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EDITOR | Beware, Your Patient May Have Hit ‘Subscription Overload?’

Did you know … Roughly 3% of cards expire every month? And this doesn’t account for credit cards that have outdated billing information or have been lost or stolen. You also won’t always have the most up-to-date information for billing your Patients for their concierge medicine subscription fee(s), which can lead to declined transactions and decreased monthly, quarterly or annual revenue.

By Michael Tetreault, Editor in Chief


AUGUST 2018 – When was the last time you examined ALL of the subscriptions you’ve actually signed up for?

If you’re like our family, your wife signed up for 30-days here, you signed-up for a $4.95 3-month run over here and the next thing you know, it’s months later and these small fees have accumulated to something like or above a car payment.


Concierge Medicine is no different. If a consumer [e.g. Patient] is finding value with you, you probably have nothing to worry about. Relationship is key though.

In an NPR story the other day, 27-year-old Michael Weinberger feels the same way. “I felt that to sign up for another program, which would have ultimately been a fee and probably would have been redundant, I kind of hit a saturation point,” Weinberger said.


Best practices for recurring and subscription payments

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While subscription-based healthcare fee collections are popular, even in Concierge Medicine, we do see that Patients are entering an increasingly crowded market of subscription service offerings. However, Concierge Medicine Doctors remain sailing in what we call a blue ocean [e.g. read Blue Ocean Strategy book to learn more about what this concept means], and actually Concierge Medicine still has a number of popular consumer subscription choices which remain appealing for communities of people around the country.

Did you know … if a credit card is lost or stolen and a new one sent to your customer, you won’t know they have a new card.

Today, as more and more subscription-based telehealth services offerings on smart phones are developed, Patients will see these as urgent care style options that will help them save money and time vs. taking a trip to the urgent care or emergency room. PAs and NPs are rising in use and popularity in some rural markets and deploying subscription-based healthcare fee programs.

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According to recent July 2018 legislative activities in Washington, DC as it relates to using HSA funds to help pay for membership medicine programs, particularly those in the familial younger cousin to Concierge Medicine, called Direct Primary Care (DPC), proposed language around this issue is problematic and could encourage more PAs, NPs to enter the low monthly fee, cash-only (not Concierge Medicine) subscription space.

“The “DPC service agreement” [e.g. 213(d)] What the heck is that?” writes one Texas family physician. “Well, it means that anyone who is a primary care practitioner can set up a DPC practice. That means that nurse practitioners, PAs, clinical nurse specialists (?) can set up a practice across the hall from you and charge $10 a month if they like.”

Anticipate many more of these low monthly fee arrangements to enter the marketplace as well as telehealth smart phone and video apps which will be consumer-targeted, smart phone friendly, to increase in the years to come. They will not compete directly with the value that Concierge Medicine delivers to a Patient or community, but younger demographics will use these programs until such a point where they see they need a closer relationship with a Physician vs. a convenient care clinic style environment for more urgent medical needs.

Characteristics Of Patient Visits To Retail Clinics, Primary Care Physician (PCP) Offices, And Emergency Departments (EDs)

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Again, I recommend you read the book Blue Ocean Strategy if you have not already.

So as we dig into subscriptions, unique payment arrangements between Physicians and Patients and analyze consumer spending trends just outside of Concierge Medicine, the case can be made in Concierge Medicine for a variety of auto-billing strategies, each with pros and cons to all.

For example, you may have found yourself asking …

  • “Why would you bill your patients monthly when you are in essence, allowing them to say ‘No’ twelve times a year”
  • “Do you really want to give the patient the option to pay by check once a quarter?”
  • “Will they see value in the subscription?”
  • “Is having a “card on file” the best option when billing patients annually?”
  • “Will they cancel?”
  • “Is the annual or quarterly subscription payment going to be small enough to justify the need for your services next year?”
  • “If I bill my patients monthly, am I charging enough?”
  • “What about those over the past two to three years in subscription-based medical offices that struggle financially when the monthly price is less than $100. The 50+ crowd doesn’t have an issue with the billing but the Millennials and Gen-Xer’s are constantly calling and haggling over the fees.

“The biggest mistake I’ve seen practices make through all these years is that they don’t give themselves a raise every year,” added the Texas Family Physician in a recent interview. “I give myself a raise of five dollars a month every year. People don’t say a word about it. They gladly pay it.”

Three (3) Advantages of “Card on File” for Membership Medicine Practices.

If you bill your patients monthly and more than 60% of your patient panel is made up of this 25-45 year old audience, lean-in and pay attention for a moment. The audience most likely according to trend analysis outside of healthcare and inside of subscription-based businesses, subscription purging occurs when younger individuals have monthly subscriptions that have accumulated to the point whereby they are emptying their wallet automatically (auto-pay) and do not see value in the subscriptions they are paying for. When that happens, this stops a Patient in their tracks when they see their bills accumulate. They take the time to logon, login and manage their multiple subscriptions.

Here is where we find insight into business and can look deeper at its application to Concierge Medicine moving forward.

Lets look at a business analogy.

Researchers offered a group of students a Lindt Truffle for $0.26 and a Hershey’s Kiss for $0.01 cents and then observed buying behavior. The found that about 50% of participants went for the Kiss and 50% chose the Lindt Truffle. When researchers dropped the price of both chocolates by one cent, suddenly 90% of the students took the free Kiss, even though the relative price between the two was still the same. Researchers also ran tests in which they lowered the price from two cents to one cent to see if it increased demand for the Kiss, but it didn’t. They ran other tests where they lowered the price from free to negative one cent, but they still didn’t see any changes in buying behavior.

Eventually, you should come up with your own experiments to test the effects patient and potential patient buying behavior. That’s just part of the creative process of business and how some doctors, change the buying patterns, pattern interrupts and metrics surrounding your income. If you take anything away from our time together today, take this … we don’t necessarily know what it is about the science of buyer psychology, but once you get someone to say the first yes, it is much easier to get the second yes. It’s as we say at Concierge Medicine Today, the “know, like and trust” factor. You get them started by saying yes to a small thing, then they are much more likely to say yes to a larger thing later.

FAST FACT: American patients have seen an average of 18.7 different doctors during their lives, according to a survey conducted by GfK Roper for Practice Fusion.

What’s Next? Now that we’ve addressed some of buying trends, challenges and opportunities for doctors, lets unpack some solutions and give you three tools you can walk away with.

LIVE, OCT 25, 2018 | ATLANTA, GA – A Beginner’s Guide To Today’s Subscription Healthcare Delivery Models

Tip #1 – Allow Your Patients to Manage Their Membership, Set-up Billing Online and provide the option of a Billing Frequency that works best for them.For example, if you have a 12-month or 13-month contract with a patient, allow them the option of paying you monthly by Credit Card. If you have a month-to-month contract with your patients which auto-renews at the first day or last day of the month, allow a card-on-file record to auto-draft and pay the bill for them, relieving the need and questionable bill, in many cases, out of the patients mind each month. Your billing and collections software service solution provider should be able to help you with this. If it’s too complicated, ask your accountant and trusted attorney about the correct state billing practice.

Tip #2 – What Name is Associated and Printed On the Billing Statement?

When subscription purging occurs, people will usually go to their bank statements or credit card statements. They will look at the subscriptions carefully which are being automatically billed to their card(s) and evaluate them line-item by line-item. So, what name or corporate identify are you using which is going to be printed on their statement(s)? Ask your Credit Care Processing Carrier what name is printed on the statement. You could be inadvertently losing money, creating billing confusion and causing patients (and your staff) unnecessary frustration when your billing identity is foreign to your patients memory recall.

Example: If your business name is “Archer Family Medicine, Inc.” … and the Credit Card Billing Statement cites “AFM, INC.” Billed You $130. Is that a recognizable name to your patients months later when they are in a money crunch?

Tip #3 – Communicate with your patients often. Go snail mail.

There’s nothing more old school than snail mail. No, I’m not talking about mailing out a paper billing statement. That’s what tax time is for. What I’m talking about is central to the relationship between a doctor and his/her patient. Building on the relationship and showing you care by putting a small note in the mail to your patients … even when they don’t call or see the inside of your practice that often.

Example: The last time Jane Doe was in, she complained about her flu symptoms. She also mentioned in passing that her son was in the school play.

Finally, consider finding a nice piece of personalized stationary, a small envelope that matches the monogrammed card and write a handwritten note to your patient … saying something to the fact that … “Hi Jane: The staff here and I hope you are feeling better. We haven’t seen you in a few weeks. We trust your sons school play was fun. See you soon!” Sincerely, Dr. John Q. Public

Remember, people don’t care how much you know, until they know how much you care. A message Concierge Medicine has delivered to countless patients for the past 20-years.

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