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Concierge Medicine is Hard, Don't Go at it Alone


Don't make the mistake of starting an alternative payment program without doing your research first, warms a healthcare consultant.

Anyone who runs a business knows that outside vendors often provide an economy of scale that cannot be matched within their own company. In a medical practice, where patient care cannot be sidelined under any circumstances, outside vendors can be even more important. Staff needs to remain focused on core responsibilities, not hung up on time consuming tasks that are outside of their skill set. For example, medical billing is practically an art form these days, and many practices choose to outsource this part of their business. With electronic medical records (EHRs) and HIPAA compliance issues, practices typically outsource IT as well.

Still, in today's medical practices, every penny counts and no doctor wants to outsource what can be effectively handled from within. 

Knowing when to rely on staff and when to outsource is tricky. Can existing staff members, who are already stretched thin, effectively sell a new service to patients? Can they introduce it properly, bill and collect for the service, and maintain it on an ongoing basis? Is it practical to expect them to?

After nearly a decade and a half working with physicians from coast to coast, we see the unfortunate cost that medical practices pay when they try to do certain things alone, without the support of experienced, outside professionals. 

Many physicians believe they can start their own concierge medical program or direct-pay program.  After all, they have a robust patient panel, a smart and dedicated practice manager, staff that is committed to excellence, and a well-oiled billing service. So, the doctor researches similar programs and decides to send a simple letter inviting patients to join.

Suddenly, the doctor is tangled up in problems that were not anticipated. There is more to creating a membership model of care than just getting patients who are willing to pay. 

Each state has unique regulations with regard to membership models and government programs.  Insurance plans are prickly too. There are very specific ways that a membership program can be marketed, very important distinctions that need to be made when communicating with patients and violations of these regulations could result in disaster. What if the doctor lost the ability to participate in Medicare? What if the leading insurance plan dropped the doctor? What would the practice look like?

Beyond the legal ramifications, is the doctor certain about the kind of program being introduced and the level of success that can be expected? Most doctors report an excellent relationship with their patients, yet behavioral science tells us that self-reporting is dicey. It's critical to have an independent, third-party analysis of the practice and the patient demographics, along with an in-depth survey of patient attitude and physician attachment.

Without this critical data, it's anyone's guess how well a membership model will perform. Is a doctor really ready to make this kind of transition with blinders on? 

On a more practical level, have you ever tried to purchase an important and expensive item from a salesperson who lacked confidence and couldn't communicate benefits properly? Selling is a skill-that is why there are professional salespeople. Practice managers, receptionists, medical assistants, and PAs are trained to manage patient care-they are not trained to sell. If a physician puts the burden of sales on a reluctant front desk staff, what kind of opportunities will they be missing out on?     

The issues don't stop there. How will a physician know how to price a program, and what to include in the price? What about the development of marketing materials and websites? Who will handle the extensive billing and collections that come direct from patients, not insurance plans? Will there be limits on the kind of payment plans patients are offered? What will that lack of flexibility cost a doctor in terms of memberships?

Whether they are large or small, medical practices simply cannot do it all. Membership medicine is a niche market and, like other areas of business, it's best to rely on the expertise of outside professionals with a proven track record of success. Over the years, we've received many "SOS" calls from disappointed physicians who launched programs on their own and are realizing the consequences and missed opportunities, don't let your practice be next.  

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