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One way to stop the insanity is to calmly and casually “leave the building in an orderly manner”…and run towards the nearest qualified consultant that can help them get off the managed care wheel, and in some cases, the Medi/Medi merry-go-round too. 

— Maria Todd

[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column width=”1/4″][vc_column_text]Handbook of Concierge Medical Practice Design[/vc_column_text][vc_column_text]Concierge Medicine sub logo[/vc_column_text][vc_column_text]

Relax over a cup of coffee with Maria Todd each weekday morning

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Each weekday morning, Maria Todd shares a useful tip to cogitate during your morning java break.

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[/vc_column_text][/vc_column][vc_column width=”3/4″][vc_column_text]The landscape of medical practice in the USA has changed significantly – and many physicians will openly tell you that it has negatively impacted the way they practice medicine.

When the bell rings… go to history

Managed care first entered the market with health maintenance organizations (HMOs) and preferred provider organizations (PPOs) in the 1970s and 1980s. The former became referred to as “take a number” medicine, because of the business models operated by Humana and others that were a clinic model. You arrived, signed in, sat and waited your turn,  until someone could pay attention to you.  The latter was the advent of discounted fee-for-service. You joined, stayed within the confines of the “preferred” providers (preferred because they accepted the discount, not for any other reason) and you got your healthcare for less out-of-pocket money.

Insurance companies shifted to a capitation (per-member-per-month) system that primarily rewards doctors for withholding care and procedures. When that didn’t work they penalized the doctors for “spending too much” by withholding up to 50% of the physicians’ pay. When that didn’t work they tried returning back to fee-for-service, but at a lower price point. When that started to deteriorate, they moved to a “pay-for-performance” system, but the performance basis was about saving money, and some arbitrary outcomes on a handful of diagnoses.  Many quickly learned and mastered each “game”.  All the while, doctors mastered the art of spinning the hamster wheel fast and faster for smaller and smaller pieces of cheese.

ObamaCare and the case of the tired hamster

Now with the implementation of the Affordable Care Act (“Obamacare”) many of the nations smaller cadre of primary care providers face the prospect of adding millions of people to the healthcare roles who will require primary care, much of which has been deferred for years. The patient load for each doctor will continue to rise and seven minute visits will become what, 4 minute visits? Or less? Or there won’t be an appointment available for weeks, or months.

Who gets the blame?

This will give rise to breach of contract arguments from insurers, because the insurers put in their contracts and administrative manuals that physicians would grant appointments within so many days for urgent or routine visits. Otherwise, the payers will face loss of their NCQA accreditation. So will they demand that the doctors work overtime and increase their overhead to cover overtime costs? Probably.

One way to stop the insanity is to calmly and casually “leave the building in an orderly manner”…and run towards the nearest qualified consultant that can help them get off the managed care wheel, and in some cases, the Medi/Medi merry-go-round too.  We’ve had more calls for assistance and inquiries about “should I” in the last four months than in the last 7 years combined. What makes it tough on us is we know they are desperate, but we just can’t hire a bunch of new graduates to be consultants off the street. This is a big, complicated deal. There are compliance issues to be dealt with, contracting issues, patient relationships, accounts receivable,  and retooling the entire business model.  I can’t ethically send an inexperienced new hire to work with concierge physicians, any more than a concierge physician would put a patient with a complex history in the hands of a PGY-1

For those who do choose to remain in primary care, many doctors are now turning to concierge medicine so they can lower their patient load and provide better care to the patients they do have.  Those who remain in traditional practices will also need help, because they can’t continue down the path they’ve followed for years and still remain a viable business.  They will need to find another way, perhaps through integrating small practices into mega-groups, and circle the wagons.

The average traditional practice has been carrying a book of business that includes 2000-4000 patients, and the doctors that have been more successful have been taking home $350,000 a year. Others less successful haven’t taken home a paycheck in months. There are examples of every point on the time and money line in between.

From Point A to Point B

Those who transition to concierge medicine don’t succeed overnight. Physicians don’t just turn into successful concierge physicians overnight. One thing that I’ve noticed missing from most concierge physicians that are struggling to thrive is that they haven’t done two things: First, they haven’t learned how to BE a concierge physician and run this different kind of a practice, and second, they  have failed to teach their patients how to use concierge medicine fully to get the advantages of membership. As a result, complaints are emanating from patients that they don’t intend to renew because they aren’t “seeing the value”.

I place the blame squarely with the consultants that transitioned their practices.  Why? Because they did some paperwork, set up a strategy, and failed to test it to see if it would work. They also failed to train the doctor how to execute the strategy. Why? Because it is highly likely, they didn’t know “how” to execute. They were hired for their talking points and salesmanship. They were already on their next conquest with the rubber met the road.

There are a lot of consultants out there with all these rah-rah articles and sales pitches and 5-star resort weekends about how wonderful it will be:

  • More time with patients
  • Improved patient outcomes
  • More satisfying lifestyles
  • More blah blah blah

None of these things will be realized if you can’t sell the memberships and get the patients to renew. On the other hand, if you can learn to become the physician that is ready for concierge medicine, and you learn what works to engage your patients to use the model correctly, I can promise you that your practice will be different. And you won’t feel as if you are stuck in 2nd gear in a 5-speed Porsche, wondering when it’s going to “go”.

If your consultant left before you hit 5th gear and you need some help, call us. We offer a complimentary 15-minute consult. You will speak directly with me, not my assistant or my intern. Let’s troubleshoot what’s happening and how to fix it.[/vc_column_text][vc_call_to_action title=”Considering concierge medicine?” button_title=”Talk with Maria” button_link=”http://meetme.so/mariatodd”][/vc_column][/vc_row]

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