DPC Business Planning: Key Sections To Focus On

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At the 2019 Concierge Medicine FORUM hosted by The DPC Journal’s sister publication, Concierge Medicine Today (CMT) in Atlanta, GA USA (Oct. 24-26, 2019)

By going through this exercise you will learn about all the things you didn’t know and quite possibly find some aspects of running a medical practice that you are glad you considered. You will also find who your local competition is and who in your community and area will be your potential customers. And yes, you do have competitors! Don’t let your professional regard for your colleagues cloud your glasses here … everyone has competition.

By Michael Tetreault, Editor-In-Chief

What’s the old adage, “Proper Planning Prevents Poor Performance.” Meaning, if you don’t put the work in, if you rely on pre-formatted templates written by other Doctors who’ve got different community dynamics, differing opinions of service standards, you won’t be original and this won’t work. Write your own plan. Design your membership medicine program the way YOU see fit. Consider things others don’t and put in the time and the sweat equity as they say. That will lead you down the path to long-term success in the subscription-based free market healthcare delivery landscape.

Doctors offices considering subscription-based healthcare programs are not immune to business planning. In fact, many of these offices and programs require quite a bit of planning in order to prevent poor performance. So, where do you begin? And, why?

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It’s daunting for sure. But here’s a few tips … and fortunately, there are also plenty of experts within this subscription-based healthcare delivery model that have proven experience. Click here to see some of those companies.

What Is A Business Plan? And, Why Do I Need One?

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A business plan is critical for most organizations but it is an absolute must for Doctors considering a change in their revenue model. By writing and thinking about your business plan or more than one, you accomplish a couple of things:

First, you enable prospective investors, perhaps your spouse or group of Physician business partners (and eventually your Patients purchasing the subscription later on …) that you have a clear vision for getting your subscription or membership medicine program up and running.

Second, by going through this exercise you will learn about all the things you didn’t know and quite possibly find some aspects of running a medical practice that you are glad you considered. You will also find who your local competition is and who in your community and area will be your potential customers. And yes, you do have competitors! Don’t let your professional regard for your colleagues cloud your glasses here … everyone has competition.

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Do Membership Medicine Models Have Competition?

You bet.

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And, if anyone tells you different, tell them to do more research about why exactly [younger] Patients are so attracted to connected care, mHealth apps and the retail healthcare sector of the free market healthcare delivery marketplace. An hour or two of deep dives down these areas and they’ll understand.

For example, The Journal of mHealth just this past year [Sept/Oct 2019] wrote an article entitled “Retail Healthcare Update: Disrupting Traditional Care by Focusing on Patient Needs” in which they stated: Proponents of retail healthcare believe that retail health clinics can help fill the gap of care created by the lack of doctors. A shortage of 12,500 to 31,100 PCPs is projected by 2025 18. There is actually evidence to suggest that retail health clinics will drive growth of PCP practices because retail care will expand the base of patients treated, and identify those that require referrals for chronic care 2, and if the number of referrals increase, the AMA is correct in pushing for retail clinics to have a structured referral system.

Competition.

So, who is your competition?

At the 2019 Concierge Medicine FORUM hosted by The DPC Journal’s sister publication, Concierge Medicine Today (CMT) in Atlanta, GA USA (Oct. 24-26, 2019)

Don’t underestimate them.

Other DPC Doctors know who you are. Concierge Medicine Practice Owners know where you are. Hospitals, retail healthcare and urgent care clinics they definitely know where you are and what you’re up to. Many membership medicine Doctors we’ve helped and spoken to over the years, particularly young Physicians under the age of 40 don’t have a loyal built-in customer/patient base. That’s a problem. That’s a issue that is hard to overcome. Your competitors don’t want you poaching patients from them and they’ll fight hard to keep them.

So, find out as much as you can about your traditional, plan reimbursed family medicine and primary care practice competition. Learn about the demographic statistics in your 20-minute drive time radius. Find out what ERs and Urgent Care are including their service menu for self-pay patients. How are the under-insured and uninsured patients being treated in your area? And, what about those non-profit charity clinics in your area? How are they serving the indigent populus in your area? Maybe you can help them? Maybe not. But take the time in this section of your business plan to explain in a paragraph or two how you will compete with the already established Doctors in your community.

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Business Plans Help You Know What You Don’t Know

We’ve spoken and helped enough Doctors find helpful education about writing business plans in Concierge Medicine, mobile medicine and Direct Primary Care (DPC) over the past decade to know that writing a business plan isn’t fun. It’s not always easy and it’s certainly not something Doctors or your team look forward to.

But “If you build it they will come” isn’t a business strategy.

Editor, Michael Tetreault at the 2019 Concierge Medicine FORUM, sister publication to The DPC Journal addressing an international and national crowd of Physicians from across the U.S. and abroad in Atlanta, GA USA, October 2019

Young Doctors in particular can fall prey to this emotional movie line but it’s not a helpful nor effective business strategy that you should stake your mortgage on, or your marriage.

A business plan is especially helpful to those new to the membership medicine economy.

It creates a blueprint for building your services, refining your pricing and building a business worth telling Patients about now and into the future. It will also help you find problems early so that you can jump through for any licensing and compliance issues in your state that may come up with current payor contracts, Medicaid or your Medicare participation opt-out dates and the like.

While most Doctors considering Subscription-Based Healthcare Delivery programs, business plans have the same general structure that other companies do in other sectors of our economy.

According to the Small Business Administration[1], your business structure affects how much you pay in taxes, your ability to raise money, the paperwork you need to file, and your personal liability.

You’ll need to choose a business structure before you register your business with the state. Most businesses will also need to get a tax ID number and file for the appropriate licenses and permits.

Choose carefully. While you may convert to a different business structure in the future, there may be restrictions based on your location. This could also result in tax consequences and unintended dissolution, among other complications.

Compare the general traits of these business structures, but remember that ownership rules, liability, taxes, and filing requirements for each business structure can vary by state.

Business structure Ownership Liability Taxes
Sole proprietorship
One person
Unlimited personal liability
Personal tax only
Partnerships
Two or more people
Unlimited personal liability unless structured as a limited partnership

Self-employment tax (except for limited partners)

Personal tax

Limited liability company (LLC)
One or more people
Owners are not personally liable

Self-employment tax

Personal tax or corporate tax

Corporation – C corp
One or more people
Owners are not personally liable
Corporate tax
Corporation – S corp
One or more people, but no more than 100, and all must be U.S. citizens
Owners are not personally liable
Personal tax
Corporation – B corp
One or more people
Owners are not personally liable
Corporate tax
Corporation – Nonprofit
One or more people
Owners are not personally liable
Tax-exempt, but corporate profits can’t be distributed

Consulting with business counselors, attorneys, and accountants can prove helpful.

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Choose a business structure |
SBA.gov

New, Updated for 2019 and Beyond. 700+ Pages … PLUS, a Physician’s Companion Journal! Learn More …

The business structure you choose influences everything from day-to-day operations, to taxes, to how much of your personal assets are at risk. You should choose a business structure that gives you the right balance of legal protections and benefits.

Here’s a quick breakdown of some key sections you should pay attention to when writing your subscription-based healthcare business plan:

The Executive Summary

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Think of this section as a brief introduction to your practice. Write it so it keeps your Patients [or investors] attention. Give the reader (eg potential patients and/or potential investors) the basics of your medical practice model. Describe briefly what is the vision and the mission of your practice is and what type of services your new business model will be providing. Write down the name of the new entity (if applicable) and where in your community you plan market and attract patients from.

Keep it brief and to the point. Don’t provide your C.V. or your bio. here. That comes in other sections. Investors, your peers, quite possibly even your spouse and yes, your Patients too — they already know all about your impressive education. That’s not what this section is for. They want to know in this section of your business plan WHAT you plan to do WITH all of that impressive and costly education, how you plan to help people and WHY!

 

Company or ‘Practice Description’

This part of your business plan explains in more detail (than the executive summary above) the operation location, legal name and the model/concept of the program/practice you want to create and deliver to your local community and target audience. This is also where you will give details on your local competition.

Who is your competition you might ask?

  • The standard ‘plan reimbursed’ primary care or family medicine office in your twenty minute drive time
  • The local subscription-based (eg DPC; Concierge) medical practices within a twenty minute drive time of your location
  • The Urgent Care Center(s) within a twenty minute drive time of your practice
  • The ER within a twenty minute drive time of your practice
  • mHealth and Digital Apps on smart phone devices and tablets
At the 2019 Concierge Medicine FORUM hosted by The DPC Journal’s sister publication, Concierge Medicine Today (CMT) in Atlanta, GA USA (Oct. 24-26, 2019)

You may have additional competitors you see in your local community that you want to list but these are just a few you should be aware of.

This part of business plan is awkward for many Physicians because you’ve been taught in medical school that all Physicians are more or less ‘created equal.’ Well, that’s fine if YOU want to think that way. However, Patients can tell the difference between a GOOD Doctor and a GREAT Doctor in less than 15-seconds. Patients today have a choice as to how and where they spend their money. If you don’t see other healthcare facilities and colleagues as friendly competitors, chances are likely you’re going into the wrong healthcare delivery marketplace and this area of healthcare won’t be very enjoyable for you in the future … as your competitors will see you as an easy target.

RELATED RESOURCES | SBA.gov

Your business plan is the foundation of your business. Learn how to write a business plan quickly and efficiently with a business plan template. Click Here To Learn More … /business-guide/plan-your-business/write-your-business-plan

Marketing Strategy and the Three Primary Parts to a Market Analysis:

Market research helps you find customers for your business. Competitive analysis helps you make your business unique. Combine them to find a competitive advantage for your small business.

HELPFUL SBA.gov Resources — /business-guide/plan-your-business/market-research-competitive-analysis

Target Audience.

Is your medical practice or new program within your existing practice going to serve Medicare aged Patients? Business professionals at lunch time? Are you doing house calls? Are you primarily in a community with middle-aged families with children not in college? Are you in a college town? Explain your target customer and why they are going to be attracted to your medical practice or new program/service and not the competition down the street which they already may have a relationship with or know about.

Marketing and Advertising.

What methods do you plan to use to promote your medical practice of new service program? And, if you simply rely on ‘Posts on Twitter and Facebook’ and sending out an email … you’d better start thinking a little harder. Patients engage with brands they know, like and trust. How are you going to target your true customer?  How are you going to get them to switch their routine? Why would they want to walk in your door vs another healthcare provider that may have more to offer?

Many Doctors use free social media services such as Twitter and Facebook. This can create a false sense of confidence. Today, very few Doctors feel comfortable sharing anything more than news stories about flu vaccines and recipes. While these contribute to the ‘noise’ in a persons news feed, they do very little to encourage new or recurring patient visits. So, start doing some research on where your competitors are marketing and think about what message they are communicating and how your messaging will and must be different.

Additionally, relying on social media is unfortunately also more challenging than it might seem. It takes a bit more to make it to the top of someones news feed these day with all of the chatter happening today on these platforms.

What is going to set you apart from your competition? Give specifics examples of messaging, headlines you might use, photos you might post and how you plan to get the word out about your practice to your local audience/customer/patient other than social media.

Management & Ownership

Who is going to run the operations of the practice? Who is going to “intake” new Patients, send the emails, do the billing? Who will run the daily or weekly reports, answer the phone? Who will assume marketing and public relations responsibilities? What role will you play in these daily operations? Are you going to be the accountant, the caregiver, the CEO, the marketing wizard or the Physician? How do you plan to get all of this accomplished? Many new subscription-based healthcare practice Doctors start out on their own while others bring in trusted staff to help with some day to day responsibilities.

Describe in this section of the business plan who is going to do what roles, describe briefly their tasks and how they will assist you on a daily, weekly or quarterly basis. It’s also smart to forecast in this section so you may want to include any potential staff and employees you feel will be needed or have a significant impact on your practice model or program which you plan to implement.

Financials

New, Updated for 2019 and Beyond. 700+ Pages … PLUS, a Physician’s Companion Journal! Learn More …

At first, keep it simple. Then as you progressively plan and budget, you can do deeper dives on the spreadsheet to accomplish and design a more complete and accurate financial forecast for your first year, next year and beyond. You may also want to bring in your tax advisor, your attorney, your accountant and/or your spouse in this section to help you.

For most Doctors, this part scares most inexperienced Docpreneurs. How much is this really going to cost you? How much should you charge, really? When do you set in price increases? How little is too little? What are my employee costs, hard costs, fixed costs, expenses? The minefield of obstacles is many that you must solve in this section. But take heart, keep it simple. This is a section in your business plan where at first, you want to list the projected growth of your new medical practice or service-oriented subscription program.

Be sure to include a profit and loss statement that will project how much are you going to spend versus how much you are going to make. Other items you may want to include in this financial section should include:

  • Break Even Analysis
  • Balance Sheet
  • Healthcare-Industry Specific Data
  • Possible Risks. Show investors, your accountant, your consultant, your attorney, your spouse, etc., that you understand that all Doctors that enter this subscription-based medicine space don’t succeed. Explain how you plan to pay expenses and overhead if you fall into this category.

In summary, these subscription-based healthcare delivery programs and practices can be great for Patients and the Doctors that enter into these niche models. With that said, there probably isn’t a membership medicine physician alive who wouldn’t add another word to the list once this planning exercise is complete: Necessary.

Citations

  1. https://www.sba.gov/business-guide/launch-your-business/choose-business-structure

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