides the best possible solution to navigating today’s complex healthcare landscape,” says Dr. Sandhoo. “The gift of more time to spend with patients is of incalculable value, enabling me to comprehensively address multiple, complex conditions and focus on prevention and wellness. It also allows me to be my patients’ advocate, whenever and wherever needed…at the office or hospital, during regular hours, or on my cell phone in the middle of the night.”

“Concierge medicine must be treated seriously by physicians and patients alike because it is a concept that is here to stay. Paying a set annual fee for “special services” may appear to some to focus on money and greed but to others it may be redirecting the focus of medicine back to preventing disease and seeking wellness. If concierge physicians are successful in preventing illness and keeping patients healthier then it is in the best interest of patients, physicians and society as a whole.” ~Peter A. Clark SJ, PhD Professor of Medical Ethics and Director, Institute of Catholic Bioethics, Saint Joseph’s University

Roy Ramthun of HSA Consulting Services based in Washington, DC, says “The IRS does not generally consider the monthly payment a ‘qualified medical expense.’ However, we do believe that they will accept reimbursements from an HSA for actual services provided by your practice physicians if you can produce something for the patient that they can use to document the services they received (including any procedure/treatment codes), the date they were provided (and by whom), and the amount you would charge the patient for the services provided.  I know your practice is not set up that way, but the patient needs something that tells them the fair market value of the services they received for tax-free reimbursement from their HSA.”

“Direct Primary Care can complement High Deductible Health Plans (HDHPs), taking care of the primary care component of health care,” adds Dr. Samir Qamar, CEO and Founder of MedLion. “HDHPs, or major medical plans, can take care of catastrophes. This combination can result in significant savings overall. Health Savings Accounts (HSAs), when structured properly with Direct Primary Care plans, can also be used. The key is working with a Direct Primary Care company, like MedLion, that has unquestionable legal and insurance knowledge.”

“In selecting only a small population of clients and providing dedicated counseling sessions, sometimes as often as weekly, allows clients to actively participate in their care plan and to move goals forward at a real-time pace. This enables all of us to realize that healthcare can be a positive experience.” ~Dr. Carrie Bordinko of Consolaré Primary Care in Paradise Valley, AZ

“The distinctions between concierge medicine, private medicine, and direct primary care may be ultimately meaningless, since some doctors call themselves whatever they feel sounds better, and there are so many practice variations, many overlapping, that it often isn’t clear which is which.” ~Neil Chesanow, Medscape/WebMD, May 2014

“It’s a different type of busy … 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.” ~MDVIP-Affiliated Physician in FL

“Since 2005, I have been providing comprehensive primary care to families and individuals of all ages in San Francisco. Through mutual respect, careful listening, and collaborative communication, I have built strong long-term relationships with patients and health care providers in the community,” says Dr. Bhandari.

Related to HSAs and Membership Medicine fees … “Most of these arrangements do not meet the criteria to be considered qualified health care expenses under the Code. If you want to submit such expenses under your employer’s FSA plan, expect to be asked to back up the reimbursement claims with documentation that medical services were rendered.” ~Janet Palcko is a partner at NEO Administration Company, a benefits consulting firm that provides FSA, HRA, HSA and COBRA administration and compliance services

BONUS CONTRIBUTIONS!

“Although there are differences in the models for DPC and concierge care, there are similarities as well…most notably, the ultimate benefit for both patients and physicians: having quality time for offering consistent care and developing strong relationships with patients that are at the heart of these primary care delivery models.”  ~Rob Lewis Specialdocs Consultants, Inc.

“I believe that is the way medical care is supposed to be.  This kind of unfettered direct engagement between doctor and Patient can never be achieved in a system of third-party networks where the doctor is a “provider” of services paid by someone else and the Patient is relegated to a passive ‘network subscriber’.” ~Direct-Pay Physician, Dr. Robert Nelson of Cumming, GA. “Primary Care needs to become relevant again by servicing patients directly and being available and offering the kinds of broad services that family doctors used to offer. Only returning to broad-based primary care that is affordable (DPC and similar), getting back in the hospitals and being available to keep our patients out of the ER and urgent care will solve this supply-demand imbalance. This kind of approach will also drive more medical students back into primary care and restore the balance back to the ratios before managed care.”

“I use PayPal merchant account to process cards.” ~Dr. Marina Gafanovich MD, New York, NY

“One major reason for the failure of many so-called wellness programs is that an outside company is hired instead of having a program structured with local physicians.” says Mike Permenter, industry consultant

“The #1 rule in successfully designing your new membership based practice is to start with defining the services you would like to provide to produce the patient outcomes you hope to achieve, then pick the model that best fits your “clock”, your marketplace and equally important covers your overhead.” ~Sonja Horner, Healthcare Business Innovator | Outcomes Advocate, CMT Contributor

“Direct Primary Care or even Concierge Medicine are not just for the rich any more. Economic models which cut out the administrative costs of insurance make this level of care affordable for your average American. For an investment of a few dollars per day, patients can buy a measure of security knowing that their physician can focus on their health rather than the well-being of 20 different insurance companies. One of the goals behind my practice, Sanctuary Medical Care and Consulting, is this mission to middle America. Old fashioned house calls combine with mobile technology while being enveloped in extended visits can rebuild the physician-patient relationship and restore some hope in the medical system.”  ~Eric Potter MD Sanctuary Medical Care

“If you possess excellent communication skills, around the clock dedication and the desire to promote optimal health in pursuit of excellent medicine, then concierge medicine is for you. It’s the best career choice I’ve ever made.” ~Brian Thornburg, MSM, DO, PA, FAAP Innovative Pediatrics

“Care is about access and communication, not doing stuff necessarily. I am not sure if there is any way to change this, but it seems that any visits my patients have (or communication with me) is something they get in exchange for my monthly fee.” ~Dr. Robert Lamberts, Augusta, GA

“Be careful with those that say HIPAA does not apply to cash practices. It is really the HITECH part of HIPAA that you need to be pay attention to. There is also Federal and State aspects of HIPAA. While the insurers are not going to be breathing down your neck about compliance issues, you are still in the “supply chain” as it were when it comes to handling records. It is just as easy to be in compliance really without spending any more. There are a variety of secure and hipaa compliant apps and video platforms out there.” ~Dr. Robert Nelson, Cumming, GA, MyDocPPS

“We offer either a membership or typical fee-for-service direct payment model to our patients. All of our medical services meet the requirements of IRS Publication 502, so it is a no-brainer for our fee-for-service patients to justify the use of their HRA/HSA/FSA for our services. (We also provide a standard CPT code on our statement for them.) We then list our standard fees (used for our fee-for-service patients) as “value of service” on statements for our membership patients when they request justification for HRA/FSA purposes for the cost of their membership. It is a little tedious and frustrating, but until the IRS determines that DPC membership costs are “qualified medical expenses” in and of themselves, I see no other way to help our patients justify their medical expenses to their health plan administrators.” ~Bruce Jung, DocShoppe

“The heart of good medicine is care,” said Dr. Rebecca Plute, a concierge doctor at Paragon Personal Health Care in Canonsburg, PA. “I think the key to concierge medicine is the personal relationship between doctor and patient.”

“As the managing partner at the Surgery Center of Oklahoma we have seen a boom resulting from our online pricing. Beware, those who reject a more price transparent model..the market is beginning to judge harshly and this will only intensify as more embrace the same market discipline that every other industry must endure.” writes G. Keith Smith, M.D. to The DPC Journal at the Surgery Center of Oklahoma

References

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Contact: Michael Tetreault, Editor/Author: Tel: 770-455-1650 ext 151 | editor@conciergemedicinetoday.com

Georgia Conference on Concierge Medicine Announces Congressman Tom Price, MD as Keynote Speaker

Atlanta plays host to Concierge Medicine leadership.

ALPHARETTA, GA | JUNE 9, 2015 – U.S. Congressman Tom Price, MD, Member of the Congressional Healthcare Caucus, Chairman of the House Committee on the Budget and Member of the House Committee on Ways and Means, will be the keynote speaker at the Concierge Medicine Assembly in Atlanta, GA August 1st, 2015. Dr. Price will address “The Current State of Healthcare and Emerging Entrepreneurial Forms of Healthcare Delivery in America.” Other nationally recognized speakers include Clint Flanagan, MD, Co-Founder of Nextera Healthcare in Colorado, Roberta Greenspan, Founder of Specialdocs Consultants in Chicago, IL, Editor and bestselling Author Michael Tetreault, Physician Coach Robert Nelson, MD and many others. They are among the more than a dozen accomplished physicians, industry professionals and speakers who will address the Conference. Additional 2015 speakers will be announced in the coming weeks prior to the Atlanta event July 31-August 1, 2015.

The Conference will be hosted at the Westin Peachtree Plaza in Atlanta on Friday, July 31 – August 1, 2015. The annual Conference is Georgia’s largest event for Concierge Medicine, attracting specialty physicians, general internists, family medical practitioners, nurse practitioners, physician assistants, practice management advisors, law firms and others who come together for 2 days of relational learning, education, networking, professional development and personal growth opportunities.

U.S. Congressman Tom Price, MD, Member of the Congressional Healthcare Caucus, Chairman of the House Committee on the Budget and Member of the House Committee on Ways and Means, will be the keynote speaker at the Concierge Medicine Assembly in Atlanta, GA August 1st, 2015.

Dr. Price and other speakers will share their experience and expertise on a range of topics including: industry trends; business models; employer partnerships; Direct Primary Care (DPC) business models; Specialty Concierge Care; Case Studies in Concierge Care and DPC; Telehealth Technology; entrepreneurship; social media branding and more. This year’s Conference theme “Ready, Set, Grow” encourages physicians to take a greater role in changing the course of their and in being a force for convenient healthcare change in their communities.

“We are thrilled to host Congressman Tom Price, MD, Richard Doughty, Dr. Robert Lamberts, Dr. Tom Joseph, Leslie Mitchell, Dr. Clint Flanagan, Dr. Edward Espinosa, Dr. Jeff Puglisi, Dr. Joel Bessmer and other inspiring physicians and healthcare professionals at this year’s Conference,” said Catherine Sykes, Publisher of Concierge Medicine Today and organizing partner along with Exl Events and Practice Builders. “What makes this event unique is that we have a wide variety of the industry’s leading female voices also. Leslie Mitchell, Julie Robinson and Roberta Greenspan, each of these women are industry influencers, experts and leaders in their respective fields who will share their collective wisdom with us all.”

READ BACKGROUNDS of 2015 ATLANTA SPEAKERS …

Exclusive to the Concierge Medicine Assembly, Mentoring-in-Minutes will offer attendees the chance to have one-on-one conversations with industry professionals, successful DPC and Concierge Medicine physicians as well as industry experts and provide an intimate expert exchange session with concierge medicine veterans.

“Conference attendees also have the opportunity to participate in a Marketing Diagnostic consultation at no-charge,” says Nina Grant, Vice President of Practice Builders. “It features an online practice reputation assessment, a web site evaluation and a mystery shopper call to determine your staff’s abilities to convert callers. This assessment and follow up consultation is complimentary to you, as part of your registration fee for the Concierge Medicine Assembly.”

CMT Launches “Docpreneur Institute” — opening up vast library of learning thru DPI Mentor Calls and Coaching Classes with help of industry leaders.

The exhibit area will also showcase industry leading companies dedicated to Concierge Medicine, technology and tele-health.

The Concierge Medicine Assembly (www.TheConciergeAssembly.com) is presented by Exl Events along with organizing partner Concierge Medicine Today and platinum sponsor, Practice Builders. The event is co-chaired by Concierge Medicine Today and Practice Builders. It is also generously underwritten by industry-leading organizations which include (alphabetical): Cypress Concierge Medicine; Specialdocs Consultants, Inc. and others.

“The Concierge Medicine Assembly celebrates the growth of free market healthcare delivery expanding across America and the visioneering spirit of a diverse community of healthcare practitioners we are proud to be part of,” said Bryon Main, CEO of Exl Events. “We are delighted to be the presenter of this Conference this year and look forward to 2 days of inspirational educational, new ideas and building great relationships.”

An early bird rate of $495 per physician/office manager, available until June 12, 2015. To register or learn more about the Concierge Medicine Assembly, explore the web site, www.TheConciergeAssembly.com

To apply for Media Credentials, please contact Bryon Main 1 (866) 207-6528 or registration@exlevents.com or Michael Tetreault at editor@conciergemedicinetoday.com.

About Congressman Tom Price, MD

Congressman Tom Price was first elected to represent Georgia’s 6th district in November 2004.  Prior to going to Washington, Price served four terms in the Georgia State Senate – two as Minority Whip.  In 2002, he was a leader in the Republican renaissance in Georgia as the party took control of the State Senate, with Price rising to become the first Republican Senate Majority Leader in the history of Georgia. In Congress, Rep. Price has proven to be a vibrant leader, tireless problem solver and the go-to Republican on quality health care policy.  He serves on the House Committee on Ways and Means. In the 114th Congress, Price was named Chair of the House Committee on the Budget. In previous Congresses, he has served as Chairman of the House Republican Policy Committee and Chairman of the Republican Study Committee. Committed to advancing positive solutions under principled leadership particularly in healthcare, Price has been a fierce opponent of government waste and devoted to limited government and lower spending. For nearly twenty years, Dr. Price worked in private practice as an orthopedic surgeon. Before coming to Washington he returned to Emory University School of Medicine as an Assistant Professor and Medical Director of the Orthopedic Clinic at Grady Memorial Hospital in Atlanta, teaching resident doctors in training. He received his Bachelor and Doctor of Medicine degrees from the University of Michigan and completed his Orthopedic Surgery residency at Emory University. For more information, visit: www.TomPrice.House.gov.

About Concierge Medicine Today

NEW RELEASE — now available! It took nearly 3 years to write … The Doctor’s Guide to Concierge Medicine (nearly 400 pages of industry insight plus, over two dozen physician contributions compiled in one book) — On Sale $129.95 (Reg. $189.95)

Concierge Medicine Today (CMT) is a news organization and the Concierge Medicine industry’s oldest national trade publication for the Concierge Medicine and Membership Medicine marketplace. Its web site is the online destination for businesses, consumers, physicians, legislators, researchers and other stakeholders to learn about the history of this industry, various business aspects of the marketplace, trends, breaking news and more that drives the conversation that Concierge Medicine and free market healthcare delivery is creating on a national and international level. For more information, visit: http://www.ConciergeMedicineToday.com.

Conference Info.: July 31- August 1, 2015
The Westin Peachtree Plaza, Atlanta, GA
Contact: Exl Events
Phone: (866) 207-6528
Email: registration@exlevents.com
Web: www.TheConciergeAssembly.com

Posted by Joel Warshaw, MD on Jun 11, 2015 9:24:15 AM

Over the years, rising costs of insurance premiums have driven many businesses to take on risk to cover health care expenditures provided to their employees. Groups are attracted to cost savings, the added flexibility in plan design, exemptions from state-mandates, and the increased control that comes with owning all claims data and reporting.

NEW RELEASE — now available! It took nearly 3 years to write … The Doctor’s Guide to Concierge Medicine (nearly 400 pages of industry insight plus, over two dozen physician contributions compiled in one book) — On Sale $129.95 (Reg. $189.95)

Self-insurance offers employers more flexibility than does commercial insurance while providing practical and economic advantages to curb costs, such as:

• Helping employers tailor plans to the health needs of a workforce, especially if guided by the right healthcare management firm
• Maximizing cash flow since claims are funded as they are paid, rather than functioning based on prepayment
• Generating as much as 3% in immediate savings because state taxes are eliminated on most self-insured plans
• Eliminating carrier profit margins and risk charges

With a self-funded plan, fixed costs represent 10% of health insurance benefit spending. The key is to have variable cost saving initiatives for utilization, quality of care, network discounts, and accessibility.

While many businesses adopt the self-funded approach, there is another thing to consider: a dedicated concierge physician. By encouraging and covering the costs of their employees to be enrolled with a Concierge Physician, a business will obtain a significant reduction in total healthcare expenditures while offering a more accessible and higher level of primary care medical service, especially preventative care. This will in turn result in an improved work culture and increase yearly revenue year after year.

In this post, we’ll explore the benefits of this partnership to both the business and to the physician.

How Concierge Medicine Benefits Self-Funded Employers

Businesses that provide self-funded health insurance have an opportunity to positively affect their cost, primarily due to 90% being variable. There are both soft cost and hard cost savings to this approach.

The key benefits to self-funded employers of enrolling with a concierge physician are as follows:

• Employees will have access to a Primary Care Physician who provides a higher level of personal care. They will be able to contact that physician at the office, cell phone, or email.
• Employees will be able to utilize Telemedicine and the growing advances in technology to improve patient monitoring and care. They will also have access to specialists (near and far) via telemedicine at a much-reduced price than seeing the physician in person. This will also reduce time away from work, as these visits can take place at work, eliminating travel time and waiting room experiences.
• Businesses will be able to promote these benefits to prospective employees and employees currently in their business who are considering making changes
• Increase in productivity with a reduction in illness, sick days, and doctor visits
• Decrease in health care expenditures, including immediate relief in primary care doctor fees and common tests and procedures. Decrease in Emergency Room/Urgent Care visits and hospital admissions that typically charge enormous fees.
• Maximizing cash flow since claims are funded as they are paid, rather than functioning based on prepayment.
• Generate as much as 3% in immediate savings because state taxes are eliminated on most self-insured plans.
• Eliminating carrier profit margins and risk charges.
• Anticipated savings to self-funded health costs are estimated to be between 10% to 25%, not including increase in revenue.

How Concierge Physicians Benefit from a Partnership with a Self-Funded Employer

Many physicians practicing in today’s “hamster wheel” working environment are frustrated by regulations being imposed on them, along with all the paperwork and insurance roadblocks that take time away from their patient care, not to mention their personal/family life. Health Insurance reimbursements have also decreased to the point that physicians do not feel they are being compensated well enough for their hard work. Many are still paying off hefty medical school loans, while also paying for high malpractice premiums and rising office expenses.

The Concierge model offers a physician an option to practice medicine the way it’s supposed to be practiced. It allows for a personal relationship between a Physician and a patient, with the insurance company largely out of the way. Practices such as these are growing all around the country. However, the challenge facing an interested Physician is to enroll enough members to sustain this type of practice. Businesses that offer self-funded health insurance are able and willing to provide for these members and this allows for a synergistic relationship.

The benefits to the Concierge Physician of partnering with a self-funded employer are the following:

• Assistance in getting members to enroll in their practice by funneling employees from local businesses that offer self-funded health insurance.
• A Concierge Physician may take on just a few members or hundreds of members if the match fits, especially for those physicians starting a new concierge practice.
• Physicians are given the opportunity to practice medicine the way they want to practice medicine, without relying on insurance reimbursement. There would be 100% financial support by members of the practice.
• Maintain individual control of all aspects of their practice and not be an employee of any hospital or insurance agency.
• Promote a high level of preventative care, utilizing Telemedicine and all the technology coming down the pike in the near future.

As you can see, the relationship between concierge physicians and self-funded employers is mutually beneficial. Are you a concierge physician that has worked with self-funded employers? Share your experience in the comments section below.

SOURCE: http://blog.empyrealemr.com/blog/why-concierge-medicine-is-the-perfect-fit-for-self-funded-employers?utm_campaign=Blog+Promotion&utm_source=hs_email&utm_medium=email&utm_content=19981258&_hsenc=p2ANqtz-9pMNma0D_5xyvtJCfFtx9x8HbQLPm42x3hvS8mUiWSnfR4L4Io1wIGYzSSsBgiA6BdHZkgSzVGYPRqSerkB-Jucf-5ig&_hsmi=19981258

2015 DPCJ Annual Report + Market Trends Summary

“Great ideas without an audience die faster than good ideas with a few fans. Tell us [the patient] your personal story and why you’re in private medicine … because no one else will.” ~J.A., Tenn.

By The Direct Primary Care Journal

JULY 11, 2015 – A 2015 Industry-Wide Analysis by The DPC Journal from December 2012 – June 2015 shows that Generation X is likely to be a significant reason DPC and Membership Medicine as a free market healthcare delivery model will continue to grow in 2016 and beyond. Here’s what physicians and patients reported:

• Less than 24% of DPC physicians polled from May – June 2015 indicated that their practice had more than 51% patient Medicare age individuals on a monthly or quarterly care subscription.
• Baby Boomers, followed closely by the population that will financially support the aging Boomers, Generation X, encompass a population of 44 to 50 million Americans.
• Now that Generation X is all grown up, they are the latest group of adult children trending towards utilizing DPC nationwide.
• On the whole, Generation X is far more ethnically diverse and better educated than the preceding Baby Boomers. They make up a growing percentage of patients in this industry.
• The Millennial Generation, is not far behind as a prominent demographic finding DPC popular.

Some larger DPC practices are facing new competitors seeking to peel away significant amounts of revenue from areas that had once been the exclusive domain of DPC Clinics. In particular, MRI, CAT Scans and pharmacy sales, the second biggest revenue generators for some larger DPC practices are under attack by big box clinics with well-known names operating under low-cost/high-volume sales models. These facilities started with treating runny noses and offering flu shots. Now retail health clinics are thinking bigger. What is also interesting about the DPC industry analysis is that some doctors (approx., 45% according to The DPC Journal) indicated that their DPC business model accepts and/or files claims through insurance. For some DPC offices, non-participation in insurance networks is the core essence of a DPC model. According to the California HealthCare Foundation, health plans see a market opportunity through the Exchange by coupling DPC with a high-deductible wraparound policy that promises to deliver a lower price than conventional insurance products. Supporters of this industry believe that DPC will have a role in helping solve the growing problems of diminishing access to primary care as well as its increasing cost.

“The $99 or less price point for the 24-45 age group is important because DPC is trying to reduce the expense on the individual,” says Michael Tetreault, The DPC Journal’s Editor-In-Chief. “While it’s true that many DPC doctors have not faced many new or inquisitive questions since the ACA passed, you do not currently see a lot of educational advertising aimed at this audience of people that’s designed to get them to switch “brands” [i.e. from using their insurance card or paying a doctor directly]. The education and advertising aimed at 25-45 needs to be all about that. If a DPC doctors program is not properly paired with high-deductible health plan policy or a wrap-around insurance product of some kind, those low price points [and monthly premiums] compete with a lot of other expenses inside the household (HH) with an annual combined HH income of less than $95,000.”

“The 55-plus hasn’t been abandoned entirely by DPC either,” notes Tetreault. “However, the current education and advertising aimed at them is simply aimed at maintaining brand loyalty and establishing that the products they love are still good and still work and maybe are being improved. Certified Financial Planners (CFPs) for example, target this audience successfully and advise their aging client to consider either a DPC program or even a Concierge Medicine membership to help cut costs. Retail Medicine however, is the next great free market healthcare delivery solution on the horizon to boost interest in DPC. Vital to Direct Primary Care’s scalability and sustainability is however creating a true value proposition for self-insured employers and businesses in the coming years ahead. It’s a fact that the same demographic who is using DPC currently in rural markets are also the same people spending daily dollars in the retail medicine space in metropolitan markets and who also have [but don’t use] their employer given insurance. DPC physicians will soon need to evaluate how many patients they want to treat each month inside their pricing model and offer value well beyond the simple price transparency and convenience factors — and we have no doubt they will consider these factors over the next two years.”

READ MORE …

By Komal Garewal

JULY 9, 2015 – “A company’s odds of success are better the closer they can get to their market,” argues Stephen Hurwitz, a thought leader in the Canadian venture capital industry, recognizing that the proximity to a VC-tech hub can help the success rate of Canadian startups.

A socialized healthcare system, Canada’s market is fragmented by province and type of care – most primary and emergency care is free for residents whereas specialty care, prescription drugs, long-term and in-home care amongst others, are not covered by the Canada Health Act. This system, while making healthcare much more accessible and affordable for citizens, leaves large gaps in coverage and therefore plenty of niches for companies to address current deficiencies with new products and technologies.

Many Canadian entrepreneurs cite a lack of resources in the country’s venture capital industry, which is also younger than its American counterpart. A lack of funding for startups translates into companies addressing immediate needs instead of long-term impending issues, early exits or premature product launches, and there is greater difficulty in attracting a talented workforce.

SOURCE: http://hitconsultant.net/2015/07/08/canadas-top-20-digital-health-startups-to-watch/

Singularity Alumni Confront Global Doctor Shortage With Curely

Amanda Coolong
Curely
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SOURCE: http://www.digitaljournal.com/pr/2605257#ixzz3fP9c2F5W

Long live the Web: Online sales in Membership Medicine Sector to top expectations according to industry experts.

By Michael Tetreault, Editor

AUGUST 4, 2015 – Innovative and trendy medical sectors such as dermatology, dentistry, surgery, LASIK, and a select few others, have adapted quickly to online appointment scheduling and social media advertisement of healthcare services. However, Primary Care and Family Medicine have yet to adopt such relationship-enhancement tools.

One early adopter in the primary care space for example we have highlighted and recognized in The Direct Primary Care Journal is R-Health. R-Health recently launched a GroupOn campaign for “Three-Month Personalized Primary Healthcare Membership for One or Two at R-Health (Up to 65% Off).”

Another example that the Chicago Tribune reported on in January 2015, noted that 400,000 patients had appointments with doctors via webcam in 2014 and experts expect that number to double this year.

Large employers also have started offering the virtual doctor visits, via phone or web, as a benefit to their employees, including about 19 percent of large companies (500 or more employees) in the Chicago area, according to Mercer data. The growth is driven by the fact that people feel more comfortable with technology than ever before, experts say, and insurers are starting to pick up the tab.

Expect online sales and purchasing of Medical Memberships to occur at a faster rate than at bricks-and-mortar clinics in the coming months and years. Point-push-click-swipe-buy — these are solutions physicians should begin talking about with their patients, EHR and EMR solution providers. Very soon, the vast majority of medical purchases and physician appointment scheduling will be made online vs. in physical locations.