Category: Concierge Medicine

Physician Leadership in a Digital World

Check this out.  What you will see is the WEB presence of a physician/entrepreneur who assists physicians in developing their “profitable brands on line.” Just let your eyes roam across the site to get a feel for what she is up to. As usual, all of this got me to thinking…

More specifically, I thought about the fact that here on Hilton Head Island, SC, PCP’s are in amazingly high demand and short supply. When one thinks of “underserved” areas, I tend to think stereotypically of places like Appalachia, not well-to-do resort golf destinations with lots of senior citizens like HHI. BUT. Many of my friends scour the area to find a PCP that will take them into the practice. “First Appointments” are often six months out, if you can get one. Too few doctors, with many who have already “Gone Concierge,” seem to be accounting for this state of affairs.

My point? PCP’s here don’t seem to need much of a sophisticated digital presence. Word of mouth seems to do just fine in filling up waiting rooms. 

Bottom Line. All of which brings me to the thought question for the day. What physicians DO need a sophisticated digital marketing strategy? Does it vary by Specialty, Geography, Side-Gig interests? Probably all of the above! And some other things as well.  

Understanding the answer to such questions could help us to understand yet another important aspect of our physician customers in 2019 and beyond!

Flirting With Functional Medicine

Check this out. What you will see is a riff by our old friend The Country Doctor, pictured above, on the topic of functional medicine. In this post, he reveals that he is starting to integrate some of the principles of this discipline into his practice. But there’s more! Embedded in this post is a 20-minute video that clearly explains the underlying principles and practices of functional medicine. Watch it. There you will learn that rather than treating symptoms and diseases, FM deals with protecting and energizing the body’s systems and mechanisms that, when abused, lead to the negative sequelae that physicians spend their time treating. A lot of this makes a whole bunch of sense. Bottom Line. Think about it. Functional medicine brings with it a whole different modus operandi for physicians and patients alike. No longer is the doctor’s day divided into 15-minute modules of patients presenting symptoms and doctors prescribing therapies. The doctor/patient interaction becomes much more consultative. Educational. Holistic. And yes, time consuming. As a result, functional medicine will be, for the foreseeable future, much more likely to be the stuff of concierge practices and less likely to be found in production line clinics. What new business opportunities, and challenges, would such a shift in focus bring to our businesses? Like I said … Think about it!

Clinicians Who Email Patients Have Stronger Patient Relationships

 Check this out. What you will see is a statement of the obvious, i.e., clinicians who are willing to exchange emails with patients enjoy stronger relationships with them. Likely, the same is probably true for physicians who will talk with their patients on the phone. Duh. It’s 2018 folks. Why must the “office visit” be the only form of physician/patient engagement that the doctor accepts, and for which she will be compensated? A recent personal experience. Several days ago, I got a piece of beef stuck in my esophagus. Not immediately life threatening, but not extremely pleasant either. After several hours, I realized that this situation was not going to resolve itself and would require medical intervention. My wife said I should go to our PCP’s office. I asked why? I knew nothing was going to happen in her office that was going to resolve the problem. I am blessed. My physician’s practice is concierge. 800 patients paying an annual fee rather than the 2,500 patients she had before going to MDVIP. A quick call to her receptionist got a return call from my physician, who quickly understood the problem and quarterbacked a connection with our local Gastroenterologist. He gave me a call, gave me his cell phone number in case I needed it, set up an appointment to meet him in the ER a few hours later, and the problem was dealt with. I will skip the gory details.No, I didn’t have to go to any physician’s office, and no I didn’t have to go through ER triage. Wham Bam. Thanks to my doctor’s willingness to talk with me on the phone, and then to take responsibility for the connection, not just a referral, to the Gastroenterologist. And his willingness to pick up the ball on his cell phone and run with it. Bottom Line. As we ponder the quality and cost of U.S. health care in 2018, shouldn’t we give some consideration to how telephone and email could be used to increase efficiency? And patient connectivity and satisfaction? If lack of appropriate physician compensation continues to thwart such use of technology, can’t something be done to eliminate this barrier? Think about it!

Small Giants of Healthcare

Screen Shot 2017-06-26 at 3.25.00 PM Here is a fascinating piece. We have written much about Direct Primary Care, or DPC. In simple terms, a DPC practice is one in which the physician enters into an arrangement to provide services to a patient for a fixed, and usually very conservative, monthly charge. Recently, several entities have tried to use the DPC model as the basis for forming much larger practices. And some have failed. Why? As this piece sets forth, DPC is an arena where the notion of “economies of scale” just doesn’t work. DPC works best in small, low overhead practices. One doctor, one nurse, simple office. Bottom Line. The learning here is sort of a DUH! Quite simply, making things bigger doesn’t necessarily make them unassailable giants. Sometimes it just makes them ungainly, awkward and unprofitable. This is one of those times!  

Telehealth-The “Other Kind”

Screen Shot 2017-02-27 at 2.24.45 PM So often when we think of electronic access to doctors, we think of patients who have no personal physicians receiving quick and convenient treatment for a relatively simple malady using digital channels. BUT. Another, very different and perhaps even more important application of the technology is in the area of second opinions, from true experts, concerning serious and complicated cases. Consider this description, for example, of a top-drawer service that provides world-wide access to the cream of the Boston medical crop.  As the verbiage sets forth, for 200 years people have been traveling to Boston to get the best medical care. The ability to do so virtually is a logical next step. Bottom Line. In the “good old days” of pharmaceutical marketing, drug companies treasured their lists of “opinion leaders,” i.e., practitioners who were big deals in their local communities. In 2017 and beyond, it will be interesting to see how centralized services like Partners’ offering will impact the ways in which ideas spread and marketing activities are conducted!

The Cash-Based Practice

Cash When we have talked before about “direct payment” practices, we have usually been talking about Primary Care Physicians. But here, a Psychiatrist weighs in on the fact that while he enjoys the benefits of a cash-based practice, he recognizes the societal impact of his approach. More specifically, he notes the large numbers of patients who are excluded from using a cash-based practice based on their inability to pay, and the fact that this inherently leads to the need for a two-tiered system. Who man’s the bottom tier, the blogger asks? NP’s and PA’s? Doctors who have been drafted for a stint in public service? And sometimes the tiers cross over, or even clash. A brief personal vignette. My concierge PCP recently referred me to a specialist for a consultation. I called the specialist’s office to make an appointment, and was curtly asked for my type of insurance. When I responded “Medicare with the AARP Supplement,” the response was a quick “We are not taking any more Medicare patients at this time.” Still wanting the consultation, I offered to pay cash. Before she hung up on me, the receptionist informed me that since I was a Medicare patient, the Doctor couldn’t take my money! So. My participation in the public safety net of Medicare precludes me from paying for my care. AAAHHH!!! Note. I have told this story to several of my friends, and they have told me that they have had similar experiences. Bottom Line. So. Sometimes having a two-tiered system is made more complicated by the intersection of the tiers. Watch out for this one!

The Magical 15-Minute Office Visit

Medical Office Visits   Question. Who decided that patients should be scheduled every 15 minutes in a Primary Care Physician’s office? Based on what? Check out this blog post. You will see some of the “risks” of a physician trying to deal with a patient, especially a new and/or complicated patient, in a quarter hour. As a point of reference, think about how much can you get done in 15 minutes. Or how little! Bottom Line. Not surprisingly, left dangling here is the answer to the question as to what other time management approach might work better. Concierge practices are mentioned as a potential solution, but with the admission that the annual charges for such practices put them out of the reach of many.   Got any ideas on how to fix this? Think about it!

Polymyalgia Rheumatica

Screen Shot 2016-02-22 at 8.00.58 PM Ever heard of it? Me neither. Until a few months ago when my muscles, especially in my shoulders and thighs, got stiff, then sore, then flat out painful. Putting on a jacket became an insurmountable task. Finally, I bit the bullet, and made an appointment to see my Internist. Blood tests, she reported in a follow up phone call, were all “normal.” Great! My presumptive diagnosis was “You are getting old, game over, forget about it, go home and read your Kindle.” Not so fast. Scroll forward through a couple more days of increasing discomfort, and I am again sitting in the treatment room telling my Doc I need Plan B. Not the contraceptive, just a different way of dealing with my complaining body, other than doing nothing at all. Whoops! She called up my blood test results on her computer screen for a second look, and realized and immediately admitted “I made a mistake.” Seems that on the phone call, she had not scrolled down far enough to see that my C-Reactive Protein was way high, a sure sign of significant inflammation. With my symptoms, this was a definitive for PMR. I’m not going to describe the condition here. Go to Mayo and learn about it if you are interested. There are 200,000 new cases of PMR in the U.S. every year, so maybe you should be interested. Funny. The good news is that since the lab findings were no longer normal, I now had something to treat. $8 worth of generic prednisone pills are doing a wonderful jobJ. Bottom Line. The learnings of all of this? Lots. Most importantly, no matter how good our physician, we need to be stewards of our own healthcare. We all need to get the best physicians we can find and afford, and then work with them, closely and proactively, to ensure a good outcome. Had I not done so in this situation, I would still be sitting here in silence, and in pain!

It’s The Dinosaur Again

Screen Shot 2016-02-09 at 6.21.39 PM This time, she’s blogging about why she will never close her practice to new patients. Check out this post. While she makes some cogent points, I’m sure that her waiting room must be a real traffic jam if she takes on all comers. As I read and reread this post, I’m thinking Lucy may have missed the point this time. Based on my experiences as a patient, you make out a heck of a lot better in a practice where your doctor has capped the size of the “panel” (funny word for patient load), and only accepts new patients when the panel size falls below this number. My concierge doc, for example, has her practice capped at 800. Before turning to a concierge model, that number was 2,000. There is today, as there usually is, a waiting list of patients ready to pony up the annual subscription fee if her concierge practice’s door briefly swings open. Bottom Line. I’m thinking that the number of active patients in a physician’s practice matters, a lot, in terms of the quality of care that can be delivered. I’m also thinking that the way a doctor chooses and maintains the size of her practice also matters. And yes, as the dreaded doctor shortage sweeps across the land in years to come, this issue will only become more important.

An Invasive Cardiologist Goes DPC???

DPC Hint. That’s Direct Patient Care. Fee for service medicine. Another hint. When we have talked about DPC before, it has always had to do with PCP’s. But, in this blog the Cardiologist pictured above reports that he has made the move to the new practice model. Why? In a nutshell, he has had it with ICD codes, insurance companies and having to see so many patients in a day that an office visit might last all of 4 minutes. Bottom Line. Fascinating to consider. What specialties can make a go of it in DPC? I wouldn’t have thought Cardiology would be among them, but this young doctor is betting a lot that this will work. Dermatology? Sure! Gynecology? Maybe. Etc. Keep your eyes on this. It could get interesting.