In researching the DPC market for months, which involved hundreds of hours talking to dozens of physicians, we have learned a lot about how to start a Membership Medicine practice. Here are some starting points to help you down this road to practice freedom.
By Pri-Med’s InLight EHR | DPC Journal Contributor
Engage with experts and peers
APRIL 3, 2015 – The American Academy of Family Physicians (AAFP) has emerged as a strong proponent of the Direct Primary Care model. There are regular Direct Primary Care Workshops held around the country – the next one scheduled for March 28 in New Castle De. These one-day workshops are an ideal opportunity to learn from peers who have successfully made the transition. The AAFP is also holding its annual DPC Summit in Kansas City, July 10-11. This is a larger educational event with the added opportunity to meet exhibitors and vendors that provide products and services to Membership Medicine practices.
There are also many experts in Membership Medicine who call themselves consultants, coaches, and mentors. They can be experts in how to start a practice, from start to finish, or in a specific field like legal, accounting, or marketing. The key is to find experts you can trust and who have a proven track record of helping others.
Create your business model and financial plan
Whether you’re employed by a hospital or already running your own private practice, making the transition to a Membership Medicine practice can be financially challenging, and you must have a business model and financial plans in place before you start. Business models are varied, and include everything from joining a large franchise DPC business like MedLion, going independent but within a network Health Access Direct like Forest Direct Primary Care, or going completely independent like Dr. Bruce Jung or Dr. Jeffery Gold. It all depends on your risk tolerance and how entrepreneurial you feel.
The most basic financial model starts with how many patients you plan to recruit, how much you will charge them per month, and what services you will provide for that retainer fee. Will fees cover the entirety of primary care services, including care management and care coordination, as well as services involving external organizations such as off-site diagnostic facilities? Or will vaccinations, lab work, x-rays, and other services be excluded and charged for separately?
On the other side of the equation are all of your expenses, including what you hope to pay yourself. Unless you have previous experience owning a practice, a private medicine consultant maybe required to help you estimate your expenses. Finally, time must be factored into your equation, since you won’t necessarily start with a full panel of patients (see next section).
Recruit a patient panel
Perhaps the biggest factor to consider when starting out is your patient panel. If you’ve had a successful private practice in primary care for 20 years and half of your 4,000 patients have expressed interest in joining your Membership Medicine practice as “members,” then congratulations! You can feel relatively confident in making this life-changing transition.
But if you’re currently employed by a large practice or hospital, or just getting out of medical residency and looking to establish a Membership Medicine practice for the first time, you must ask yourself the question: where am going to get my patients? Maybe you’re already situated in a medically underserved area, and simply opening a local practice will attract patients. Or maybe you can make a deal with a local business or two to provide primary care to all of their employees. Those are both common solutions, but not available to everyone.
Most often, recruiting a patient panel takes hard work and patience. It starts with getting to know the local community and its needs. This is one part research and two parts marketing. Since this isn’t what most physicians want to do, consultants can play an important role once again. They can set up “town hall” style meetings, where potential patients can meet you, ask questions, and sign up. They can create direct mail and social media campaigns to attract new patients. In short, they can help you connect with the patients in your community.
Drop Medicare and other third-party payers
The process of disengaging with third-party medical payers, especially the Center for Medicare Services (CMS), can be complicated and should not be attempted without a lot of forethought. There are ways to separate from CMS that will prevent you from being hired for at least five years by any practice or hospital that bills Medicare/Medicaid, and other ways that will preserve your flexibility for the first few years while you establish your Membership Medicine practice.
Choose the right EHR for Membership Medicine
EHR software can help drive the growth of Membership Medicine, but only if it’s designed to make this new style of practice easy to adopt and allow a small staff (usually one doctor and one nurse) to operate efficiently. Look for an EHR with membership management, patient engagement tools, and intuitive clinical documentation.
There are only a handful of EHR vendors that cater to Membership Medicine. Because of the lack of solutions that meet all of these needs, there is increased demand for a singular user experience from Membership Medicine EHRs.
The newest entry into this small cadre is Pri-Med’s InLight EHR, DPC Edition, featuring membership management for managing the revenue stream and a problem-oriented documentation approach that lets physicians be more people-oriented. A free 60-day trial is available.
Everything starts with education and knowledge, so start reading everything you can get your hands on and start talking to everyone you can meet. What you learn may inspire you to take the next step, or cause you to pause and rethink.