Questions and Answers

Things have been crazy.  It\’s much, much more difficult to build a new practice than I expected.  I opened up sign-up for my patients, getting less of a response than expected.  This, along with some questions from prospective patients has made it clear that there is still confusion on the part of potential patients.  So here is a Q and A I sent as a newsletter (and will use when marketing the practice).

About My New Practice

Q. When will it open?  
A.  My office will open in January, 2013, but the exact date is still not set.  I had initially hoped to be already seeing patients, but things always are harder than they seem.
Q. How much will it cost?
A.  I will charge only a monthly payment which depends on the age of the patient:
  • $40/month for children under 3
  • $30/month for people ages 3 to 29
  • $40/month for people ages 30-49
  • $50/month for people ages 50-64
  • $60/month for people 65 and up.
  • There is a $50 charge for the first month for people under 40, $100 for those 40 and up.
  • There is a $150/month family maximum ($200 maximum for 1st month).
Q.  Are there other charges?
A. As of now, there are none.  All office visits and any procedures done in the office are covered by the monthly fee.
Q. How can I afford to do this?
A. I have greatly decreased my overhead by not accepting insurance and keeping my charges simple.  My goal is to have 1000 patients paying the monthly fee, which will limit the number of staff I need to hire.
Q.  What will patients get for the monthly fee?
A.  In addition to office visits, patients will get:
  • Direct access to me via phone
  • Access to me through secure messaging
  • A personal health record, a health summary customized for each patient giving detailed information to help with care outside of my office.
  • A personal care plan summarizing scheduled care done, due now, and due in the future.
  • Regular review of the personal health record and care plan to assure it is up to date.
  • Enhanced coordination of care with specialists, hospital physicians.
  • A health library of information for patients to answer questions when they come up.
Q. Why did I do this?
A.  I get to be a doctor again (perhaps for the first time).  I got tired of giving patients care that wasn’t as good as it could be.  I got tired of working for a system that pays more for bad care than for good.  I got tired of forcing patients to come in for care I could’ve given over the phone.  I got tired of giving time that should be for my patients to following arduous regulations.  I got tired of medical records not meant for actual patient care, but instead for compliance with ridiculous government rules.  Making this change gives me the one thing our system doesn’t want to pay for: time devoted for the good of my patients.
Q.  What makes this better for patients?
A.  The main advantage is that I am finally able to give them the care they deserve: care that is not hurried, not distracted by the ridiculous complexity of the health care system, and not driven by the need to see people in person to give care.  This means:
  • I don’t ever have to “force” people to come to the office to answer questions.  This means that I will let people stay at home (or work) for most of the care for which I would have required an office visit in the past.
  • I will be able to give time people deserve to really handle their problems.
  • I won’t have to stay busy to pay the bills, so I can take care of problems when they happen (or when they are still small), rather than having to make people wait to get answers.
  • Patients won’t get the run-around.  They will get answers.
  • I won’t wait for patients to contact me to give them care.  I will regularly review their records to make sure care is up to date.
  • I will help my patients get good care from the rest of the system.  Avoiding hospitalizations, emergency room visits, unnecessary tests, and unnecessary drugs takes time; I will have the time to do this for my patients.  This should more than make up for my monthly fee.
Q.  What’s the advantage of patients having their records?
A.  Health care is disjointed, with little communication occurring between different locations of care.  Care is often done blindly, not knowing the overall picture of the patient’s care done elsewhere.  This means patients repeatedly answer questions about their care, care they often don’t understand or remember.  My patients will have an accurate summary of their care which they can print out or bring up on their computer, phone, or tablet when information is needed.  I will work with them to keep this summary up to date and as useful as possible.  While others may be afraid of the consequence of patients seeing their records, I am far more afraid of the uninformed care they get when those records are not available.
Q.  Will this mean patients will need to come in more often to “get their money’s worth?”
A.  There certainly is a risk of this happening, but my intent is to empower my patients, not coddle them.  The ideal for every patient is that they spend as little time dealing with doctors and hospitals as possible.  My goal will be to use my time to give my patients tools to make good decisions and stay healthy.  My old business (and the rest of the health care system) depended on people being sick or uninformed to pay the bills, but my new system has no such motivation.  I can finally have the same goal as my patients: their health.  I think this will ultimately save them a lot of money, and (most importantly) keep them healthy, informed, and away from doctors.
Q.  What are my future plans?
A.  If the business is successful, my hope is to add staff to offer more services.  I hope to hire a dietician to educate my patientsabout their diets.  I hope to hire a social worker to deal with the non-medical burden many of my patients carry.  I hope to hire nurses to visit complicated patients to make sure they are taking medications properly, or to deal with small problems before they become big ones.  I hope to hire a counselor to improve the emotional welfare of my patients.  This will enable me to grow the size of the practice without becoming overly busy.

10 thoughts on “Questions and Answers”

  1. Dr. Rob,
    As someone who wishes you well on this experiment, here’s my two cents. For your next version of the newsletter, here’s a bit of marketing advice. Switch the content around so that it talks about what the patient gets, not what your situation is. One of the basics of advertising is that you sell some advantage to the customer – the product will be cheaper, make them healthier, make them sexier, make them look trendy, or whatever the pitch is.

    In addition, giving examples can help – it helps people visualize what they can get out of it. For example, they don’t have to take time off from work, they can call you to find out if their child’s sniffle means they should come in, you’ll send out reminders for mammograms and flu shots, or what ever the specifics might be. You should be looking for “pain points” – things that bug patients, and show how you are going to make them less painful.

    I know you’re a doctor, not a business man (“Dammit Jim, I’m a doctor not a businessman”), so I thought I’d throw it out there for you.

    For example, here’s the revised version of one of these sections

    Why is this better for your and your family?

    A. You and you get the care you deserve – care that is not hurried, not focused on filling the paper work to satisfy an insurance company. With this approach, the doctor spends less time on paper work, and more time on you, so that you won’t be rushed through an appointment.

    There are many benefits, including:

    You don’t have to come into the office unnecessarily – I can communicate with you by secure email or phone. If you are worried about your child’s cough, I can help you figure out whether you need to bring her in to be seen.

    No run around – timely answers to your questions

    You’ll get proactive care – I’ll review your records and make sure that you are getting the care you need. With this approach you’ll get the preventative care you’ll need, which help you avoid a trip to the emergency room, avoid unnecessary drugs, and limit the development of avoidable health issues.

    Help navigating the medical system. I can help you find the appropriate specialists and care for more complex problems, because I have more time to do this for you.

    Original

    What makes this better for patients?

    A. The main advantage is that I am finally able to give them the care they deserve: care that is not hurried, not distracted by the ridiculous complexity of the health care system, and not driven by the need to see people in person to give care. This means:

    I don’t ever have to “force” people to come to the office to answer questions. This means that I will let people stay at home (or work) for most of the care for which I would have required an office visit in the past.

    I will be able to give time people deserve to really handle their problems.

    I won’t have to stay busy to pay the bills, so I can take care of problems when they happen (or when they are still small), rather than having to make people wait to get answers.

    Patients won’t get the run-around. They will get answers.

    I won’t wait for patients to contact me to give them care. I will regularly review their records to make sure care is up to date.

    I will help my patients get good care from the rest of the system. Avoiding hospitalizations, emergency room visits, unnecessary tests, and unnecessary drugs takes time; I will have the time to do this for my patients. This should more than make up for my monthly fee.

  2. (1) I’d have you as my doctor if I lived within 100 miles of you. No question.

    (2) I’d work for you in a heartbeat.

    (3) I agree with Kate S. – make it all about what your patients are getting out of this, and they are getting a LOT. This is 24/7 access – no middleman, no gate-keepers, no maze to make it through to get to “their” doctor. This could mean no more 3 am trips to the ER because the baby has a sudden fever. No more losing time from work because no one is “allowed” to give advice over the phone anymore. Access to records – no filling out forms and waiting (and paying) just to see lab results.

    and
    (4) Those are damned good rates, Rob. I have 3 adult children. Even back when they were little, to have had a family physician for $150 a MONTH would have been a bargain.

  3. Thank you for having the courage to practice medicine as it should be done. I wish you all the best as you embark on this great new venture.

  4. In a way, what you describe comes close to some excellent past primary care relationships. I’m going to be an outlier, in that I’m a clinical decision support engineer with substantial knowledge of medicine — as I tell people, I’m not a physician but play one on a computer. When a previous PCP knew me well enough, no one was particularly worried about proactive health planning or counseling — I’d ask for it if I needed it. On the other hand, if I called and asked for a lab order, or requested a prescription along with specific indications, there were standing orders to support this — meds did get a second look in some cases.
    I’m wondering how my needs would fit under your pricing model.

    Is it your assumption that you will not do procedures are of a cost to need insurance reimbursement?

  5. Hi Dr. Rob! Love your blog and wish you all the best going forward. Quick question: are there any licensing issues that would prevent you from seeing one of your patients via phone or Skype while they were on vacation in a state where you are not licensed currently? Could you call in a script remotely in such a case?

  6. I wish a PCP in my area would follow this path, but i don’t think the numbers will motivate many to do so. Math isn’t my forte, but according to my calculations based on the monthly rates you list, it looks like if you have 100 patients on your service the gross earnings would only be about $60K a year, and that’s before any expenses. Is that right?

  7. I will have 200 patients by the end of the 1st month, and my goal is to get to 1000. Then the math turns quite favorable. My total numbers will be determined by how busy we are. I’ll hire staff, other providers if we go gangbusters, even considering the option of decreasing the monthly fee to make it more accessible to patients.

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