Wayne Lipton

Which model is best for your practice - and your patients? Only you can answer that question, but look carefully at pros and cons, as well as the risks and benefits for you and your patients.

Direct Pay vs. Concierge Practices

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Direct pay medical practice models are sometimes confused with concierge care. But there are important differences to consider.

Direct Pay vs Concierge Practices

The sweeping changes in healthcare have spawned a number of alternative practice models, and several are membership-based. But just because models are built around a membership fee does not make them the same.

Here are 10 ways in which concierge medicine and direct primary care (DPC) membership models differ:

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Concierge medicine and direct primary care both have membership fees, but that doesn’t make them the same. Here are 10 differences you should know.

Concierge medicine and primary care: The differences

Over the last ten years, most physicians in private practice have found the revenue their practice generates is not what it once was. Reimbursement rates have declined, and overhead has substantially increased. 

If you find yourself in that situation, it may be time to acknowledge these concerns are not going to go away, and consider options for your practice.

2. Do I think I can continue in private practice until retirement?

Older doctors have to consider their pace and the age at which they’d like to retire. Can you reasonably continue to work this hard and this fast? For those doctors who are nearing retirement, this many not be a cause for concern. They have the patient relationships and the equity in their practice to last a few more years. 

But physicians who plan to work for another five years or more may have to consider new options to maintain a stable and secure private practice and a healthy work/life balance. This is especially true for older physicians who love the practice of medicine and intend to put off retirement. Is there a way to slow down the pace but keep the revenue up?

5 questions every older physician should ask themselves

3. What have I done to supplement my income? 

Many physicians have supplemented their income by offering patients healthcare programs or products outside of basic healthcare. These kinds of “extras” are often highly valued by patients and sold directly, outside of insurance. They introduce a new, private revenue stream to a practice-one where the doctor sets the price, not the insurance company.

What do you offer outside of reimbursed healthcare services? Have you thought about services and products such as aesthetic services, nutraceuticals and supplements, special weight loss programs, stress relief, or sleep disorder support programs?

4. Have I explored all the options available to remain independent?

There are many extras physicians can sell directly to patients. One important extra that capitalizes on the care and attention you offer your patients is concierge medicine. It may be the easiest program a physician adds because, unlike aesthetic services or nutraceuticals, it doesn’t require the physician to learn anything new. The program enhances the care and service the physician and the staff already provide patients. 

Concierge medicine and other forms of membership medicine are becoming increasingly popular with both physicians and their patients. The fact is, you’re not the only person struggling in this new healthcare marketplace. An aging population of baby boomers need more medical support than ever before, and it’s becoming more and more difficult for them to get that attention. 

A 2020 asset protection checklist for physicians

Concierge medicine allows these patients to purchase an enhanced healthcare experience, complete with the peace of mind that comes with having a physician they know and trust by their side. For physicians, the revenue concierge memberships generate makes a huge difference in their bottom line, while also allowing them to practice a highly enjoyable, personalized form of medicine.  

There are many different forms of concierge medicine being practiced today. It no longer has to mean a complete practice transformation. Many doctors now offer the program as simply a service that patients can elect to purchase. It doesn’t have to upend a practice’s patient panel or business structure. The flexible models are uniquely suited for specialists or doctors who don’t want to dismiss any patients.

5. What is my plan for the future of my practice?

Today’s physicians are so busy caring for patients and managing the business end of their practice, many don’t have time to think about the future of their practice. Unfortunately, sometimes things reach a critical point and the doctor may decide to do something rash, like retire abruptly or sell their practice to a large health system, finally putting an end to their worry. 

Before things get to that point, make sure you do your due diligence. Don’t sell yourself or your practice short. There may be revenue left untapped in your practice that can mean you remain strong and independent. You can even add value to your practice with a private program like concierge medicine that means more revenue for you, if the right time to sell does present itself. 

This year, resolve to carve out time to learn more about practice alternatives so you are well prepared for whatever comes next.

The questions you should be asking, and the plans you should be making.

5 considerations for private physicians in 2020

After just two years, it appears the jig is up for CMS and the Merit-based Incentive Payment System (MIPS). MIPS is now expecting to pay out just 1.68% in bonus dollars next year to those doctors who achieved a 

.  This is down from last year’s payout of 1.88%.  It is no wonder doctors are disappointed!

As every doctor knows, reporting takes precious time and resources. For the promise of a financial bonus, many physicians have put in all the extra effort that MIPS requires and then some. But after all that hard work, to cross the finish line with a perfect score and receive such a small reward makes it all seem pointless.  “Pay per Value” versus “Fee for Service” sounds good in theory-but if you aren’t going to actually be paid for value, perhaps it’s time to consider new options.

Doctors work hard and they deserve to be paid for their efforts. While they may not be able to protect their practices from the pressure of value-based payment schemes like MIPS, they can look into other proven and predictable ways to support their practice and their patients.

Doctors who want to be reimbursed properly and in a timely way for the value, service and support they provide should look into the many styles of membership medicine available today.  These programs are much different than the concierge medicine programs of the past, which mainly transformed the practices of primary care doctors in affluent neighborhoods.   Today’s models support a wide variety of physicians including specialists and doctors who are part of large health systems.  They vary in their scope and application, providing either a helping hand, a much needed crutch, or the backbone of a medical practice-depending on the doctor’s needs and goals.  And the programs are compatible with Medicare, so there is no issue with MIPS or any value-based government program you may be working with.

The new crop of membership medicine models allow doctors to continue to treat all of their patients and accept Medicare and even commercial insurances, if they want to.  The programs supplement the support and service the patients already receive with more time, connectivity and medical advocacy.  The kind of services that aren’t reimbursable through insurance or Medicare, but mean a lot to the peace of mind of vulnerable patients.  

Perhaps most importantly, unlike MIPS bonuses, results from membership medicine programs are fairly predictable. When physicians enlist the support of experienced professionals, their practice will be analyzed carefully and reviewed against data accumulated from years of practice transitions to project an accurate level of success.  The doctor will know how many members to expect, where to set the membership fee, and which style program would result in the highest revenue or, for some doctors, the best balance between pace and revenue.    

And, instead of working hard today to secure an unknown financial bonuses next year, physicians earn predictable new revenue in real time, doing what they love to do each day: caring for patients. 

CMS appears to be sticking with MIPS, with penalties increasing next year and in the coming years for physicians who fail to meet their standards, and the promise of bonuses increasing for high-performing physicians.  Bonuses actually decreased from their modest levels last year, so these increases do not seem promising.  Unfortunately, there isn’t too much physicians can do regarding MIPS.  Participation is mandatory and physician quality scores are public.  But rather than just working hard, and waiting and hoping for the best, consider introducing a proven practice model to support your practice with the additional revenue MIPS can only promise.

Wayne Lipton is managing partner of Concierge Choice Physicians.                                                                                  

 The MIPS disappointment: Why physicians should consider alternatives

Today, more primary care practices are affiliated with large health systems than private practices. 

, opening clinics in select Texas markets. Similarly, 

, is the largest network of provider groups in the country. And, if all goes well for 

There is no doubt about it: For-profit corporations are taking over the delivery of healthcare in America.

At first glance, this can seem like a good thing. The influx of investor cash makes everything look bigger and better. Offices get spruced up and slick websites that make booking appointments easier. Health systems tout efficiencies in their vertically-integrated models. Pharmacy urgent cares can diagnose and treat patients and in a one-stop shopping experience. This is excellent service, right? Not necessarily.

Corporations are businesses, not callings. Profit is the measure of their success. They’ve gambled on the idea that the market is demanding convenience, and they’ve invested in those systems. But what about quality? Do patients still want a standard of continuous care, empathy and understanding from a physician who knows them?

Consumers ultimately choose with their pocketbooks. Do they prefer convenience over quality? Sometimes. Younger and healthier patients, including those juggling careers and kids, just might. The lure of online appointment booking and one-stop shopping may be too enticing to ignore. These low-risk patients may be just right for a CVS Minute Clinic, where a nurse practitioner or physician assistant administers their care. But for more vulnerable populations, continuity of care from a trusted doctor is not a luxury - it can be a matter of life or death. These patients want to remain committed to their primary care physician. 

It doesn’t have to be entirely one or the other, though. In an era with significant physician shortages, especially in rural areas, there may be room for both. And private practices can learn something from the corporate approach to healthcare. 

If the world demands convenience, then it is important that private practice stay up to date. Private practices need modern, functioning websites so patients can easily use their smartphone to book an appointment or download forms in advance of their physicals. Online reputations must be properly managed and referrals sent electronically, for example.

Obviously, private practices don’t have the corporate cash to make major investments in modern conveniences. But in many ways, they can’t afford not to invest in themselves to improve patient care. After all, patient satisfaction is key to healthy, stable practices.

Fortunately, there are turnkey approaches private practices can use to help them in this digital age. There are also businesses that handle digital marketing and reputation management as part of a larger customer service support system.

Physicians and practic should explore their business relationships to make sure they are getting the most value possible out of them. Business relationships are symbiotic, and vendors should be adding services to support their clients whenever they can.

, and is one of the most experienced and successful executives in concierge medicine. He was formerly the COO for PhyMatrix, a public healthcare company; COO for Physicians Choice, a Connecticut IPA and practice management company; and president and principal of Richmond Way Stores, a local chain of drug stores that he operated for 20 years. 

Lipton graduated from Harvard College and attended the University of Chicago Business School and the Boston Architectural Center. 

Although far from perfect, private practices can learn something from the corporate approach to healthcare.

The balance between convenience and quality in private practice

The changes occurring in healthcare today put so much pressure on physicians that, at times, it seems we can only focus on the business aspect of medicine. With declining reimbursements and ever-increasing overhead, maintaining a stable and secure practice is certainly an overwhelming concern.  However, sometimes it’s rewarding to take a look at the human side of our work.

“National Doctor’s Day,” which was celebrated on March 30 this year, provides a great opportunity to showcase the important role physicians play in the lives of their patients.

We are fortunate to have a large membership to survey each year. The patients we serve provide touching and emotional insights into just how meaningful a personal relationship with their doctor is to their health, their life, and their general peace of mind. There is no substitute for a caring doctor who can take the time to know their patients and provide crucial care coordination and emotional support when they need it most.

To honor doctors who are making a difference in the lives of their patients every day, we’d like to share some comments from our concierge members:

“My doctor has been a wonderful lifeline during a year of so much heartbreak and stress. He monitored my physical wellbeing following my husband’s sudden death and spent time listening to me.  I have nothing but overwhelming praise for him.”

“I cannot express how very grateful we are for the instant care we received with a single phone call. My wife is terminal and my doctor is looking after us like the hand of God. Bless them both.”

“This year, I experienced a number of medical problems.  My doctor responded quickly each time and stayed connected until I felt better. Being able to reach him 24/7 probably saved my life.  It is expensive for me, but I can’t afford to be without it at my age.”

“I was recently discharged from the 30 days in the hospital that included three major surgeries in 12 days. My doctor saved my life and my sanity.”

“My doctor is very good about explaining everything to me. He takes time to listen! He gives me great peace of mind at my age-this is very important.”

“My doctor really saved me from a bad situation. She provided some key intervention when my old doctor couldn't help. She is very thorough. Most importantly, she is so compassionate and caring, and I value that.”

“Having my doctor advocate on my behalf while I was in the hospital two years ago probably saved my life.”

“I have really needed my doctor this past year. He has given urgent advice when we needed it. As my husband has had significant health concerns, I’m so thankful for his attention.”

“I could not be without this service for my brother, as he has special needs. It’s most comforting to know we get the same doctor each and every time and he knows my brother’s needs so well.”

“I am recovering from a serious and worrisome illness. My doctor and his nurse were there for me, even though I had plenty of doctors while in the hospital.”

“My doctor has been our doctor for more than 30 years. He is great-compassionate and very patient. I am a pancreatic cancer survivor of eight years thanks to his prompt diagnosis.”

“I have been a member for only a few months, yet right away I could feel how dedicated she is to her patients. She is compassionate, totally involved, taking as much time as needed, and will drive to the end to find the problem for her complicated patients. I also appreciate her extensive medical knowledge, so I can avoid trying one doctor after another, as was the case before. I am thankful to be under her care.”

“Doc knows me as a person-I’m not a social security number. He knows my medical history and listens to my complaints and has great empathy. I trust him completely. My husband is an MD and agrees.”

“She has been an extraordinary support to me. Her professional knowledge and support are outstanding. She is a blessing.”

“My medical care has been excellent. As I have Crohn’s disease, it is so reassuring to know that my doctor can coordinate all my medical needs. I have never met a more caring and compassionate doctor.”

When managing a practice gets so tough that you think you may just have to retire early or sell your practice, try to think about what you mean to the patients you serve. If your practice is struggling, remember that there are alternative practice models you can explore that tap into the value of the relationships you have spent so long cultivating.

ayne Lipton is managing partner for Concierge Choice Physicians, LLC, and one of the most experienced and successful executives in concierge medicine. Lipton graduated from Harvard College in 1973 with a degree in Biochemistry. He attended the University of Chicago Business School and the Boston Architectural Center. He was formerly a chief operating officer for PhyMatrix, a public healthcare company; chief operating officer for Physicians Choice, a Connecticut IPA and practice management company; and president and principal of Richmond Way Stores, a local chain of drug stores that he operated for 20 years.

When managing a practice gets so tough that you think you may just have to retire early or sell your practice, try to think about what you mean to the patients you serve.