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First, Understand What Resources Are Available
As a reader of CMT and The DPC Journal, you have access to one of the most powerful resources available—a community of fellow small business owners and physicians to talk to, learn from and grow by. But that’s just the start. You’ve started your journey into this industry at the right time. If you currently feel caught between the tension of your day job and your dream job, there are a lot of resources that can help you as a physician, both young and seasoned. That gap between what you have to do and what you’d love to do needs to narrow. As one of our favorite recommended books and authors writes … ‘It’s time to close the gap. It’s time to be a Quitter!’
Please be sure to read this entire page (below) as it has access to additional educational articles, downloads and resources that may be applicable to your individual situation.
If you are one of the thousands of physicians, emergency room doctors or recent medical school graduates currently considering starting up a direct primary care or concierge medicine practice selling exceptional service, time or home visits, the first thing you need to seriously consider is not your start-up budget, not the location and not the hours you will be working. The first thing you must consider is the services you will be selling and the business model you want to use. What’s the old adage, ‘plan your work – then work your plan.’ Patients, start-up capital, leased space and even employees will follow an confident leader with a plan.
Physicians today considering entering this niche marketplace must understand that doing good work by caring for the patient isn’t the whole job. Part of ‘getting there’ (the job you dream of), is that things like the unique services you incorporate into your physician-patient contract actually matter — even when you don’t think they will. My favorite story to write is from the physician who transitioned in the past two or three years and says ‘I wish I had done this years ago.’ Thus, if you put the dream before the work, you’d never get in front.
Before You Take The Next Step To Pursue A Concierge Medicine or Direct Primary Care Model For Your Local Area, We’ve Put Together the Following Fifteen categories to help you Self-Evaluate Yourself and Your Practice Before You Take The Next Steps.
Next, Fifteen (15) Self-Assessment Criteria:
YEARS IN PRACTICE. Experts within the concierge medicine industry suggest that physicians (of any specialty) should have a minimum of 6 years in private medical practice. However, 10 or more years is preferable.
YOUR PATIENT PANEL & HOW MANY PATIENTS YOU TYPICALLY SEE PER DAY. According to Concierge Medicine Today, Physicians considering a successful move into a concierge medicine practice should have a patient panel of at least 1,800 patients that they’ve seen within the last 24 months. They also recommend that a minimum of 15 patients per day are seen across a 4-day period as the current number that your practice is routinely seeing prior to making a transition into concierge medicine.
LEGAL ASPECTS to CONSIDER. According to Dr. Samir Qamar, CEO, MedLion, a Direct Primary Care practice with multiple locations across the U.S., he notes “Besides the usual business barriers, the most important factor to navigate is compliance with the law. Not structuring the practice properly can lead to drastic consequences if the model is perceived to be insurance.”“The next issue would be to consider how to either terminate or not renew third party contracts and how long each choice would take,” said Joy Twesigye, a Nurse Practitioner and Health Policy Analyst (www.hopestreetgroup.org). “It is a breach of contract under Medicare to charge Medicare beneficiaries for services covered by Medicare. The last and most important issue is regulatory. Each state has different statutes and a retainer-based/Concierge practice must be careful in contract wording to not have patients paying prior to care is provided (otherwise you may accidentally be construed as starting an insurance company). This is why most of these models use “membership fees” that are separate from charges for services rendered at time of visit. The GAO report may be accessed here: http://www.gao.gov/new.items/d05929.pdf
MARRIED or UNMARRIED? Many physicians and their spouses work together in the same office. We also found in the practices surveyed and interviewed that changing your business model requires the joint agreement of both spouses, whether they work together or not. If your spouse is not in agreement with the change, a transition to a concierge medical practice is not recommended.
SOCIO-ECONOMIC PROFILE of YOUR CURRENT PATIENTS. According to Concierge Medicine Today, while over 63% of current concierge medical programs cost less than $135 per month, the socio-economic profile of patients in successful concierge medicine practices typically consists of middle class / affluent individuals and families.
AGE RANGE of CURRENT PATIENTS. According to industry consultants, more than 50% of your current patient-base (last 24 months) should be 40+ in order to start, sustain and grow a successful concierge medicine practice in the future. (Source: The DPC Journal/Concierge Medicine Today)
Technology, Marketing and Collection Barriers. A physician and thought leader recently said “There are a number of barriers to implementing direct [or Concierge] practice. In short, they are technology barriers, and these are multiple, so one must have an integrated platform of health IT.”
She adds “The second major barrier is marketing, customer discovery and validation of pricing. The Third is collections, as you will need some methodology to create streamlined money flow from patients into your bank account. The list of Health IT platforms that also enable streamlined direct practice collections is very short. The Fourth is legal, as physicians are making the transition from a variety of third party contracts. Direct collection of money from patients violates these contracts, in particular Medicare is a felony offense.”
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LOCATION. A lot of Doctors in this field practice in metropolitan and suburban areas. Some, though few, open and make a practice model like this work in a rural environment. Remember, different locations represent different demographics which all have their own set of advantages and challenges to running and operating a medical practice. According to a GAO report, annual patient membership fees in concierge practices ranged from $60 to $15,000 a year, with about half of respondents reporting fees of $1,500 to $1,999. Further analysis from Concierge Medicine Today and The Direct Primary Care Journal, trade publications and thought leaders in this healthcare sector note that fees average $1,800- $2,500 per year and most Doctors have an average of 400 to 600 patients in their subscribing patient panel.
Medically Underserved Areas In My State: Another consideration for some Doctors recently who want to operate and run a practice in a rural environment is to find shortage areas or medical underserved areas. While not common, this is a rather new strategy some Doctors are considering to help their communities. You can use this HRSA tool located here HPSA Geographic, HPSA Geographic High Needs, or Population Group HPSA or an MUA/P.
Don’t Jump Into A Lease. Consider Reducing Your Real Estate Footprint and Evaluate Your Options Carefully. Remember, your major investment will obviously be in the purchase of the leased office space itself, it usually is in over 60% of the concierge medicine and direct primary care clinics nationally, according to Concierge Medicine Today.
Find Your Own Unique Value To Your Community. Next, what do you want to offer that’s something completely unique and new for your patients? Such as a coffee or beverage bar in your lobby area with a flat screen cable tv. Do they even need a place to sit down and take some time rest – afterall, they’re probably seeing you because they need a short time-out. Just because this is a so-called concierge medicine or direct primary care operation does not mean you have to forget adding value for patients. Renewal rates at concierge medical clinics nationwide are declining because physicians are over-promising and under delivering services to their patients. What strategies are you going to implement to help differentiate you from the rest of the competition.
So, in putting legs to this concept, first, make sure you understand the services you plan on offering from your patients and local community before making financial business and emotional decisions on everything else.
However the type of services you will be offering and selling will determine the type of office you are going to need. What we’ve learned from countless interviews with physicians over the years is that one of the first things doctors do when they start a concierge medicine or direct primary care practice is reduce the amount of leased office space they use and the amount of employees they have.
Employee Needs: Most clinics average between 1-2 employees according to Concierge Medicine Today. So, research which types of office spaces that are most used for selling the services you will be basing your new medical practice on. This will serve to narrow down the list of equipment and operational components to something that is much more manageable for you and future staff.
What’s Your Patient Subscriber Number? Another issue you will need to consider is the volume of patients you are going to be striving for. Most concierge medicine clinics see an average of 5 to 10 patients per day, according to Concierge Medicine Today. This will affect how many employees you are going to need inside the practice to assist with administrative support, sales, blood pressure checks, etc., and this in turn will affect the actual space you are going to need in the front office itself. If it is too small, you may lose sales and valuable patients; too large and you waste valuable investment capital.
Technology Needs and Assessment Planning: Consider how you will incorporate technology, cell phone visits, SMS text messaging, appointment reminders and local are home visits into your practice timescales. When will you rollout home visits? How soon will you implement credit card statements? Between acquiring the basic operational technology for your new startup practice and the time it takes to acquire a new patient can become sizeable investments in this new venture.
Remember, failure to plan is planning to fail in this business. The more planning you place on your practice now before you begin, the greater your success will be in the very near future.
MP3 Download | The Eight (8) KPIs Needed For Successful Startup
Here Are Some Additional Resources and Educational Tools we suggest you review:
‘There are only two paths in life: average and awesome. The average path is easy because all you have to do is nothing.’
All of this and much more is available at your fingertips. I want to encourage you to get involved, get motivated and use the resources above to help you in your discovery of Membership Medicine. You won’t regret it!
As always, our door is always open to you and your staff and if you have any questions whatsoever. Call us directly at 770-455-1650 or via email at email@example.com.
Concierge Medicine Today/The DPC Journal
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Additional Educational Resources