Vantage Clinical Solutions is proud to partner with author and concierge physician, Dr. Steven Knope to present a one-day workshop dedicated to the concierge medicine model (also known as retainer medicine).  The workshop is titled, “Become a Doctor Again: Making Concierge Medicine Work for your practice,” and is intended for primary care physicians who are interested in learning about how the concierge medicine model works, how to determine when concierge medicine makes a viable business model, and how to ultimately transition a current medical practice to the concierge, or retainer model.

The concierge medicine workshop will be held Saturday, November 15th from 8am - 4pm in Phoenix, AZ at the Doubletree Phoenix-Gateway Center.  Early bird registration is $595 (received by October 17th) and regular registration is $695 and must be received by November 7th.  Registration is available online by clicking here, and phone/fax registration is also available.  Phone: (888) 827-5613/Fax: (541) 550-7356.

Dr. Steven Knope is the author of “Concierge Medicine: A New System to Get the Best Healthcare” and has owned his own concierge practice for 8 years (click hereto visit Dr. Knope’s website).  He is a pioneer in the area of concierge medicine and is cited frequently by publications and news agencies on the topic of healthcare trends, including the role that concierge medicine plays within our current healthcare arena.

Vantage Clinical Solutions is proud to partner with innovative practice owners and leaders such as Dr. Knope to educate and mold the healthcare landscape through the use of entrepreneurship, creativity, and innovation.  We encourage primary care physicians who are interested in learning more about this innovative trend in healthcare business models to take this opportunity to learn from this dynamic and pioneering physician.

We’ve blogged a lot about the primary care shortage in America (read a few posts about it here and here and here…and here) and the resulting impact this is having on patients who are looking for a primary care physician and can’t find one.  But this is only one impact the shortage is having on the healthcare economy.

There are many primary care doctors who have made the choice to stick it out and remain “cognitive specialists” in a failing system, and while it is a struggle, many find a way to survive.  There is strength in numbers though, and the ability for primary care physicians to stick together, recruit, and partner together to tackle the challenges that are thrown their way is reaching a tipping point whereby the numbers aren’t there to support a group approach to primary care practice - there simply aren’t enough doctors, especially in rural and underinsured areas.

Read more in the Baltimore Sun about a report released by the National Association of Community Health Centers on the topic.

When his colleague departed in December, family doctor Charles Bennettthought he would soon find a new partner for his private practice in Lusby. But he has had no luck for the past eight months.

“I’m still trying to find someone, but I don’t think it will get any better in the foreseeable future,” said Bennett, whose Calvert County practice employs four staff members. “The process is very time-consuming, and I am already very busy as it is.”

Bennett’s troubles stem from the fact that the United States faces a serious shortage of family physicians, especially in rural and poorer communities. There are too few primary care doctors and nurses to meet growing health care needs, according to a report released yesterday by the National Association of Community Health Centers. The study found availability depends on location.

How’s this for a healthcare policy trifecta? - Gift bans for pharma reps, $25 million in EMR incentives for private practices, and university requirements to boost primary care graduates.  Three big issues in healthcare today…one clean law to deal with them.

Tackling major issues in healthcare policy isn’t easy, and tackling three large ones with one fell swoop is quite ambitious.  Pushed forward by Senate President Therese Murray, the new Massachusetts law was signed into law yesterday by Governor Deval Patrick.

The law is just the beginning however, and much more planning will be required to achieve what the law intends over the coming years.  Read more about the law at the Boston Globe.

Patrick’s Human Services Secretary JudyAnn Bigby said that while universal health insurance is an important goal, the current system is lacking if everyone cannot get access to quality care, or premiums and out-of-pocket costs become too costly for patients.

“We have to make sure that people have access to high quality care and that we are being efficient in the way we pay for that care and that we are paying for the right things,” Bigby said in an interview. The law Patrick signed yesterday “puts the challenge to those of us who have to implement it to do more planning.”

This article in USA Today reports on a trend reported by the CDC regarding the frequency of visits to the physician’s office.  The CDC reports that visits increased 26% between 1996 and 2006, the same time period that experienced an 11% growth in population.

The reason?  An aging population.

Juxtaposed against this information from the University of Missouri which predicts a shortage of 44,000 primary care physicians by 2025 (I blogged about this recently in a post about supply in demand in healthcare here) and we’ve got a problem on our hands.

Time to get crafty with our access points into the healthcare system…

The aging of the U.S. population is translating into many more visits to doctors’ offices and hospitals, a reality that is taxing weak spots in the health-care system, according to a government report released Wednesday.

Boston’s mayor announced an innovative service to help residents find primary care physicians in one of America’s oldest cities: a telephone referral service staffed by city workers.  A concierge health desk of sorts, the calls will come in through the mayor’s health line and attendants will provide callers with a list of primary care physicians who are accepting new patients.

The primary care referral service is a result of outrage by Mayor Thomas Menino in response to the primary care crisis in Boston, whereby many sick patients are unable to find physicians.  It appears that the retail healthcare movement in Boston spurred recent concern by the mayor over the “allowing of retailers to make money off of sick people.”  (Read more about retail clinics here and here)

An innovative idea, the primary care referral service is not the only card up the mayor’s sleeve.  The mayor is also considering the feasibility of requiring medical institutions to subsidize housing for primary care physicians in order to lure them into the city. 

The primary care crunch has been in the works for a while now and there isn’t a clear end in sight - in fact it’s looking like it’s going to get a lot worse before it gets better.  Hats off to some healthcare innovation out of one of America’s most historic cities.  Click here for a link to the article on Boston.com.

“One of the most important things we need to do as a city this rich in resources is make sure that all of the residents, particularly those who are most vulnerable, have really good access to primary services.”

If the “it” is e-medicine, and the “they” refers to patients, the “build it and they will come” strategy doesn’t necessarily apply - not without a bit of work, that is.

Readers of this blog will know that we support efforts to challenge normative business models in the practice of healthcare, including those that incorporate the use of the Internet to communicate and interact with patients (here are some posts about Jay Parkinson and the use of e-communication in medicine).  We don’t know exactly what the practice of healthcare is going to look like in 20 years, but the Internet will definitely play an increasingly important role in the future - and we will be there to greet it.

Many of the healthcare providers that are using the Internet to provide care to patients today will someday be acknowledged as pioneers that helped to shape the evolution of the industry, regardless of whether or not their efforts were immediately successful in today’s healthcare economy.  One of these pioneers, Dr. Ben Brewer, has developed a savvy and secure electronic interface for patients of his Illinois medical practice - one that helps define “cutting edge” e-medicine in today’s largely status quo healthcare economy. 

The problem is - patients aren’t interested.  It’s a common problem in business, where great products in the absence of interested markets do vastly worse than decent products in ripe markets.  Dr. Brewer likely has a great service, but if patients aren’t interested in (more likely, not ready for) it, it’s not going to sell, and the doors will have to close if changes aren’t made.

The key to selling “cutting edge” services, especially in healthcare, is to make sure a market exists that will demand the service, and if no market exists, create the market yourself through a combination of customer education and market hype.  This takes a lot of work to do, and though it may be too late to pay off for Dr. Brewer, there will likely be no shortage of opportunity to introduce cutting edge services into the healthcare market in the coming years.

The Wall Street Jounal’s Health Blog recently commented on the fate of Dr. Brewer’s practice:

Brewer counts himself among the minority of doctors willing to take the online plunge. “Most doctors I know seem unwilling or unable to make even email part of the way they practice medicine,” he writes. Legal worries and data overload are the deterrents.

At Brewer’s office the technical end works as promised, but patients don’t really seem interested. They don’t want to pay the (usually unreimbursed) $30 for the online visit with Brewer, and they’d rather just send a regular email, even though it’s vulnerable to snooping.

I came across this great post by Peter Levinson on the Medical Practice Business Blog in regard to the future of physician practices.  The post is from 2007, but the principles remain the same and it is a good, quick read that summarizes the major issues and objectives faced by medical practices and physician clinics.

If you read this blog regularly, this won’t be the first time you’ve read a post about the growing trend in medicine that favors reimbursement for procedures over time spent with patients, regardless of how important or necessary that time is to the overall plan of care.  As the leader of many trends in medicine, Medicare is the driving force behind this direction our reimbursement system is taking, and there isn’t an immediate end in sight.  This article from the Wall Street Journal explains how this trend is reducing the availability of needed specialty care in the United States by providing a disincentive for medical students to pursue specialty areas that rely on cognition rather than procedural expertise.

A discipline built on spending time with patients to gather clues for a diagnosis, neuro-ophthalmology could become another casualty of a medical payment system that favors high-tech procedures over low-tech exams. The median income of a neuro-ophthalmologist at a teaching hospital is $200,000, according to the North American Neuro-Ophthalmology Society. That’s a third less than most general ophthalmologists, who undergo less training but can see more patients, and do more pricey procedures, in a given day.

Many in health-policy circles have focused on how the current health-care payment system is helping create shortages among primary-care doctors, internists and others on the front lines of medicine. But often lost is how the system is endangering some of the country’s most highly trained specialties as well.

Endocrinologists, rheumatologists and pulmonologists — specialties that also don’t involve performing many procedures — face acute shortages. Many of the severest deficits affect children. Though nearly 300,000 children in the U.S. are diagnosed annually with juvenile arthritis, lupus or other complex rheumatic diseases, there are fewer than 200 pediatric rheumatologists to take care of them, according to the U.S. government’s Health Resources and Services Administration.

Solo provider medical practices in Canada are having a tougher time making money than their multi-provider facility counterparts, according to NRM’s Survey of Medical Practice 2007.  The study indicated that physicians in group practices achieved net profits 400% greater than physicians practicing in solo practice facilities. 

An inability to benefit from economies of scale as well as government incentives that benefit multi-specialty practices are cited as the primary reasons for the discrepancy in profits.  This article from the National Review of Medicine, a Canadian medical practice journal, explains.

Part of the reason for the decline of solo practice is the simple reality of economies of scale: buying in bulk saves money. Group practitioners, because they can share some costs, typically have lower overhead for things like rent, office maintenance, staffing, office and medical supplies and technology support.

But the trend towards group practice is largely attributable to the slew of hard-to-resist incentives that governments are using more and more to encourage physicians to practise in collaborative, group settings. It’s simply becoming less and less financially rewarding to run a solo practice instead of joining a group.

A medical practice business plan is fundamental to the financial success of any medical practice, regardless of whether the practice is a small physician clinic or a large multi-specialty facility.  A good business plan is both a guide and a tool that should be used to plan, communicate, improve decision making, and attract talent; all of which are critical to the success of medical practices and healthcare clinics.  This guide will serve as a brief resource used to create a medical practice business plan, speaking to a number of key components that should be included in the business planning process: mission and vision, objectives, company, market analysis, marketing strategy, exit plan, and financial projections.

Mission and Vision
Defining a mission and vision is the most fundamental step in creating a longstanding medical practice.  Simply stated, the mission of a medical practice serves as the most elemental definition of what the practice intends to do, and why it exists.  Good mission statements are easy to understand, to the point, and meaningful.  A mission should be practical as well, used to assist in the decision making process when a medical practice considers expansion, joint ventures, or other shifts in practice operations.

The vision for a medical practice outlines what the future should look like.  The question, “What do I want this medical practice to look like in 5 or 10 years?” helps to bring clarity when identifying a medical practice’s vision.  A vision can be complex and intricate, or can be more vague and esoteric depending on how it will be used.  It is important to note that if the vision is not clear enough to help provide direction to the medical practice however, it may not provide the necessary guidance that should be found in this important section of the medical practice business plan.

Objectives
In contrast to the mission and vision for a medical practice, objectives must be clearly defined, measurable, time-based, and integral to the success of the medical practice.  Objectives are often outlined in 1-year, 3-year, and 5-year increments, but they can be defined for any time frame pertinent to the exact business plan at hand.  Meaningful medical practice objectives are usually relevant to the financial health, efficient operations, and quality of care of the medical practice.

Company
The company section of a medical practice business plan discusses the detail behind the history of the medical practice, the ownership structure, staff members, clinical specialties, and overall operations that constitute the day-to-day existence of the medical practice.  A good description in this section often helps to clearly communicate the general operations of the practice, as well as the community benefits that are achieved through the care that takes place at the medical practice.

Market Analysis
One of the most important elements of the medical practice business plan, a comprehensive market analysis provides justification for the existence of the practice within the community.  A good medical practice market analysis includes an understanding of the market demographics, competition, sources of payment, referral sources, and clinical need; all of which combine to support the services provided by the medical practice.  Red flags in any of these areas may be cause for considering adjustments to services provided, populations served, or location of the medical practice.

Market Strategy
If the market analysis supports the potential for success of a medical practice, there is still the need to define a specific strategy that will open the pipeline of patients to the front door of the practice.  In the medical profession, this pipeline revolves heavily around the existence of a referral network, however the most successful medical practices also execute a clear and consistent general marketing and branding strategy in order to “widen” the pipeline through name recognition and brand awareness.

Exit Plan
Though sometimes difficult to think about during the planning phase for startup or new growth, an exit plan should always be in sight, and should align with the overall business objectives identified earlier in the business plan.  Lack of a defined exit plan leaves much room for ambiguity and unclear decision making in regard to potential partners, mergers/acquisitions, joint ventures, or other important possible exits that are presented over the years.  A good exit plan will include a number of contingencies for possible scenarios that may unfold, both good and bad.  Remember that not all that happens in the operation of a medical practice is expected, and knowing when and how to exit in response to a number of scenarios will improve the likelihood that a practice owner will be able to extract value from their hard earned investment upon exit.

Financial Projections
After all of the previous sections of the medical practice business plan are defined and documented, the business plan elements must be integrated into a comprehensive and articulating picture of how the numbers will flow through the medical practice.  The culmination of a well crafted business plan, financial projections provide the actual roadmap to be used to guide the practice on a monthly, quarterly, and annual basis.  At a minimum, medical practice financial projections should include one to five year profit and loss and cash flow projections.  Good projections will also include an analysis of key ratios and metrics, benchmarked against industry standards.

Conclusion
There are many elements that should be included in the creation of an effective business plan, and it is important that the medical practice owner think through and document their plan according to those elements that are most crucial to the success of their practice.  The elements described in this article have served as the framework for the creation of many business plans specific to the healthcare industry, and provide a solid foundation for considering the important aspects of building a successful medical practice.  Know that it is the time and energy that is applied toward the creation of a comprehensive business plan that is of the most value, and the better the analytics and forethought that goes into a business plan, the better the end result.

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Vantage Clinical Solutions is a private practice consulting, management, and financing firm that specializes in business planning, marketing strategy, and financial analysis for small to medium-sized healthcare practices nationwide.