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

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.

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.

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.”

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 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.

We understand the business of healthcare.  Well, at least we think we do.

From our perspective, “business” has a role in healthcare, and we believe that in today’s healthcare arena we can’t stand around and expect things to get better unless we contribute to the solution ourselves.  At Vantage, the particular tool we use to effect change within our scope of influence is pretty simple…it’s entrepreneurship.  There’s not a single way we do it, not a perfected process that we share with the world, and we often don’t even use the same ideas twice.  Entrepreneurship doesn’t work like that, at least not around here.

To us, entrepreneurship is always a unique process, but it does involve three common elements: (1) the recognition of opportunity, (2) the acceptance of the risk required to take advantage of the opportunity, (3) and the enjoyment of the rewards that [may] follow from entrepreneurial endeavors.  By involving these elements in the development of private practice business models within healthcare, practice owners will find a way to navigate through whatever the economy, government, or corporate America throw our way.

The trick is not knowing how to “fix” the healthcare system.  There isn’t a single fix.  The trick is being creative, innovative, and entrepreneurial in our approach to today’s healthcare environment, and with this, being willing to experiment and learn about what works and what doesn’t. 

There are many business models in development today (and many that have been in development for years) that might, and might not change the face of our healthcare landscape.  But, in the same way that the creation of some of our most valuable inventions and most successful business models of today started with nothing more than a few visionaries willing to accept some risk in order for the chance at some future reward, so our healthcare industry exists as well.

On The Healthcare Entrepreneur and at Vantage Clinical Solutions, we look first to encourage entrepreneurship within our industry, and second at the merit of the ideas that come our way.  Bad ideas can be refined into good, but ideas that are never brought to the table can do nothing to help our current healthcare situation in America.

In a recent post on the Health Business Blog, David Williams also acknowledges the role of entrepreneurship within healthcare, and provides examples of entrepreneurs within a variety of areas within the healthcare industry.  It’s a great post and a quick read, so take a look.

I’d like to suggest that entrepreneurs and private industry more generally are underappreciated assets in the health reform debate –and that just possibly some entrepreneurs are already in the process of helping the country turn the corner on key dimensions. If that’s true, the role of policymakers –and voters– becomes clearer and more achievable: to create the conditions under which entrepreneurs can thrive.

It’s a good thing nobody told Stephania Bell, PT that you can’t make a living playing fantasy football.  Bell has done just this, as ESPN’s fantasy injury analyst.  That’s right, Bell provides her take on the injuries that plague professional sports’ most notable players, providing fantasy sports participants with much needed information with regard to strategies behind sports trades and team builds.

Stephania is a physical therapist who still practices clinically, but travels to ESPN headquarters to provide much needed analysis of all of the recent sports injuries through television broadcasts, blogs and podcasts.  Talk about crafting a dream career - way to go Stephania…now that’s entrepreneurship!

Read this article from Portfolio.com for the full story.

To the data-obsessed fantasy-sports community—a population numbering nearly 20 million and driving a $1.5 billion-dollar industry—Bell is a hero, one of a handful of analysts covering sports injuries for the fantasy crowd that forms a sort of parallel universe of analysts, beat writers, and producers alongside that of traditional sports (and, yes, she does go to spring training and the Super Bowl).

Bell discovered the unlikely profession after she sustained an injury, underwent physical therapy, and developed an increased sensitivity to both the physical and psychological components of a sports injury. After attending graduate school in physical therapy, Bell opened up her own practice in the San Francisco Bay Area.

The fantasy aspect came through pure personal interest in fantasy sports—football and baseball in particular. After she let it be known to one league that she was a physical therapist, a fellow fantasy player begged her for a medical assessment of an athlete’s injury. Soon enough, she became the go-to gal for injury tips in her league. Through connections, she landed a gig writing a column for fantasy-sports site Rotowire.com, which led to gig on XM Satellite Radio and ultimately caught the attention of ESPN. The sports channel flew her out to its headquarters, in Bristol, Connecticut, for a screen test and made her a regular on-air expert.

More and more I’m seeing healthcare practices (medical, dental, physical therapy, optometry, etc.) getting really entrepreneurial about their business models.  Most of this is born out of necessity in order to find ways to stay profitable, but some of it comes from clinicians making the decision to run their practices in a way consistent with their passions, interests, and lifestyle.

There is a lot to be learned from a client of mine who is starting up a practice.  She is really doing things right.  When developing her business concept she knew early on that she wanted her practice to be different, and truly wanted to enjoy the way she spent her time each and every day.  She began with a mission and vision for her practice model, and has crafted everything else around it.  From brand position, to information systems, to software selection, to interior design, to financial modeling, she has built a practice that all ties back to her mission and vision.  This is the first step in creating a business that lasts.

There are some very practical things she is doing right as well.  She is putting a great team of business advisors and experts around her and has allowed us all to provide her with direction and guidance.  She realizes that this is a team effort, and the better the team, the better the end result.  Financially she is sound, and has secured the necessary operating capital to get her through several months of operations based on “worst-case” scenarios.  And regarding her patient clientele, she is pounding the pavement in order to build up her caseload months before the doors even open.  She will be successful for the long term, and it’s because she’s acting not only like a clinician, but also like an entrepreneur.

I read an article today that started me thinking about the client above, and it was about an entrepreneurship forum in Kansas in which business owners were learning about how to plan for success for the long haul.  Interestingly, one of the speakers at the entrepreneurship forum was a founder of a medical group.  This is exciting to me, as I believe that entrepreneurship within healthcare is the answer to many the problems that befall us in this industry.  Private practice owners need to become entrepreneurial in their approach to business practices in order to make significant shifts in payment models, service offerings, and cost reduction.  I’m really glad to see that entrepreneurship in healthcare is being used to educate others through this healthcare panelist, and I especially love to see it within the clients I work with day to day.

Three successful Wichita service-based entrepreneurs told a story of faith Thursday at Wichita State University’s Center for Entrepreneurship.

Have a business idea, believe in it, find people who complement your talents and establish a brand, said business owners in medicine, advertising and investment.

Joseph Galichia, founder of Galichia Medical Group; Sonia Greteman, chief executive of Greteman Group; and Corporate Lodging Consultants founder Barry Downing were the speakers at WSU’s final spring entrepreneurship forum.

The advice-oriented session focused on what makes a service-based business go, something the three panelists largely agreed on.

I’ve found that along with anything that can be used to create good in life also comes the ability for someone to create bad.  Examples of this are abundant in the areas of the Internet, medicines, politics, and on an on.  Entrepreneurship is no different, and while the innovation and passion that accompanies entrepreneurs likely holds the key to improving our healthcare system, many will use (and have used) this same characteristic for personal gain that does not have a positive impact on the healthcare system.

This article from “Repairing the Healthcare System” discusses one viewpoint on this topic, and suggests that there are definite challenges associated with maintaining an ethical approach to entrepreneurship in the healthcare industry.

The healthcare insurance industry has been entrepreneurial in taking advantage of the leverage it has in negotiating physician fees and healthcare insurance premiums. They are trying to figure out how to appease the consumer without losing any of their power.

Some physicians have left the traditional healthcare system and opened concierge practices. Some physicians have been entrepreneurs in opening preventive health clinics and spas that have attracted wealthy patients to get fit. Most add no value to the care of patients in my view.

On close inspection none of these entrepreneurial ventures have been undertaken for the public good even though they have discovered patterns in society that lead to successful business undertakings.