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Do you have questions about CONCIERGE MEDICINE STARTUP, MARKETING, BRANDING, ADVERTISING, MEMBERSHIP PROGRAMS, FEES, HYBRID PRACTICES, PAYER CONTRACTS, AND OTHER RELATED ISSUES TO BE SOLVED?
Here's your one stop resources for any questions you want to ask.
Dr Maria Todd, author of the best selling managed care contracting handbook will answer!

About Your Expert

Trusted by more than 4500 healthcare organizations, facilities, physicians, and ancillary providers in the USA and 116 countries, Dr Maria Todd is frequently hired to help physicians, plan, design, launch and operate concierge medical practices and cash paid, direct primary (and specialty) care (DPC) programs.

She's been a director of contracting for several health plans (HMOs & PPOs), IPAs, PHOs, MSOs, ACOs, medical groups, ASCs. She leverages her OR nursing experience, hospital and clinic administrator hands-on experience, and health law paralegal and mediator work experience and training. Since 2007 she's assisted over 400 physicians in the USA and abroad to transition or start concierge membership and direct primary care practices. One direct pay cash practice she's assisted has over 35,000 patients and offers primary care, lab, imaging, dentistry, psych, and more under one roof - proving the cash pay primary care model can be successful with people with modest means!

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WHAT PROBLEM DO YOU NEED HELP WITH TODAY?

Whether the problem is the need to develop a competitive and unique cash pay membership product for primary care or specialty medicine, what to charge, what to include in the amenities package, how to build a brand, transition from a contracted payer (HMO/PPO) business model, targeting corporate clients, or diagnosing high attrition at renewal – Maria can probably help you.

In most cases, these problems are not unique, personal, or limited to your organization. Others have had similar situations and Maria has been able to come up with workarounds, solutions or reassurance that they were on the right pathway. One of the most daunting problems is the sudden (2018) termination by many HMOs and PPOs to prohibit hybrid concierge medical practices to continue in-network participation. Another is that some of the major payers now compete directly with former network providers with their own brand of concierge hybrid forcing patients to abandon their concierge physician in order to get any benefit from their insurance coverage.

Maria will schedule a time to take your call so you can explain what’s going on or what has you stuck. She’ll tell you if she can help, or if she believes another expert with whom she works from time to time can offer a better solution. 

If you decide to work with her, she’ll quote a price – by the hour, by the assignment, or for coaching via web-based conference or at your location.

What you’ll find on this Ask the Expert section of her website are answers she’s provided to others in a similar situation to yours in the past. Reading her responses will provide you inspiration, hope, and tips and pointers you might not have considered. 

From there, you can read more tips, research the topic further on your own, decide you’d like to learn more about working with her on a detailed solution, or get a recommendation for what to try next.  Or, alternatively, you can ask Maria if she has time on her schedule to meet your deadline to handle the matter for you. The choice is yours.

But first, read on to learn what others have asked Maria Todd and the answers she’s provided.

EMPLOYMENT, TRAINING, WORKING LIFE

Will I need to terminate most of the staff that I hired to operate my former managed care traditional practice?

You may. Some of the roles can be transitioned over, but the personality of your brand will change and many of the former personnel may not be cut out for the new brand requirements. Others, such as insurance billing and follow up, contracting with payers, may simply be irrelevant. You’ll need to find candidates who know marketing, branding and social media because you’ll be on your own for marketing and patient steerage once you exit out of contracts and plans no longer steer business your way.

What is the average income for a primary care physician in concierge medicine?

That depends on too many variables to answer as asked. The variables include the business model you decide, the membership fees, the cost to deliver care and the amenities included in the fees, the number of hours you’ll work, the number of patient members you’ll accept, staffing, expenses, and marketplace.

If you meant to ask what is the average annual concierge fee per member, the number is around $1650. This too is dependent on the value proposition you offer and if it aligns with prospects’ needs, desires, and services included.

Have all managed care networks prohibited concierge membership fees by network providers?

To date, we know of United, Aetna, Cigna and many BCBS affiliates.

What will happen concierge medicine under Medicare for All?

It’s premature to answer a question about a concept that is not yet approved, enacted, or the rule of law. Concierge medicine and DPC that are cash pay business models will be a personal option just like there’s an option to own a Honda CRV or a McLaren. 

GETTING MANAGED CARE CONTRACTS

I am a new physician in private practice. How can I get payer contracts?

First, determine which payers operate in your county and/or your region. Next, contact provider relations to discover their contracting criteria and need for your services. Next, create a contracts strategy to prioritize which contracts with which payers, what you want, what you don’t want, and why. In your strategy, include solutions to the problems they have and how you might help them arrive at a solution with what you do that’s different from the rest of their providers.  Then prepare cover letters that address each payer’s needs and what you offer to help solve for that need and that you’d like to discuss the possibility of joining their network.  

Realize that there may be silent forces working against you in your area. Someone may have an exclusive deal carved out, someone may have disparaged you, your social media feedback and stars may be less than wonderful, or you may lack privileges at the facilities they are contracted with – or other market forces which you may lack influence or control. If you find some nasty or shady deals, contact an antitrust attorney for guidance.

CONCIERGE MEDICINE STARTUP MODELS

How should I compare the corporate concierge models with independent practice?

Many of the corporate transition companies transition your practice and your patients ( your assets) to theirs. If you read most of the contracts, they say they don’t charge you for startup assistance, but in essence 50% of an assumed base of 600 patients for five years means that they assign themselves a “consulting investment recovery” fee of about $900,000 dollars. Until that’s paid off, they own your membership contracts in that patients pay them, not you. If you quit their contract prematurely, the patients you once had are then urged to agree to be reassigned to the new doctor the corporate entity and contract holder recommends. On the flip side, in independent practice, you pay for the consulting (usually less than $5000) and you own the contracts. Patients pay you. 

What’s the one thing that established concierge physicians wish they could do over?

Most state that if they could know then what they know now, three things stand out: a) What to include in the membership package and what to leave out; b) don’t allow patients to pay month-to-month – set the fee for an annual contract, and c) appreciate how critical and time consuming marketing, advertising, public relations and professional services branding is to survival and plan to actively manage this on a daily basis.

Is there a published checklist or set of tips or business rules I should be using to frame my business strategy and membership product strategy?

Yes, it exists in my Handbook of Concierge Medical Practice Design. I’ve not seen others. But having the list is only part of the solution. You must prioritize the list according to how you want your practice and product to be designed. This book does not offer business plan templates or income and expense pro forma templates because there are several books on physician business plan templates and financial projection should be done with accountant assistance. These business plan books don’t offer the tools included in my book. 

Can I operate a concierge medical practice without a membership fee?

In a word, yes. You just offer concierge service.

Whether people pay cash or somehow finance their care in another way, you simply upgrade the level of service you offer. That’s more akin to direct pay (DPC) models, but the direct pay models offer a flat fee – unlimited service per month. There are many choices from which to design your product but first and foremost, it is a “product”, not just office visits.

MEDICARE PATIENTS AND CONCIERGE MEDICINE

Do I need to resign my Medicare participation to include Medicare patients in my concierge practice?

Not unless you want to. But there are regulations and limitations on what you can offer or include in your membership program fee in terms of Medicare patient products. Beyond that statement, it would not be appropriate for me to answer further in this ATE forum.  If you do resign from Medicare, you cannot change your mind and come back for at least 2 years.

MANAGED CARE TERMINATIONS

A payer has sent me a termination for cause notice stating that my concierge medical practice violates our contract? I read the contract. That was not a term or condition anywhere in the document. What do I do?

Read the parts of your contract that incorporate, by reference, the provider manual. If it says you shall abide by and comply with the terms and conditions in the provider manual — whatever it says, whenever it is changed, with or without prior notice or your advance agreement, you’re done. But this is serious because whenever a provider is terminated “for cause”, the National Practitioner Data Bank is notified, and you must disclose this incidence to all your other payers. Prepare to be ejected from the network, don’t waste money on legal – almost all appeals have been lost, and prepare to notify your affected patients.

Is there a way that people can finance their membership fees so that I don’t have to carry the debt on my books or manage monthly membership fee billing?

Yes. The best vendor for this is CarePayUSA. The patients pay zero interest, pay 25% down, pay biweekly over 9 months and you get 50% of your fee up front and the remainder over the 9 months as they get repaid. They literally “buy” the account from you and they manage the monthly billing, collections, late pay follow up for a percentage you discount and you and your staff get to focus solely on patient care and service delight. I would be delighted to make an introduction to their corporate VP if you like.

Where can I find a good Concierge Membership Fee Contract Template?

I can provide a template. But first, you must design your program.

What you decide to offer as your product deliverable becomes your part of the “Obligations of the Parties” section.  The patients’ “Obligation of the Parties” is to pay you.

FORMER PATIENT TERMINATIONS

A few former traditional patients won’t find another doctor. They continue to call for prescription refills and such but have not paid the membership fee. What can I do?

Yes, this is a lesson I focus on in my Concierge Medical Practice Transition Master Class.  First, have you already written to the patients and sent them the 30 day termination letter? Many physicians fail to do this and then wonder how to separate from the former relationship under the new business model. If they cannot afford the membership, you can do what many doctors do which is to “waive” membership fees as a courtesy to a few specific patients. There are a few other options to consider, such as hiring a NP or a PA and have them see those patients under a separate corporation and you see the membership patients under a “NEWCO” corporation.

MANAGED CARE CONTRACT TERMINATION

A major national payer has terminated our 10-location, senior-centric practice from its MA plan without proper notice, for no cause, and is now telling our patients to change doctors because we refused to sign their new contract. What can we do?

Well first, call your attorney! You have a conflict if there is a “because” to the public and a “termination without cause” to you. There could be a defamation issue as well as the conflict. 

“Without proper notice” is a procedural issue that your attorney will sort out. 

” Your attorney may need to get a court-ordered action to “stay” the termination effective date to benefit your patients, and a “cease and desist” on telling patients untruthful statements to interfere in the doctor-patient relationship and divert patients (their assets, by the way) to a different provider, until the matter is sorted out.

Books by Maria Todd on this and related subjects

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