By Michael Tetreault, Editor-In-Chief, with special contributions by Roberta Greenspan of SpecialDocs, Richard Doughty of Cypress Concierge Medicine, Scott Borden of Direct Pay Consulting, Mike Permenter, CMT Contributing Writer and Executive Vice President and Chief Development Officer at MedFirst Partners LLC, and Dr. Chris Ewin of 121MD in Fort Worth, TX
JULY 9, 2014 – When you think about concierge medicine, you probably don’t think about the word ‘Franchise’ … but you should know that this is a business and industry-relevant term routinely used by physicians and early adopters in this marketplace that you should be aware of how it’s defined.
Typically, franchising is a business opportunity that’s somewhere between buying an existing business and launching a startup. It involves creativity, independence, high-energy, a bit of entrepreneurship and risk. Usually, a franchisee buys a license from a franchisor to be a dealer of that business model. The owner of the franchise sells a product or service through its franchisees.
In the concierge medicine marketplace, things operate just a bit differently however.
When you purchase a franchised business, you’re usually paying for two things. First, you’re paying for a proven system. You’re stepping into a business plan and a company that likely has been around awhile and has a proven track-record of financial success. The second thing a franchise offers is a national brand.
Franchises are a very popular method of entering the concierge medicine or direct primary care marketplace for some doctors. It allows physicians to change, start and even grow a unique medical practice while at the same time learning from the experts in place with a proven track record to help you. One of the biggest advantages of joining a franchise concierge medicine or direct-pay medical care group is that you have access to an established company’s brand name; meaning later on, you don’t have to spend additional resources to get your name and services out to patients.
Generally speaking, franchising means opening additional outlets through the sale of franchise rights to independent physicians who will use the Company’s name and system of operations. A franchisee pays a franchisor an initial franchise fee in return for the rights to operate a practice under the franchise trademark and for training in how to operate the business. For many doctors, franchising can appear to be the ideal form of business expansion.
Let’s look at a couple of industry-relevant examples.
There is, in theory, less risk to transitioning into this healthcare delivery model than starting a medical practice or altering your existing one because the business model has been tested, vetted and proven by companies and physicians over time. While we don’t think of these national brands or regional players as franchises, early adopters and physicians tell us that they’re using this term to explain these unique healthcare delivery models to their colleagues — and it’s peaking their curiosity.
Also, as a franchise unit owner, you have a built-in advisory board in the management staff of the umbrella franchise organization. Sound familiar yet? A downside however, you may have slightly less creative control over your business as a franchisee than as an independent business owner.
In today’s direct-pay and concierge medicine industry, plenty of players have come and gone and few have emerged as industry leaders.
What Does The Marketplace Look Like?
Concierge Medicine Today’s (CMT) research and data collection arm, The Collective, recently evaluated the number of physicians participating in franchise-like medical practices verses those doctors who chose to use consultants or simply join other concierge-like practices and become employees. We found the following in the marketplace:
- Concierge Medicine Physicians Inside Franchise Models = approx. (not precise) 22%
One of the most common questions physicians ask when exploring this private-pay medical marketplace for the first-time is ‘how much does it cost to transition my insurance-based medical practice to this new direct-pay or retainer-based business model?’
Franchise and consulting fees can move from five-figures and easily into the six figures. According to Concierge Medicine Today, they’ve found the average cost is between $150,000 – $250,000 over a period of two to five years and in some rare cases, even longer. Some consultants have even quoted figures less than $60,000. However, depending on your practice, it’s demographics, your bedside manner, patient surveys (very important), complexity of internal operations in a practice, a financial feasibility analysis, and many, many other variables, a concierge medicine or direct primary care (DPC) practice may or may not be the right option for you.
CMT has found this to be as low as 15% of each patient’s individual membership fee and in most cases, between 29% to 33% for a period of approximately 3 to 5 years. In some rare cases, up to 25% of your per patient fee for eight years has been reported to CMT by doctors considering a career in concierge medicine or DPC. These fees usually include continued support and training in advertising: marketing; sales; operational guidance; technology; legal; regulatory; financial and human resources consulting; and other services.
“Perhaps most important from a doctors perspective,” says Mike Permenter, Executive Vice President and Chief Development Officer at MedFirst Partners LLC., “is that a consulting company should typically furnish all of the capital required to start or modify your medical practice and assumes all risk for success of failure. Thus, the high fees. My fees are much different than the industry standard.”
Related: P&G Sells MDVIP
Companies, like MDVIP and Concierge Choice continue to capture a significant portion of the market share. Other successful companies operating in the marketplace: SpecialDocs; Cypress Concierge Medicine; Signature MD; Latady Physician Strategies and others, continue to innovate, offering differing models, competitive transition fees and personal service to a doctor’s practice to help them succeed. All of these companies have an edge in that they helped build the existing industry over the past several years. More and more consultants and franchise-like companies like these have now come along in the past three years and help to keep prices low and competitive for not just their physician clients but satisfied patients as well.
SpecialDocs with offices in Chicago, IL and Florida states that while we are often asked, ‘what is the optimum number of patients in a personalized care practice?’ the correct answer is that there is no “one size fits all” model. Each physician individually determines the appropriate number of patients in their practice based on their ability to deliver on the promises they made to their patients. A word of caution…even when an optimal patient panel size is achieved, attracting new patients will continue to be important to maintain this threshold and/or to grow the practice. Over the course of each year, all of our (ie SpecialDocs) physician-clients experience the loss of a small number of patients for a variety of reasons including relocation, financial setback or death. Therefore, whether you have just transitioned or have a more seasoned practice, it is important to focus on viable methods for practice growth.
SpecialDocs also adds … Over ten years of experience has led us to develop a “Prescription for Practice Growth.” These programs include initiatives in the following areas: Interactive, Educational, Proactive Wellness and Digital Marketing. A combination of several strategies and initiatives can be used to grow a practice. Each physician needs to find his/her “marketing comfort zone” as well as what is a good fit for the community and what will provide value to their patients.
“The key, whether you choose to use a franchise or do-it-yourself, is to go into this private-pay medical marketplace passionate about helping patients,” says Michael Tetreault, Editor of Concierge Medicine Today and The Direct Primary Care Journal. “Even if one type of business model is considered more low risk, remember that businesses close every day. Doctor’s tell us every day in their editorials and opinion articles that ‘… you’re going to put a lot of time and money into this endeavor over the next several months, so you need to make sure it’s something that you care about.’”
Many doctors startup a concierge medicine practice or pursue a satisfying career in direct-pay medicine for a multitude of reasons such as: spending more time with patients; a yearning to use their medical expertise more effectively; a more satisfying lifestyle; and more. Some doctors enter this field of medicine because their tired of hamster wheel healthcare and frustrated with treadmill medicine that has now become their day job.
“Business is tough,” says Dr. Chris Ewin of 121MD in Fort Worth, TX. “If you’re doing something just for the money, you’re never going to enjoy it. You will be the hardest boss you’ve ever had. So, find something you love and pursue it. Follow this advice and you’ll set yourself up for an enjoyable future in medicine.”
Currently, there’s a phenomenal opportunity for doctors to innovate and move into concierge medicine or direct primary care.
“Even after 10+ years in this still rather exclusive space,” says Roberta Greenspan of SpecialDocs, “I continue to have great enthusiasm for the successes and ongoing growth of the concierge model. Every day we hear another story from our physicians and their patients about how much this type of practice change has improved their lives.”
Are you considering a career in concierge medicine or direct primary care? Do you have family, friends, and patients telling you that you should look into joining one of these medical practice companies?
“It’s about believability. Would it work for me? Could it work for me?” says Richard Doughty, CEO of Cypress Concierge Medicine. “In places where physicians have taken an early leap of faith [and started a concierge medical practice], they have been satisfied. As a result, physicians now have many examples of colleagues experiencing the benefits of concierge medicine for themselves and their patients. We see momentum continuing to build.”
CMT encourages physicians, business leaders and others to remember eight key points before you decide on which franchise, concierge medicine company or DPC consultant you select:
- Don’t go into debt to purchase a franchise. Downsize your lifestyle and save up and pay cash. According to a 2013-2014 poll of startup concierge and DPC physicians by Concierge Medicine Today, the majority of doctors used personal assets (savings, house, 401K) to fund their medical venture. Financial experts encourage that if needed, take an extra job while you are saving.
- Get an informal PhD in concierge medicine or direct primary care. Talk to a bunch of franchisee physicians. Find out why some are struggling and why some are successful. Build a relationship with your franchisor and stay in contact with them regularly. Gain as much perspective as possible before you begin and make an educated decision.
- According to surveys conducted by The Concierge Medicine Research Collective from 2007-2012, the majority of private-pay practices employ less than one staff person in a concierge medicine clinic. These offices are often less than 2,500 square feet. Do you have leased office space that you could no longer use?
- Most franchise transition companies and consultants will provide you with a patient sales or educational support team to help you explain your new billing and services to patients. If you have administrative or support staff that you could see coming with you, be sure they believe in where you are going and understand the new model of serving patients. The last thing you need is your front office staff telling patients behind your back that this isn’t a good deal – when in actuality, it very much is.
- Related Story … Instill Passion in Your Staff For Your “Concierge” Practice Model
- Related Story … Stop Hiring Like A Start-Up Concierge Practice
- Many franchise, practice transition companies provide EMR, patient/membership billing services and legal document review. Ask them what support services they provide as you plan and prepare for opening day as well as up to 9-months after your opening day.
- Most importantly, look for an opportunity and evaluate the services you will enjoy providing to your patients — not just something that offers lower risk or more money. For instance, if you’re starting a concierge medicine or a direct medical care practice, ask these types of questions: Do I like dealing with people? Do I care about helping them with their healthcare needs, or am I more motivated by the potential money and working less hours?
“Don’t start out too high,” said Scott Borden of Direct Pay Consulting. “Many physicians choose patient pricing plans that are unaffordable for most of their patients. Remember that a higher monthly / annual membership fee will likely result in fewer patients each with higher medical needs. Do you want to spend every day treating a few chronically ill patients? A lower membership fee will allow healthy individuals and families that value your time to remain with your DPC practice. And you can always increase your fees next year if you completely fill your practice.”
By now, you get the picture: the more you pay, the more brand recognition, service, technology, etc., you will get and the more operational benefits you will receive.
Permenter also adds “There are a few things you should consider before joining any company. Start by asking ‘Is there a wide market for my concept?’; What makes me different from my neighbor who is already doing this?; and Does my form of delivery [of medical care] offer a reasonable return on investment (ROI) to prospective patients?’: If the answers to questions like these is ‘yes,’ then you should start the information gathering process and contact consultants and companies who can help you.”
“The key to success in any concierge medicine or DPC practice is, and always will be, the relationship that the doctor has with his or her patients,” notes Permenter. “With that in mind, one of the most important things for a new or established doctor to do is to constantly strive to improve the value proposition — at the patient level. The more you can do to improve the patient experience, the better each doctor’s financial returns are likely to be. Successful doctors need less in the way of support after the operational and internal planning has been done and should be hesitant to sign long-term contracts for longer than three or five years. Of course, a long-term contract can bring more patients and make your practice more profitable, thus improving the eventual sale of your practice or retirement plan. Nothing sells a concierge medical practice faster than patients that are exuberant about their experiences with a particular doctor’s office.”
Ultimately, it all comes down to the Physician’s ability to structure a program that delivers value in his/her practice. If doctors succeed in delivering value to the patient, they’re much more likely to create the win-win-win relationship that’s the hallmark of successful business.
Franchising can be a tremendously advantageous — and fast — way of expanding your medical practice into the area of concierge medicine. This is particularly true for the doctor who lacks the time, the manpower, and the finances to open a practice alone. It is a strategy that prospers even during times of economic uncertainty.
“Starting a concierge medicine or DPC practice we understand can be complicated if you do not know what you are doing,” adds Tetreault. “While choosing a concierge medicine or direct primary care company is often the fastest way to enter into the marketplace, it is not something you should venture into lightly. Physicians who’ve travelled down this road before you tell CMT … ‘You need to have a careful plan for controlling costs and quality before you begin. Start by asking yourself why you want to ‘do’ this?’ and then surround yourself with a trustworthy team that will support you and believe in what you’re doing in the months ahead.’”
Looking for a trusted consultant, coach or physician in the concierge medicine or direct primary care marketplace that you can talk to? Connect with CMT’s INNOVATOR’S PANEL … Expert Advice, Guidance and Resources. Safe, Secure and Trusted.
Typically, our Innovator’s Panel of services falls into one of 3 categories:
- Startup Experts … with experience in multiple startups.
- Industry Experts … individuals with a wealth of industry-specific experience.
- Knowledge Experts … mentors with experience in a specific range of business skills (Legal, Accounting, Finance, Marketing, IT, Infrastructure, Operations, etc…)
You’ll be amazed by the level of advice and customer service our INNOVATORS Panel provides to physicians, patients and businesses. Our network of concierge medicine and direct primary care companies, businesses, mentors and coaches can discuss with you your needs and provide nonbiased information and guidance you can trust. They will give you sound guidance — without any sales pitch. Simply drop us a line or send us an email to Editor@conciergemedicinetoday.com or call (770) 455-1650 and we’ll connect you with a CMT Trusted INNOVATOR in your area that you can start talking to!