I ride my bike to work (most days) and I have a very detailed path I take pretty much each day.  I ride down my street, turn right onto Mt. Washington Dr., which is one of Bend’s larger thoroughfares, and then I cut across into a neighborhood so I can get to the dirt trails that take me most of the way to the office.  It’s really a great ride, and I’ve never had reason to change it.  Until today.

It wasn’t  big deal at all, but today as I’m riding down Mt. Washington Dr. and getting ready to cut across and into the neighborhood so I can get to the trails, I couldn’t cross the street.  Not that there’s that much traffic on the road, but today there were just enough cars to strike me as impatient as I said, “[nuts],  I’m just going to keep going straight.”

Well I did, and guess what…I now have a new path to work.  I liked it sooooo much better.   A bit quicker, a bit safer, and it actually got me to the fun part (the trails) much faster than the old way.

So, like I said, not a big deal - but…

I improved my daily routine, not by choice, but by force (technically, I suppose you could call it impatience, but for purposes of this illustration let’s pretend that the traffic really did “force” my new route).  I immediately began to think about other times that my life or my career or my financial situation has changed for the better - not by choice, but by force.

A good example is Vantage.  This company didn’t start as a pipe dream while my partner and I were teenagers.  I actually didn’t get a promotion I was looking for at my hospital and my partner wasn’t advancing in his career as quickly as he wanted to, so we were “forced” to take our career into our own hands - and Vantage was born.  Not a bad change for our status quo.

Same goes for many of the private practices that exist out there.  Often times we’re dealing with all of the headaches of the healthcare industry and forget that we, and our clients, are being “forced” to change our status quo, and it isn’t always a bad thing.  Sure, the healthcare industry is far less than perfect, and while I’m not trying to imply that its warts are something we should cherish because they force us to become better, there is certainly opportunity to allow change to happen in a way that benefits our industry.

Here are a few of examples of the non-status quo happening in the healthcare industry, and I would guess that not one of them happened because the path well traveled was easy.

• Hello Health - Improved access to a physician through a variety of formats (office, house calls, email, IM, phone)
• Concierge Medicine - 24/7 access to physicians with greater emphasis on prevention, wellness, and personalized care
• Minute Clinic- Walk-in only care for busy and underinsured persons who want to know the costs of their care upfront
• Best Doctors - A collection of highly qualified physicians who provide second opinions when diagnosed with a serious illness
• Google Health - Online storage of health information and medical records for patients on the go

Patients are increasingly moved through a healthcare system unaware of the powerful market currents shaping the direction and costs of their healthcare. A moonscape of larger and larger behemoths of healthcare are slowly taking shape across America as more and more doctors succumb to the inevitable market forces intent on squashing the former entrepreneurial healthcare climate, resulting in fewer patient options for affordable healthcare.

Are you positioning your practice to fight against these “inevitable market forces”?  Are you looking outside “business as usual” for your practice to find ways to expand your revenue sources, decrease costs, and strategically plan for the future?  Are you preparing that inner entrepreneur that exists inside of you to allow your independent practice to flourish?  If not, your practice may just be gobbled up by hospitals or large groups.

I’m beginning to feel as though this next decade will see the end of medicine as we know it. The market forces have become too powerful to fight anymore.

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.

When consulting these individuals on building value into their business prior to exiting, we often discuss moving some income into investments for the business (i.e. savings, money market, portfolios, joint ventures, ownership in subsidiary companies, etc.)  We try to instill that these are strategies that need to be implemented well before that moment of exit so that when it does come time to sell the net worth of the business is substantial enough for someone to take a second look at.

On the list of investments provided above, I left out Real Estate.  Here is a recent post on the idea that Real Estate may be the most valuable item on the books.

In any small business, including running a physician’s office, the most valuable piece of your business is the real estate. Most people have heard the McDonald’s story of founder Ray Kroc, who believed that the most valuable aspect of McDonald’s was the real estate underneath each restaurant. For small business owners including physicians, getting a piece of the dirt underneath their business is essential.

Here are some of the key elements as I interpreted them based on my conversation with the negotiator.

1. Unique: If you are the only one of your specialty in a 20 or so mile radius, you may have some leverage.
2. Efficient: If you can save the insurer money by operating at a lower cost to them, such as by doing in-office procedures, or with less errors due to an EMR, you may be able to make a case for the insurer to cut you a piece of the action in return.
3. Desirable: If you are one of few doctors who does something that people want or need and will pay more to the insurance company for it in the form of premiums or plan selection–then the insurer may cut you into the action as well.

And, here is the summary for those (the majority of us) that don’t have these characteristics:

Therefore, don’t feel like you are the only schmuck on the block that takes whatever contract is offered you. If you live and practice in an over saturated market and don’t have one of the big 3 characteristics in my list, you simply must sign on the line and work like a dog.

Here is a good primer from Fortune Small Business on many of the different business structures available, diving into just the right amount of detail for a future practice owner who wants to learn some of the basics.

What exactly is an LLP? What’s the difference between an LLC and a corporation? What about S-corps and C-corps? Sorting through the legal jargon and tax codes defining these business structures can be daunting for entrepreneurs - but picking the right structure for your company brings vital tax benefits and legal flexibility.

This article from The Economist discusses the increase in intercontinental healthcare that’s being driven by market forces worldwide.

One motive is to save money. America’s health inflation has consistently outpaced economic growth, making it the most expensive health market in the world. The average price at good facilities abroad for a range of common medical procedures is, by Deloitte’s reckoning, barely 15% of the price a patient would have to pay in the United States (see table).

But costs have long been much higher in America than in poor countries, so this alone does not explain the new exodus. Two other factors are now at work. One is that the quality at the best hospitals in Asia and Latin America is now at least as good as it is at many hospitals in rich countries. The second, more worrying, factor is that America’s already imperfect insurance safety net is fraying.

Over 45m Americans are uninsured, and many millions more are severely underinsured. Such people may find it cheaper to fly abroad and pay for an operation out of their own pockets than to find the money for deductibles or “co-payments” charged for the same procedure at home. Arnold Milstein of Mercer, a consultancy, calls them America’s “medical refugees”.

For most small business owners, the productivity of each employee increases revenue. Whether the product is a widget or a hot-dog or computer software, the general concept of employee productivity is that employees increase revenue and the more revenue per employee the better. Thus as sales escalate to the point of needing another employee, the revenue from that person’s productivity more than covers his cost. Thus scaleable businesses typically have desirable business models.

In private practice medicine, revenue is dependent on the productivity of one person - the doctor. Hiring more employees does not increase his productivity. The only thing that can increase revenue is for the doctor to work harder and faster to see more patients or do more procedures. He is the rate-limiting step in the business model. This is the reason why your trips to the doctor’s office get shorter and shorter.

Check out the rest of this article here.

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And what about the kiosks that are now present at most airline ticket counters?  I’d be hard pressed to count the number of times I’ve been “trained” in the last year by ticketing agents on how to use the kiosk to speed up my check in time.  The kiosks work (most of the time) and I actually like the convenience of anonymously speeding through the terminal without having to talk to the ticketing agent.

So why not in healthcare?  I mean, credit cards and kiosks probably aren’t for everyone, but I bet they would work for a lot of people, especially when you’re trying to speed up the amount of time you spend in a place like a hospital or medical clinic.  Imagine a small credit card that stored all of your insurance and general information, and allowed you to check in by simply sliding it through a terminal - no clipboards, no rotten strings holding slightly chewed pens, and no waiting in line twice (once to get the paperwork, an once to turn it in).

Probably has a ways to go, but I bet it’s where we’re all headed.  Check out this Indianapolis-based healthcare system that introduced it’s card and kiosk system this month in an effort to put it’s patients in more control of an efficient and error-free check in process.

The service, unveiled Wednesday, offers a variety of free tech tools to patients who sign up to receive a credit-card-sized “myCommunity” card. The service features express check-in kiosks (similar to those at airports) to be installed at Community North first, then throughout the system eventually. Patients will swipe their myCommunity cards and use touch screens to complete the inpatient and outpatient check-in process.

“It involves the way people are going to interact with health care in the future,” said Daniel Rench, vice president of e-business for Community Health Network, which operates five hospitals and numerous other health facilities in Central Indiana.