How to Become a Concierge Doctor
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Considering a switch to concierge medicine? Not sure where to start or whether a concierge model is right for you? Tune in for our webinar and learn the key steps to becoming a concierge doctor. Concierge medicine has been steadily gaining popularity, especially with the uptick in high-deductible insurance plans and the burden of ballooning overhead costs and overflowing patient loads on primary care doctors. In a world where physician burnout affects almost half of all doctors, many have turned to a concierge model to alleviate headaches with insurance, increase practice profitability, and refocus efforts on providing high-quality patient care. In this presentation, you’ll learn: *Which model is right for you — concierge or direct primary care. *If your patient population is a good fit for a concierge model. *How to establish your rates. *How to break the news to patients — the right way. This slideshare is also available as a webinar with speaker Nathaniel Arana. To request a recording, visit http://try.evisit.com/june-webinar-how-to-become-a-concierge/
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How to Become a Concierge Doctor
- 1. Nathaniel Arana, NGA Healthcare Teresa Iafolla, eVisit How to Become a Concierge Doctor Converting to a Concierge or Direct Primary Care (DPC) Practice June 2015
- 2. Who We Are Teresa Iafolla Content Marketing Manager, eVisit tiafolla@evisit.com Nathaniel Arana President, NGA Healthcare nathaniel@ngahealthcare.com Host Speaker
- 3. Your Presenter Nathaniel Arana President, NGA Healthcare With his expertise from a top business management program, Nathaniel was able to found and grow one of the nation’s largest out-of-network billing companies. He also worked as a manager and consultant for a physician consulting company. Nathaniel started NGA Healthcare because he wanted to change the way physicians practice medicine by lessening the influence of insurance companies. As a physician advocate, he has helped his clients start concierge and DPC practices, marketing their practices and negotiating reimbursement rates. nathaniel@ngahealthcare.com www.ngahealthcare.com Connect
- 4. The role of health insurance • Cost to bill insurance: $471 billion • 80% considered waste • Cost contributed to complex rules and inefficiencies • Problem for both physicians and health plans • Higher premiums and lower reimbursement are the result
- 5. Concierge vs. Direct Primary Care Concierge • Smaller patient population (around 500) • Still may bill insurance • Typically higher priced ($200 - $500+ /month) Direct Primary Care • Larger patient population (1,000 – 2,000) • No insurance billing, no insurance billing overhead • Lower priced (as low as $50 /month)
- 6. Which is better? • Depends on your goals • Depends on your location • Complete an analysis to understand which will work better • Wealthy area? • Medicaid and Medicare population?
- 7. The middle-class model $50 - $100 per month depending on level of service and patient population/demographics • At $50 a month with a 1,000 patient population, physician collects $50,000 monthly, $600,000 annually • Lower overhead (let’s assume conservatively 40%) • $400,000 annual salary Concierge medicine for the rest of us… Direct Primary Care
- 8. What about Medicaid and Medicare Patients? • Medicaid patients are typically financially indigent • Charging Medicare patients cash for covered services • Charging Medicare patients for non-covered services • Grey area at the moment - best to look at your situation with the help of a qualified healthcare attorney
- 9. What should I charge? • Understand your location and patient population • What is your payer mix? • Many variables to understand what patients will pay/conversion rate
- 10. How can I convert strategically? • Analyze your payer mix • Look at your underperforming contracts • You don’t always need to terminate your contracts • Start with the bottom 1/3
- 11. How can I convert strategically? • Calculate break-even: variable costs > reimbursement • When a contract pays less, convert these patients
- 12. How can I convert strategically? • Convert existing patients • Patient education is key! • Market aggressively
- 13. The importance of customer service • The concierge/DPC patient expects higher quality of care • Staff needs to be trained to focus on customer service Friendly demeanor Follow-up Organization
- 14. Is it only for primary care? • Can be implemented with any specialty • Great for chronic care patients • The answer to the ‘healthcare crisis’
- 15. The importance of technology • Use technology to increase convenience • Use technology to decrease unnecessary visits • Enhance the patient-physician relationship
- 16. How do I market a DPC practice? • Explain the benefits of this practice to patients longer consultations customized plans same-day appointments better access technology to speak to your physician
- 17. How do I market a DPC practice? • Use current patient base • Educate current patients • Reach out to new patients • Internet marketing • Targeting marketing • Word of mouth • This is the void in primary care patients are looking for
- 18. Benefits of Telemedicine Increase patient satisfaction Keep your patients within your practice (not an UC or ER) Better patient engagement and more opportunity to interact with your patients Less no-shows or cancelled appointments Optimized patient flow
- 19. NGA Healthcare • Strategic DPC/Concierge conversion • Negotiate reimbursement rates • Marketing strategies for DPC/Concierge practices • http://www.ngahealthcare.com/direct-care/ • nathaniel@ngahealthcare.com
- 20. Questions? Teresa Iafolla Content Marketing Manager, eVisit tiafolla@evisit.com Nathaniel Arana President at NGA Healthcare nathaniel@ngahealthcare.com @eVisitapp #evisitwebinar
- 21. Nathaniel Arana, NGA Healthcare and Teresa Iafolla, eVisit Thank You! Looking for a telehealth solution? sales@evisit.com (844) 693-8474 evisit.com/request-a-demo/ Follow us @eVisitapp evisit.com/blog/ April 2015
Editor's Notes
- Teresa: Welcome everyone to our webinar on How to Become a Concierge Doctor. We’re really glad you could join us today for this topic, which has been getting a lot of interest lately as Concierge and direct primary care models are on the rise. So today’s talk will be focusing on how to make the transition to a concierge or direct primary care practice model, and the steps and factors that’ll you need to consider.
- So first, a little about who we are. My name’s Teresa Iafolla, and I run the content program at eVisit, a telehealth software company for healthcare providers. In case you haven’t heard of eVisit, we offer an affordable, user-friendly telemedicine platform that lets healthcare providers consult their patients through high-res, secure, 2-way video. But as a physician-first company, we’re really in the business of giving healthcare providers solutions to make their practices more efficient, and more profitable. So that includes providing you with valuable content like today’s webinar to help your practice. So then of course we have today’s speaker, Nathaniel Arana, who is president of NGA Healthcare, a healthcare business consulting firm. Nathaniel has a lot of professional experience helping medical practices navigate this tricky transition to either a concierge or direct primary care model. So he’s going to share a bit of his expertise with us today. And Nathaniel, I’ll let you go into a little bit more about your background now.
- Thank you Teresa. I’m Nathaniel Arana and I have been working in the healthcare field for over 6 years. Coincidentally, my first experience in Healthcare was working with out-of-network providers and helping them get paid. I’ve worked on several practice start-ups, contracting and reimbursement rate negotiation and practice operations improvement. In a sense, I’ve been a kind of liaison and advocate of the physician to the insurance company with a special interest in protecting and helping practices that want to keep their autonomy and remain profitable. Over the years, as participating and billing and collecting from insurance has become more challenging, many of clients have been looking for solutions that allow them to stop participating in insurance plans outright. With the implementation of ACA and a changing healthcare environment, the time was ideal for physicians to start participating in DPC and Concierge models – but they needed help on how they could convert to this type of model. I will be going over some of the major questions physicians have on how exactly they can implement DPC and concierge models within their existing practice.
- I wont cover too much about insurance today, but it is an important precursor to discuss the need for concierge and DPC practice models. If you are a physician or work in a medical practice, I don’t need to tell you that billing and collecting from insurance and patients is costly. It accounts for almost 10% of healthcare costs in direct costs. There are also other costs involved with participating in insurance such as hiring consultants to navigate the system, hiring billing companies, staff dedicated to billing and collecting, credentialing costs, pricey software. The complex system also requires a lot of money to be spent by the health plan – which results in higher premiums for patients, higher deductibles and reimbursement for physicians. I could certainly go into more detail about insurance companies – but the take-away is that this third-party is not the answer to fixing healthcare – concierge and DPC is the direction we need to go in order to protect and in some circumstances re-establish the sacred patient/physician relationship.
- So let me first explain the differences between concierge and DPC models….Concierge models typically have a much smaller patient population and they still may bill insurance. They charge a fee per month to allow for more personalized attention. The per month fee allows the physician to have a lower patient population and give more individualized attention. These models are typically higher price and offer services to a wealthier clientele including. Some of the extra services include house visits, call phone access to their physician, hospital visits to coordinate and oversee care and act as your advocate in cases where you are admitted to the hospital. This is more of a personal physician. DPC models are similar – but there are some subtle differences. The population tends to be larger. While some still bill insurance, most do not. The ability to eliminate insurance billing dramatically decreases the overhead of the practice – there is a reduction in staff, professional fees from consultants and billing companies, elimination of contracting and credentialing, no patient balance bill collection, insurance follow-up and write-offs. Much more personalized care than a standard practice.
- Which model works better for you is dependent on your location, primarily. Both the concierge and DPC model offer a much higher salary. The beauty of both practices is that you can set your own rules – there are no contracts and constraints from the health plan that dictate how you practice medicine. You need to understand your demographics and patient population in your area. If you are in an area that is heavy with Medicaid patients, then it’s safe to assume that this is not an area for DPC patients – these patients typically have no cost sharing for medical services and are typically financially indigent.
- DPC is the model for the middle class. The price is reasonable, and patients enjoy better access to care. The costs involved with billing insurance are eliminated, so you can charge a lower rate to the patient. Even on the lower end, a physician with a 1,000 patients paying $50 a month would enjoy an annual salary of $400,000 with half of the current standard patient population.
- We discussed Medicaid patients and how they typically don’t fall under this category. I also want to covered some information about Medicare patients. Understand that Medicare patients fall under a certain category that requires due diligence if they are to be covered under a concierge or DPC model. You can charge a patients for services outside of the realm of services covered by Medicare through what is called an advanced beneficiary notice. You need to be very careful, however, to ensure that your model isn’t charging cash for what would be considered a covered service. It’s best to be overly cautious and contact a healthcare attorney to ensure that your practice is not violating any Medicare rules and regulations. Some physicians do opt-out of Medicare entirely but remember that you wont be able to re-contract with Medicare for a period of two years.
- The biggest question is what to charge for your services. We through a model that was low priced AND provided for a great salary for the physician. Again, we need to look at the local population. Another indication is your payer mix – what percentage of your patients are Medicaid, Medicare and commercial? If you have a large number of commercial patients with PPO plans, then this is a strong indication that the location can support a DPC or concierge model. Another factor to consider is median income of the area. If the median income is in 80,000 range, then this is another indication that the area could support a DPC practice. Remember, however, that you don’t want to not consider your competition. If there are a large number of DPC and concierge physicians in the area, take this into consideration. It doesn’t mean that you can’t start a DPC or concierge practice, it just means you will need to market more aggressively, and price your services more competitively.
- Take a look at your current payer mix as an indication of where to start. It’s not a good idea to convert your practice overnight – you could end up without an income for a long time until you become established. You need to understand which contracts are not performing well for you. Some contracts, believe it or not, might actually cost you money to see these patients! You don’t always need to terminate these contracts outright – and in fact I recommend that you start a pilot project of a DPC and Concierge model in your practice before you implement it outright. My recommendation is to start looking at your bottom 1/3 performing contracts. How do you determine which contracts are underperforming? (Next slide)
- Understanding what your overhead is can help you to better understand how much it costs to treat a patient – and which contracts aren’t worth your time. Certainly, as your volume goes up your fixed costs aren’t as high of a consideration – but a significant portion of overhead can be attributed to variable costs – or costs you encounter per hour. Take your entire costs for the year, and subtract them by the number of hours worked. This gives you an idea of your per hour costs. Then consider a patient consultation with XYZ insurance. If a consultation is paying you about $100 per hour, and each consultation takes half an hour, but your costs are $250 per hour, then you are losing money by participating in this health plan. This is a very simple scenario, but it hopefully gives you an idea of what to look for when analyzing your contracts.
- Use these underperforming contracts as the baseline to start. Announce your new program to these patients as a start. Let them know that you are implementing this new model. If the patient decides to leave your practice, then the financial impact is minimal. It’s important to educate your patients on the benefits they will receive when you can reduce your patient load. Let them know that they can participate in electronic communication with you, that they will have better access. Most importantly, with patients that have high deductibles, participation in this type of program could potentially save them money!
- The most important aspect to converting to DPC/Concierge is to understand that the operations of your practice need to change. The way that a medical practice is run now has been based on the efficiencies required by reimbursement rates. You need to consider changes to how your practices deals with patients. As a physician, you will need to increase your accessibility – but that is ok to do when you decrease you population. My recommendation is that you look at hiring someone that can help you bring your customer service up to par. Your staff needs to be trained to be friendly, accommodating and provide a better patient experience. This isn’t about making a physician take more time but rather utilize resources of his/her staff to assist with patient follow-up. You will need to have an organized practice that conveys customer service and access.
- This model, although traditionally meant for primary care practices, can be implemented within many different practices and specialties. Working in tandem with primary care physicians, specialists can also implement this type of model.
- So, I want to talk about how important technology is to the patient experience. Patients want convenience. There is an influx of patients to the market and there are a lot of physicians that don’t have time to treat patients for things like urgent care visits. This is something that needs to change when you convert to the DPC/concierge model. Patients expect a higher level of convenience. The great thing about urgent care patients is that they can be treated relatively quickly – either through a telemedicine visit or through same-day appointments. Technology allows you to lessen the time spent with these patients. These are patients that traditionally present at urgent care facilities – but would rather see you!
- **Note: concierge and DPC can be marketed through the same methods*** Better patient clinical outcomes and better access to care are the benefits to offering concierge/DPC care to patients.
- **Here I will reiterate a lot of what I discussed during the presentation**
- I do think it’s important because it is vital to the DPC/concierge practice. If you feel like it sounds too self-serving, lets integrate some of the content throughout the presentation instead** Teresa: Great! Ok, let’s leave this in then.
- Again, I’m Nathaniel and I’ve worked with many practice to help them convert to DPC and concierge practices. After seeing the trouble that physicians endure with insurance, I want to see a change in healthcare where we can reestablish the patient/physician relationship. Teresa: Nathaniel, we don’t need to do this if you don’t want to, but this is a chance to list out your services, say where you’re located, mention the areas of your expertise. Or we can just include your contact info and you can encourage people to reach out if they want to talk with you. We could move your contact info from the next slide to here instead.
- Nathaniel – let’s prepare a list of 5 commonly asked questions people might have in response to this presentation. I do this in case we don’t have a lot of people actually engaging or submitting questions. Here are some questions – I can go into detail with each. Can I still start a DPC/concierge practice while working as a physician (employed) at another practice? (Yes) Can patients use health savings accounts (HSAs) or bill out of network for reimbursement? (Yes – with some exceptions) Will my patients need to purchase their own insurance? (Yes – they still need ACA compliant insurance) Won’t this create an even greater shortage of PCP physicians? (In a sense, yes – there has been an influx of midlevel providers to assist. The idea here is that technology and changes in healthcare will allow PCPs to better manage a patient’s healthcare) Should I start talking to my patients about adopting high deductible plans? (I would never advise assuming the role of insurance broker. Find a trusted broker to talk to your patients)