Archives : entrepreneurship

More physicians leave private practice

I was recently interviewed for an article which was published in the Carolina Journalism Network, titled “Physicians move out of private practice,” a story by Laura Montini.  The interview was prompted by an article I wrote for The Healthcare Entrepreneur Blog titled, “Time to throw in the towel on private practice…or is it?”

Click here to visit the article (excerpt below).

As an advocate of entrepreneurship, Quatre said that doctors should not lose hope on keeping their private practices afloat.

“When the owner of a practice has a vested interest in seeing the practice succeed, that’s an equation where incentives are alive in a way that has a real natural benefit to the community,” Quatre said.

There is still a place for more entrepreneurial practice owners in health care, he said.

“It’s not time to throw in the towel.”

Via: Physicians move out of private practice | Carolina Journalism Network.

Time to throw in the towel on private practice…or is it?

I don’t buy it.

An article in the New York Times today titled, “More Doctors Giving Up Private Practices,” told the story of an increasing number of physicians who are finding their “bliss” through employed, salaried positions, rather than at the helm of their own private practice.  The reason – increased costs, decreased pay, and ultimately unhappier doctors in the private practice environment.  Again, I don’t buy it.

The article spoke of the increasing financial burden on physicians who, in order to keep up with the demands of today’s healthcare arena, must invest heavily into expensive electronic medical record systems (EMR) and practice management softare (PMS), along with the staff required to collect payment from a growing number of patients who lack the financial wherewithal to pay their bills.  Sure, the challenges are real, but it’s still bullhonkey.

The silver lining in this shift toward larger, safer, and inevitably more monopolized healthcare practice – if there is one – the article goes on to say, is the continuum of care that is far facilitated by larger, more integrated systems which employ large numbers of physicians from a variety of specialties.  Not convinced.

The Medical Group Management Association (MGMA) reports - according to the article - that in 2005 more than 67% of medical practices were physician owned, however three short years later this number had dropped to below 50%.  With admitedly disturbing facts such as this, and the industry knowledge that is near and dear to my heart – that private practice owners are, in fact, struggling in pockets across the country – how could I possibly scoff at the fact that an article in the New York Times suggests that quite possibly it is time to throw in the towel by the physician masses?

Because it’s short sighted, cowardly, and undermines the creative and entrepreneurial fabric from which many of our country’s greatest practices are woven.

In a nutshell, it’s the wrong way to go.

I’ve been around healthcare my entire life, and my professional career has known nothing else.  I care deeply about people, and understand that passion, freedom, autonomy, and creativity are the inspiration behind the greatest care that our country can offer.  I also understand that in order to attain autonomy, passion, freedom, and creativity requires risk, hard work, and often times, failure.

I’ve worked salaried positions and have spent much of my life in a risk averse bubble, looking fondly at the status quo and fearing anything that risked upsetting it.

But I’ve also lived the other side.  The side that guarantees nothing, but promises everything.  The side that allows me to be exactly who I’ve been created to be, and to relish in failure as it is a means by which I will improve my service to others.  It is this side about which I am passionate, and about which I know I can change my life, the lives of others, and through my current mission with Vantage Clinical Solutions, change healthcare.

I don’t think the healthcare industry is going to benefit from bigger companies who can promise the world to its salaried professionals, while placing handcuffs on the passion and creativity that comes only with the ability to chart one’s own professional course.  I don’t think the continuity of care is going to suffer if small town doctors have to refer to one another rather than down the hall in order to provide the specialty care that is needed of their patients.  And I don’t think that failure is inevitable to those who try to make it work.

There are challenges, yes.  We, at Vantage Clinical Solutions help private practice owners deal with them everyday.  We feel the pressures of the economy just like the next guy.  The difference is that we see the challenges as an opportunity to look to entrepreneurship, creativity, and innovation as the tool from which our problems will be fixed.

We understand that the “corporate” way which benefits from huge economies of scale and infrastructural efficiencies does indeed have merit – but more importantly we know that it is not the only answer.  We work with numerous private practice owners every day who are delivering healthcare their way, doing it profitably, and changing their patients’ lives in the process.

At the risk of belaboring my diatribe of a post, I do want to make clear that I understand that entrepreneurship indeed is not for everyone, and the thousands upon thousands of professional, caring, and excellent healthcare providers who do thrive in the corporate, structured environment, need not change a thing.  Indeed, consolidation and centralization is a viable solution to many of the challenges we face in the healthcare industry.

My point, however, is to suggest that it is not the only solution, and to those who’s fuel does come from a burning passion to create, be different, and deliver care in their own way – bear down and get after it.

The system that the NY Times article speaks of is not for you.

Where do the entrepreneurs come from?

Ever wonder where the entrepreneurs are coming from?  The 2008 State New Economy Index says it’s in the Northeast, mid-Atlantic, Mountain West, and Pacific.

The 2008 State New Economy Index indicates five states—Massachusetts, Washington, Maryland, Delaware and New Jersey—are leading the United States’ transformation into a global, entrepreneurial and knowledge- and innovation-based New Economy. The report was released by the Kauffman Foundation and the Information Technology and Innovation Foundation (ITIF) during Global Entrepreneurship Week, an initiative to inspire young people around the world to embrace imagination, innovation and creativity.

via 2008 State New Economy Index.

Top 10 creative souls in health care | Fast Company

We love creativity and innovation around here…and here we simply tip our hats to Fast Company’s Top 10 Most Creative People in Health Care.  Keep a-changing the health care world as we know it fellas. 

Congratulations, and thank you.

Vantage Clinical Solutions

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Tannus Quatre PT, MBA is a private practice consultant and principal with Vantage Clinical Solutions, Inc., a nationwide healthcare consulting and management firm located in Bend, OR and Denver, CO.  Tannus specializes in the areas of healthcare marketing, strategy, and finance, and can be reached through the Vantage Clinical Solutions website.

How do you change the status quo? By forcing it out.

I took a new path to work today.  Not by choice, but because I couldn’t cross the street.

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

Concierge medicine course presented by Vantage Clinical Solutions, Dr. Steven Knope

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.

The hostile takeover of medicine: An entrepreneurial response

Introduction by Tannus Quatre PT, MBA

It pleases me to welcome Dr. Steven Knope to The Healthcare Entrepreneur.  Hailing from Tucson, AZ, Dr. Knope is board certified in internal medicine and has owned his own practice in the Tucson area for several years.  Dr. Knope is considered by many as one of the pioneers in the area of concierge medicine, and has been referenced and featured by a number of news organizations for his efforts and accomplishments in this area. 

Dr. Knope recently authored the book, “Concierge Medicine: A New System to Get the Best Healthcare,” a publication dedicated to sharing with both physicians and patients a history of the concierge medical model as well as the practical aspects of the model that can be used as an alternative to the traditional 3rd party payment system (learn more about Dr. Knope here).

Dr. Knope is a true healthcare entrepreneur, and will author a series of posts on The Healthcare Entrepreneur about the benefits of entrepreneurial business models within the healthcare arena, and specifically the viability of concierge medicine.  Please enjoy reading the first post in his series below.
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The Hostile Takeover of Medicine: An Entrepreneurial Response – by Dr. Steven Knope

Fifteen years ago, after graduating from Cornell Medical College and completing my residency at UCLA, I settled into private practice with five other internists in Tucson, AZ. After only a year, I knew I could not continue.

I was too independent. I quickly learned that I was not employable. As I talked with my colleagues about opening my own practice, I received many warnings. They said I was “too idealistic.” They said that by striking out on my own, I would be losing the protection of the pack. They projected that I would soon be eaten by the corporate predators – the third-party payers who controlled their lives.

All around me, doctors were forming larger groups and capturing a greater percentage of the “market share of patients,” all in an attempt to maintain some level of control at the bargaining table. Instead of defending their profession on their own terms and focusing on their mission of patient care, they tried to hire their own corporate foot soldiers to do battle in the business arena.

Stating the obvious, this strategy was doomed to failure from the beginning. Over time, it has not been successful in putting doctors back in control of their professional lives. It has been disastrous for patients. Doctors were outflanked by their opponents. Their office managers squabbled pitifully over minimal increases in reimbursement rates from insurance giants and Medicare.

They got bogged down in small, meaningless battles as they slowly lost the war. Meanwhile, physicians in these large groups seemed willing to accept the fact that their patients were getting precious little of their time and less than optimal care. The quality of their “product” in this business model (patient care) was deteriorating.

Most new problems, like our current healthcare crisis, are at their core, old problems with a new face. Here is the age-old problem that doctors faced: One of the basic rules of nature is that as soon as you have something worth taking, someone is going to try to take it from you. It’s just that simple. This rule applies to hyenas prowling the Serengeti, and it is true for predators in the medical marketplace. Business predators realized that there was a lot of potential cash to be made if they could morph the old Marcus Welby-style of medicine into a Wal-Mart model. The brand without the goods.

They first made a deal with the employers, who paid for much of nation’s expensive healthcare. They sold the idea that they could limit rising healthcare costs and manage “greedy doctors.” Having made the sale, they soon controlled large panels of patients. They then moved on the Medicare arena and offered to take some of the administrative load off of Uncle Sam. Controlling the healthcare dollar, they could now manipulate doctors at every level, essentially stealing doctors’ medical practices and forcing them into employment relationships. Physicians were no longer doctors; they were “providers.” Is this evil? Maybe, but it’s just what predators do: the frog must recognize a scorpion for what he is.

As a practicing martial artist, I seek to recognize the world’s ethical people. However, I also fully accept the fact that there are predators and scorpions on the planet; people who would just as quickly cancel the insurance policy of a sick child as they would throw a half-eaten sandwich into the dumpster. Years of fight training have taught me how to survive a battle brought by a predator: I had better fight smart.

So I urge private practice physicians – Play to your strengths. Make your opponent do battle on your terms.

If you want to lose a fight, battle on your opponent’s turf. Follow his rules. This is the mistake that doctors made. They tried to play the game of big business against a giant that they didn’t understand, using his rules.

The way to beat the third-party payers is fundamentally easy: opt out of his system. Walk off of his battlefield. Stop.

What most physicians fail to realize is that healthcare predators have no weapons other than intimidation. They are not licensed to practice medicine. They cannot operate without doctors. By contrast, doctors don’t need third party payers. As primary care physicians, we do NOT need the third party payer to treat the sick or to make a living. The patient/consumer does need one valuable service offered by insurance companies – namely catastrophic healthcare coverage – but there is no reason why every dollar in the healthcare system must flow through their hands. There is no reason why the patient cannot, or should not, pay the doctor directly for his services. This is what is being done in the concierge medicine movement across this country. It is not a pipe dream. It is not complex. It is both an effective and simple way to deal with the predators.

It is now quite clear that patients who are dissatisfied with the present system are willing to pay their doctor directly for more time and access.  Concierge medicine is very much a consumer-driven phenomenon. Doctors who are willing to respond to this market can change the rules of the game, without any change in the law or the need for any governmental intervention. Primary care physicians can return to focusing on patient care. They can increase their income to a level commensurate with the demands and responsibilities of their calling, and regain control over their professional destiny.

How do I know this is possible? In the year 2000, after dropping all of my HMO contracts, I opened one of the first concierge practices in the country in Tucson, Arizona, which was ground zero of the for-profit HMO movement. At the time, I was one of a few doctors in the country experimenting with this model. Today, there are approximately 1,000 doctors engaged in direct financial relationships with their patients. The genie is out of the bottle and he is not going back in.

Many believe that a “nationalized healthcare” system is the only way to solve our current healthcare woes. However, make no mistake about it: We Americans are not socialistic at heart. Nothing else we do involves socialism. We are uniquely free-market driven and an independent breed. Our people will not tolerate a mediocre, socialized medical system, regardless of political stripe.

Like all freedoms, the freedom to practice medicine the way that doctors want to practice medicine comes at a price. If physicians are currently experiencing taxation without representation, it is time to dump the tea into the harbor. There are times when fighting is appropriate and necessary, to defend what is dear to us.

If doctors want medicine to be reformed, they must take back their own profession, one practice at a time. Unless we are willing to pay the price for professional freedom, we will be at the mercy of those who wish to subjugate us and subjugate our patients for their own profit.

Vantage in the news: PT Magazine

Last month, Vantage was featured on the cover of PT Magazine in an article that focused on the topic of “healthcare consumerism.”  Healthcare consumerism is the shift toward the treatment of patients as “consumers” of their healthcare services, rather than simply passive recipients in their care.  As a result, the focus of many [smart] private practice owners is on the development of services and environments of care that will create loyalty and satisfaction among their patients.

Here is a link to the article - Thank you to PT Magazine for their coverage of such a relevant topic to today’s healthcare environment.

In traditional industry, says Quatre, businesses compete for customers by either lowering prices or improving product quality-say, by building a better widget. “In health care it’s much different because you can have a different service based on your training, your staff, your expertise, and so forth, but can you charge more for that because the quality’s a lot better? Your hands are tied to some extent, unless you’re on a strictly cash-based model. To compete for the customer, what you really need to do is make it an experience with which they would prefer to be involved.”

Independence day in healthcare: Are we really free?

Everyone loves a holiday.  Thanksgiving, Memorial Day, the Fourth of July…most of us get a day off and enjoy spending time with family and friends.  I know I do (except, of course when the family is out of town and I choose to spend the day blogging instead of watching the Fourth of July pet parade).

As cool as they are though, holidays are like just about everything else that’s good in life – they soon become taken for granted and the true meaning they were originally intended to bring soon play second-fiddle to what we’ve made of them.  The Fourth of July is no different, but today I did want to take a step back from the fireworks, put the watermelon down, and comment on the concept of freedom in America, and how, if at all, this impacts the healthcare industry (believe me, I’ll get to the fireworks and watermelon a bit later).

We often hear about “freedom” and “independence” in America, and how the “land of the free” is one of the most sacred constructs of our way of life in this country.  I agree that it is.  We are free to choose how we live, free to go where we want to go, and free to do what we want to do.  Freedom really is a pretty cool thing, and even though many of us prefer a cold beer and a hamburger on Independence Day rather than a deep discussion about our founding fathers and the Declaration of Independence, I think it’s OK as long as we’re living “freedom” and “independence” in our everyday lives, providing living testimony to the significance of our freedom.

Living “free” has many benefits, and has allowed our country to evolve into the technologically advanced and economically powerful force that we are today (Did I just say that?  Give it a couple of years, we’ll swing back around).  Living free allows us to express ourselves creatively and try new things, hoping to improve ourselves and others through an endless pursuit of the biggest, the brightest, and the best.  And while many fall down in their pursuits (I know I have), we as Americans are free to stand back up, try again, and get it right the next go around.

Now, freedom, as great as it is, is an interesting concept as related to healthcare.  In my opinion, there’s no other industry in which freedom should play more of a role – innovation, creativity, compassion, progress, and many other by-products of freedom form the cornerstone of the healthcare industry, allowing us to care for each other, improve the quality of our lives, and form the foundation for future generations of healthy individuals.  The problem is, this isn’t the way it works.

Unfortunately, the healthcare industry is far from “free.”  On the provider side we don’t have the freedom to choose the treatments that we know will help our patients because they aren’t reimbursed, we don’t have the freedom to spend the time we need with our patients because we need to see large volumes in order to keep our doors open, and we don’t challenge the system with new business models and delivery methods because of fear of professional fallout and failure.  On the patient side we don’t have the freedom to choose our providers because they aren’t part of our insurance plan, we don’t have the freedom to leave our employers because they insure our health, and we don’t have the freedom to work as a team with our providers because they don’t have the time to spend with us.  Doesn’t sound too “free” to me.

So, what’s the answer to this apparent lack of freedom in healthcare?  Well, I think it’s entrepreneurship.  I think we need to spend more time evaluating the drivers of good healthcare, and how to align the incentives of our healthcare business models with those of our patients (our “customers”).  I completely understand the argument that there are many who will fall through the cracks in a system that doesn’t provide a safety net – I get it, and I agree.  I don’t agree however that the safety net should effectively reduce the “freedom” of our best and brightest to find new, more efficient, and more profitable ways to deliver healthcare to our country – entrepreneurship as I would call it.

There’s not a simple fix to the healthcare problem in America, but I firmly believe that innovation and creativity is the foundation from which the tides will begin to turn.  Much of our freedom has been lost in the healthcare industry, but the good news is that getting it back is not as far off as one might think.  Making the decision to say “no” to insurance companies that won’t allow you to provide good care and deciding that you will find a way to be profitable using new, perhaps even untested business models in your area is a profound, but good first step.  There are many great new models of care out there that may or may not work change healthcare as we know it.  But my hat is tipped to all that are trying something new in an effort to be “free” and to improve our system through innovation, creativity, and entrepreneurship.
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Tannus Quatre is a passionate blogger and writer, as well as a principal/consultant with Vantage Clinical Solutions.

Vantage in the news: The Bulletin

Vantage was featured today in The Bulletin newspaper.  Here’s a link to the article which goes into detail about our services as well as a Q&A regarding how we position private practices for various economic conditions – Thank you to The Bulletin for the profile of our company.

The single best way we help medical practices originates directly from our mission statement, which is to “improve health care through entrepreneurship.” We believe that entrepreneurship has a vital role in health care, especially in today’s economy. … We always start with an entrepreneurial foundation with our client to make sure that they are heading in the direction of optimal opportunity for their practice and their community. This applies whether we are consulting, managing or helping finance a health care practice.

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