Wayne Lipton

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. 

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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.

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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.

Author | Wayne Lipton

Articles

Concierge medicine and primary care: The differences

5 considerations for private physicians in 2020

The MIPS disappointment: Why physicians should consider alternatives

The balance between convenience and quality in private practice