DPC Webinar - Engaging Medical Students in the Practice of Free Market Medicine

[AtlasMD]

If you're interested in the direct primary care movement, Dr. Doug and Dr. Josh of AtlasMD will be participating in a webinar with www.primarycareprogress.org this Wednesday:


AtlasMD: Engaging Medical Students in the Practice of Free Market Medicine


Register is free here at http://goo.gl/EjsPT7


Thanks

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[deleted480308]

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also....love it atlas!

 

[AtlasMD]

(placeholder to find this later)

also....love it atlas!

thanks!!!

 

[AtlasMD]

here's the link for the webinar -

1) yes we give our "cell" phone number to all of our pts (600 actually) but its an internet # (www.twilio.com) that is linked to our chart. And yes we're on call 24/7 for the last 4 years almost, but its really not bad. I don't get a phone call every night, and almost never woken up in the middle of the night. very doable. b/c they can text and/or email, they call a lot less often.

2) a decent income based on our math would be 200-240k (after expenses) per year for 600 pts. and thats for seeing an avg of 5 per day

3) this works great for IM!!

anything else i can help with? feel free to contact directly [email protected]

 

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[AtlasMD]

The membership is for unlimited visits, no copays, all procedures we can do in the office are included free of charge, and access to our wholesale med/lab pricing.

So yes mole removal or medical laser treatments are free in our clinic.

Each doctor is free to set their own price though.

There's is indeed an incentive which is to add value to your clinic and save them money. Also other docs will invest in more features to help recruit and retain patients.

 

[AtlasMD]

In our clinic, the clinic covers all of the operating costs.

 

[bulldogmed]

If you're interested in the direct primary care movement, Dr. Doug and Dr. Josh of AtlasMD will be participating in a webinar with www.primarycareprogress.org this Wednesday:


AtlasMD: Engaging Medical Students in the Practice of Free Market Medicine


Register is free here at http://goo.gl/EjsPT7


Thanks

AtlasMD, I loved the webinar. It's really exciting to hear how y'all are succeeding with new markets. I was especially interested in the public health implications with reducing hospital readmission rates and having better outcomes with HF pts. Maybe it's already in the process, but an epidemiological study should be done on exactly that. Changes in medicine could come pretty quickly if substantial benefit were demonstrated and published.

One question I had, could DPC work if you were interested in doing OB and inpatient? With fewer pts doing OB wouldn't be as bad on your call schedule, and if I end up liking it (I'm an M3) why not offer it? Would you make that a one time charge of $500 or $1000?

 

[apoptoaster]

@AtlasMD, thanks for posting this. As a med student, I've been curious about DPC for a while, and the webinar has really helped to clarify a lot of questions. I'm only half way through the webinar, so forgive me if you address this in the webinar, but I was wondering how you manage vacation time and how you balance being on call all the time with family obligations. Do you split call coverage? Or are you always available to your own patients? With 600 patients, on average, how many evenings do you get calls/messages/emails in a week on average? Do you end up on the phone or computer a lot, or are you able to manage most things during normal working hours? I guess I'm just wondering if this practice model makes it hard to draw boundaries between your work life and family life (and if it would cause a physician to be less "present" when spending time with his/her family or doing anything other than work knowing that you're always on call). But then, I know that in actual practice it might be completely different than I am imagining. Thanks again for taking the time to share your experience and enthusiasm for primary care.

 

[AtlasMD]

AtlasMD, I loved the webinar. It's really exciting to hear how y'all are succeeding with new markets. I was especially interested in the public health implications with reducing hospital readmission rates and having better outcomes with HF pts. Maybe it's already in the process, but an epidemiological study should be done on exactly that. Changes in medicine could come pretty quickly if substantial benefit were demonstrated and published.

One question I had, could DPC work if you were interested in doing OB and inpatient? With fewer pts doing OB wouldn't be as bad on your call schedule, and if I end up liking it (I'm an M3) why not offer it? Would you make that a one time charge of $500 or $1000?

Thanks for the support, but this is really a movement by hundreds of docs across the country that are fighting for a better system for their patients and themselves.

The public health affect could be enormous! Imagine what the internet did for communication....and what it could do for medicine.....

Could this work in OB? of course, people need affordable obstetrics care too. Could it work for inpatient? Possibly, but thats a tougher nut to crack

 

[AtlasMD]

@AtlasMD, thanks for posting this. As a med student, I've been curious about DPC for a while, and the webinar has really helped to clarify a lot of questions. I'm only half way through the webinar, so forgive me if you address this in the webinar, but I was wondering how you manage vacation time and how you balance being on call all the time with family obligations. Do you split call coverage? Or are you always available to your own patients? With 600 patients, on average, how many evenings do you get calls/messages/emails in a week on average? Do you end up on the phone or computer a lot, or are you able to manage most things during normal working hours? I guess I'm just wondering if this practice model makes it hard to draw boundaries between your work life and family life (and if it would cause a physician to be less "present" when spending time with his/her family or doing anything other than work knowing that you're always on call). But then, I know that in actual practice it might be completely different than I am imagining. Thanks again for taking the time to share your experience and enthusiasm for primary care.

Glad you liked the webinar! We also have a podcast that answers a lot of questions.

https://itunes.apple.com/us/podcast/atlas-md/id674138661

Vacations - easy with 3 docs in the office, we just cover for each other.

Call coverage - most of the time we take our own call. Yep, on call, 24/7/365....but honestly, its not that bad at ALL. its better than residency life I don't get a phone call every weekend or even every night. With sms/email options, more patients chose to do that which are easy to respond to as needed.

Volume - we don't currently track the #/type of messages (although it would be a fun study), but we see %1 of the 600 in the office per day (ie 5-6 pts per day in the office) and several more digitally.

We are on the computer a lot during work hours but not much after hours.

Family life - i think its WAY better in this model b/c you're happy and not burned out. Makes a huge difference.

 

[deleted480308]

the podcast is good info if you want to get a better feel

 

[AtlasMD]

anyone is welcome to contact us directly if you'd like to chat or learn more. [email protected] @AtlasMD and www.facebook.com/atlasmd

 

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[AtlasMD]

wonderful questions and happy to answer all of them. I'll be brief but can expand on anything you'd like:

hours per week - 45-50. We work m-f 9-5 plus a few hours combined after hours. We looked into this recently for a med student who asked about weekend hours and all 3 docs agreed on 1-2 hrs per weekend. so yes, we're at the office all day, but we read, chat, surf the internet, manage pts etc during the day. But we still have a fair amount of down time most days.

Take home pay - 200-240k/yr/doc is 360k - 120k business overhead / doc. The doc pays their only taxes, malpractice, etc.

Locked in - yeah i'll agree but this is true to some extent with any practice. Its hard in any job to take extended vacations. But pts understand that docs get ick too. Having partners makes all of this much easier.

Call coverage - i haven't been woken up by a pt call after 10pm in 3-4 months. and if i miss a call, they aren't mad b/c im available so often. So no, there is not a caveat that i'm not mentioning.

anything else? thanks!

 

[apoptoaster]

Glad you liked the webinar! We also have a podcast that answers a lot of questions.

https://itunes.apple.com/us/podcast/atlas-md/id674138661

Vacations - easy with 3 docs in the office, we just cover for each other.

Call coverage - most of the time we take our own call. Yep, on call, 24/7/365....but honestly, its not that bad at ALL. its better than residency life I don't get a phone call every weekend or even every night. With sms/email options, more patients chose to do that which are easy to respond to as needed.

Volume - we don't currently track the #/type of messages (although it would be a fun study), but we see %1 of the 600 in the office per day (ie 5-6 pts per day in the office) and several more digitally.

We are on the computer a lot during work hours but not much after hours.

Family life - i think its WAY better in this model b/c you're happy and not burned out. Makes a huge difference.

Thanks so much for your response. Also, thanks for pointing out the podcast - I'll definitely be checking that out.

 

[AtlasMD]

my pleasure, let me know if i can do anything else for you

 

[Marcus Brody]

Bunch of random questions out of curiosity:

1. About what % of your patients end up having an acute complaint per year?
2. Do you do more acute visits or annual visits compared to regular primary care?
3. How do you cover vacations, and do patients mind it? How much vaca is realistic?
5. What types of pts are a net cost to the practice and what are the common reasons?
6. Isn't DPC essentially just small scale health insurance being sold by the providers themselves?
7. How do you handle a pt who is legitimately a high utilizer, ie taking up all your time? When do you know their needs are too much of a burden for you?
8. Do any DPC practices cover their pts in the hospital?
9. Do you try to avoid referrals, how do patients pay if they're referred?
10. What are the main oversight/regulations/mandates that you avoid and which still apply?
11. How do you approach health maintenance and screening type things now that they are actual costs without any reimbursement incentive?
12. What kind of medical records do you keep?
13. Has Obamacare hurt DPC by mandating against high deductible emergency type insurance plans DPC pts tend to use as backup?
14. What do traditional primary care physicians think of DPC?

 

[AtlasMD]

always happy to help answer questions, I will be brief but can expand on things as needed:

1. About what % of your patients end up having an acute complaint per year?
We see 1% of our patients, or five or six patients per day, in the clinic. In a smaller number by email phone calls or text messages. I am rarely called after-hours.
2. Do you do more acute visits or annual visits compared to regular primary care?
I think we do more acute visits because we are more accessible.
3. How do you cover vacations, and do patients mind it? How much vaca is realistic?
We covered each other's patients during vacations, we typically take 15 days of vacation per year
5. What types of pts are a net cost to the practice and what are the common reasons?
Can you clarify your question
6. Isn't DPC essentially just small scale health insurance being sold by the providers themselves?
Not in the least. It is doctors selling their services.
7. How do you handle a pt who is legitimately a high utilizer, ie taking up all your time? When do you know their needs are too much of a burden for you?
Usually a high utilizer has a legitimate reason and we manage their health. If they do not have a legitimate reason then we set boundaries.
8. Do any DPC practices cover their pts in the hospital?
They can, but that depends on the hospitals bylaws to have privileges. I would say typically they use the hospitalist service.
9. Do you try to avoid referrals, how do patients pay if they're referred?
We try to avoid unnecessary referrals. If a patient does need the referral we try to help negotiate for cash discounts if they do not have insurance.
10. What are the main oversight/regulations/mandates that you avoid and which still apply?
Where free of most insurance, Medicare, Medicaid regulations. So now you just need to stay within your license, scope of practice, the standard of care.
11. How do you approach health maintenance and screening type things now that they are actual costs without any reimbursement incentive?
We tried to do as much or more health screening for patients. The wholesale medications and wholesale labs help to minimize their costs.
12. What kind of medical records do you keep?
Standard medical records but we do not have to file with insurance.
13. Has Obamacare hurt DPC by mandating against high deductible emergency type insurance plans DPC pts tend to use as backup?
Obama care has helped direct primary care practices to grow because people need affordable healthcare options. Yes we still recommend patients have a major medical or catastrophic health insurance plan.
14. What do traditional primary care physicians think of DPC?
Once doctors learn about direct primary care, they realize they can make more money, seeing fewer patients patients, providing more affordable care, and avoiding most insurance hassles.

 

[Doctor4Life1769]

I'm a current resident. Should I look into getting a PCP who runs direct pt care/concierge practice? how much is the retainer fee usually? What should I look for? I may do my practice management rotations in a similar practice setting. I am very intrigued in this and would like a similar practice. Much prefer seeing 10 patients a day and know them well and be readily avail to my patients than seeing 30-40/day and barely know them while turfing out patients to other specialists.

 

[AtlasMD]

I'm a current resident. Should I look into getting a PCP who runs direct pt care/concierge practice? how much is the retainer fee usually? What should I look for? I may do my practice management rotations in a similar practice setting. I am very intrigued in this and would like a similar practice. Much prefer seeing 10 patients a day and know them well and be readily avail to my patients than seeing 30-40/day and barely know them while turfing out patients to other specialists.

Hi, great to hear that you're interested in the DPC model. I can't begin to tell you how great it is to know your patients and actually have time to figure them out.

The retainer fee can vary quite a bit. We have a website to help connect interested doctors and patients, www.iwantdirectcare.com

If you need any help finding a DPC doc to shadow for your management month, just let me know. We frequently have residents rotate through our clinic but there's lots of DPC docs who'd be happy to help residents.

Anything else i can help with?

 

[LVFMDOC]

Hello AtlasMD!
I'm a 3rd year FM resident, graduating in 9 months. Would it be impossible to start a private DPC practice right out of residency?

 

[AtlasMD]

Hello AtlasMD!
I'm a 3rd year FM resident, graduating in 9 months. Would it be impossible to start a private DPC practice right out of residency?

absolutely. I started my clinic, www.atlas.md/wichita straight out of residency and we've helped other docs do the same.

Feel free to contact me directly anytime either by email or cell. [email protected] and C 316.734.8096 I'm happy to help.

 

[bronx43]

Hey Atlas, how much is a standard EMR costing a new practice? I saw that you developed your own emr. How much is your EMR compared to the competition? What are the biggest hurdles to having existing PCPs get or change their EMR? Thanks.

 

[AtlasMD]

Hey Atlas, how much is a standard EMR costing a new practice? I saw that you developed your own emr. How much is your EMR compared to the competition? What are the biggest hurdles to having existing PCPs get or change their EMR? Thanks.

Well it can really run the gamut.
- practice fusion is free, but no billing component
- AtlasMD (ours) $300/mo for emr & practice management
- Dr. Chronos up to $450
- Athena is around 30k/doc/year for an insurance based practice.

Our biggest hurdle? I would say physicians are so frustrated with the idea of regulation and EMRs that they want to wash their hands of the whole process. EMR is still a 4 letter word to most doctors, and rightfully so, b/c most are really poorly designed.

We tried to build an emr that actually made doctors jobs easier from enrolling patients, communicating, charting, prescribing, billing etc. So we try to win the hearts and minds of other doctors by building a quality product.

Let me know if there is anything else I can do to help.
Thanks,
Dr. Josh

 

[bronx43]

Well it can really run the gamut.
- practice fusion is free, but no billing component
- AtlasMD (ours) $300/mo for emr & practice management
- Dr. Chronos up to $450
- Athena is around 30k/doc/year for an insurance based practice.

Our biggest hurdle? I would say physicians are so frustrated with the idea of regulation and EMRs that they want to wash their hands of the whole process. EMR is still a 4 letter word to most doctors, and rightfully so, b/c most are really poorly designed.

We tried to build an emr that actually made doctors jobs easier from enrolling patients, communicating, charting, prescribing, billing etc. So we try to win the hearts and minds of other doctors by building a quality product.

Let me know if there is anything else I can do to help.
Thanks,
Dr. Josh

30k/doc/year??? That's outrageous. What kind of services are they providing that would provide that much value? Between just buying the EMR and paying someone to do your billing, that's a BIG chunk of your annual revenue. I mean, how much more robust an EMR does it have to be to offer billing assistance? I can't imagine 30k worth of value.

 

[AtlasMD]

hahaha, yeah thats what i said when i first heard that. When you hear docs complain about the cost of an EMR, thats what the mean And i'm not saying with a busy 40+ pt/day model, that its not helpful. Insurance is increasingly complex so if it saves you one staff person per year, then its helpful.

But no thank you