Oh how wrong they were about DPC!

[AtlasMD]

http://www.prnewswire.com/news-releases/direct-...

Ok so i just finished reading this press release from www.specialdocs.com and was somewhere between laughing out loud and furioius. The innaccuracies inhere are embarrasing for a consulting company!

Point by point:

- DPC is best fiewed as a fee for service model -- UM NO! nearly every dpc practice i know of is based on a membership

- conceirge clinics focus on prevention and wellness b/c it takes extended time and attention (by inference, dpc doesn't b/c they don't have the time). The average dpc practice sees 6 pts/day....we have plenty of time.

- Majority of care in a conceirge model is provided by a physician and in DPC its primarily (just) NPs/PAs....i bet the 250 physicians that are attending the DPC summit this weekend might take issue with this

- in DPC there is no cap on pts...and frequently swell to over 1500 pts....WTF says the doctor who caps his panel at 600 pts

- Small DPC practices are not finacially viable - don't tell that to my docs who are salaried at $200k/yr....paying them in monopoly money seems to work

---My Favorite---DPC model will not be able to alter the treadmill nature of modern medicine....those are fightin' words!!

--Given the large number of patients they continue to see, the DPC physician cannot offer the dramatic change in how they deliver care.....now i'm just confused...do they even know what the hell they are talking about

--nor will [dpc] experience the remarkable transformation in their professional and personal lives,----ooops! i've been enjoying my life, i wish they would have told me sooner that i can't be happy

---

Members don't see this ad.

 

[deleted480308]

They need to discourage looking outside the system to get people to tolerate the system. Who would want to work in the grinder that is normal FM nowadays if they saw how much better it can be?

 

[VA Hopeful Dr]

In SC, the other parts of the state have DPCs that will essentially function as regular cash-only practices. They have a membership but will also see anyone just cash up front. I bet their panels are not capped at the same level as those of us doing pure subscription-based care.

 

[Promethean]

I was just wondering where I could put this file that Dr. Pamela Wible emailed me this morning, with the numbers and logistics of how her ideal medical clinic works...

DPC, Ideal Medical Care, whatever you wanna call it... Relationship based medicine is the solution to the "health care crisis." Happy patients, happy docs... The only people who suffer are the ones who have made an industry out of physician exploitation.

 

[JustPlainBill]

Rather interesting -- immediately after my hour long conversation with AtlasMD, I contacted a few people who had hit me up about becoming my patients when I opened my own practice --

I described the DPC model as well as the monthly fees -- I used $50/month just to check their reaction -- the first person flat out told me that they'd pay $100/month for that -- they also flatly told me that they could get me a lot of patients who would happily pay that amount in cash, no sweat. So at 600 patients, that's a chunk....

The second person I contacted asked me when I was opening up --- and all of the responses were positive ---

Now I just need to really figure out the particulars and maybe come shadow a doc or 2 who are doing this ---

 

[olivarynucleus]

So, what if you have patients who need test and labs done, where do you send these people if its just a doc there?

 

[Mad Jack]

I mean, PRNewswire is basically a site you pay to run an article for you- this is nothing but then trying to sit down the competition. They see a threat, and they'll lie all they have to to keep their business model going.

 

[VA Hopeful Dr]

So, what if you have patients who need test and labs done, where do you send these people if its just a doc there?

I have a CMA who draws blood. We then send to Quest, which gives us a big cash discount. CBC $4, CMP $5, TSH $7.

I have a local imaging place that offers big cash discounts. Extremity XR with read, $30. CXR $40. CTs are around 3-400, MRI around 5-600.

 

[VA Hopeful Dr]

Rather interesting -- immediately after my hour long conversation with AtlasMD, I contacted a few people who had hit me up about becoming my patients when I opened my own practice --

I described the DPC model as well as the monthly fees -- I used $50/month just to check their reaction -- the first person flat out told me that they'd pay $100/month for that -- they also flatly told me that they could get me a lot of patients who would happily pay that amount in cash, no sweat. So at 600 patients, that's a chunk....

The second person I contacted asked me when I was opening up --- and all of the responses were positive ---

Now I just need to really figure out the particulars and maybe come shadow a doc or 2 who are doing this ---

I can't recommend a visit to AtlasMD enough. Totally worth it.

Alternatively, if you're really close to SC and don't want to pay airfare to Kansas I'd be happy to host but with the caveat that Atlas is better.

 

[JustPlainBill]

I can't recommend a visit to AtlasMD enough. Totally worth it.

Alternatively, if you're really close to SC and don't want to pay airfare to Kansas I'd be happy to host but with the caveat that Atlas is better.

VA Hopeful Dr -- sorry brother but I'm in North Texas with kinfolk on the OK/KS border --beautiful little town called Caldwell at the end of the Chisholm trail -- family farms 8,000 acres -- great place to watch the paint dry, eat copious amounts of good, home cooked, made from scratch fried chicken, mashed potatoes and gravy, biscuits with fresh milk -- so I'll probably hook it to AtlasMD's place next time we're up --- although always wanted to visit S.C. ---

 

[AtlasMD]

tthanks everyone! and anyone is welcome to come to the office anytime and see how it all works. and i think most dpc docs are so happy to share what they are doing that you could probably visit anyone of them.

www.atlas.md/starter for all of our free startup materials for a practice.

[email protected] if you want to email me questions

or call my cell 316.734.8096

 

[VA Hopeful Dr]

VA Hopeful Dr -- sorry brother but I'm in North Texas with kinfolk on the OK/KS border --beautiful little town called Caldwell at the end of the Chisholm trail -- family farms 8,000 acres -- great place to watch the paint dry, eat copious amounts of good, home cooked, made from scratch fried chicken, mashed potatoes and gravy, biscuits with fresh milk -- so I'll probably hook it to AtlasMD's place next time we're up --- although always wanted to visit S.C. ---

No worries, at this point I would totally recommend Atlas over me for learning how to do it.

 

[Doctor4Life1769]

In my final year and I'm not a huge fan of the job market.
I am considering this route but have no real capital.

 

[VA Hopeful Dr]

In my final year and I'm not a huge fan of the job market.
I am considering this route but have no real capital.

Most of us had to take out loans to do this

 

[Doctor4Life1769]

Most of us had to take out loans to do this

Good to know.
I'm knee-deep in loans. I will probably work for a priv group or hospital system, make some green, and then use that to build up something.

 

[AtlasMD]

It really doesn't have to be so scary. It's getting easier all of the time. You could connect with a few small employers would LOVE to work with you and pre enroll / fund your start up costs.

 

[Doctor4Life1769]

It really doesn't have to be so scary. It's getting easier all of the time. You could connect with a few small employers would LOVE to work with you and pre enroll / fund your start up costs.

few small employers i.e. with a hospital system?

 

[deleted547631]

Rather interesting -- immediately after my hour long conversation with AtlasMD, I contacted a few people who had hit me up about becoming my patients when I opened my own practice --

I described the DPC model as well as the monthly fees -- I used $50/month just to check their reaction -- the first person flat out told me that they'd pay $100/month for that -- they also flatly told me that they could get me a lot of patients who would happily pay that amount in cash, no sweat. So at 600 patients, that's a chunk....

The second person I contacted asked me when I was opening up --- and all of the responses were positive ---

Now I just need to really figure out the particulars and maybe come shadow a doc or 2 who are doing this ---

Can you all imagine a panel of 600 paying an average of $100/month for DPC practices? I love hearing this.

 

[VA Hopeful Dr]

few small employers i.e. with a hospital system?

Not so much that as local small businesses that would help you get off the ground.

Alternatively, you can easily moonlight enough to pay your expenses with a loan to cover equipment only (and you can do that for pretty cheap as well - I borrowed 60k for equipment and have some left over AND have way more stuff that I probably will actually need).

As of right now, hospital systems don't seem to have much interest in the DPC model - though they really should be paying closer attention. Insurance companies won't pay these outrageous facility fees forever...

 

[Promethean]

Pam Wible started her clinic on $3000. Admittedly, she is very whimsical and her practice model won't necessarily fit everyone. But the idea that starting a practice has to cost tens or hundreds of thousands of dollars just doesn't stand up to scrutiny.

Sent from my SM-N910P using Tapatalk

 

[Doctor4Life1769]

Pam Wible started her clinic on $3000. Admittedly, she is very whimsical and her practice model won't necessarily fit everyone. But the idea that starting a practice has to cost tens or hundreds of thousands of dollars just doesn't stand up to scrutiny.

Sent from my SM-N910P using Tapatalk

Who is she and what's her practice model like?
I don't mind finding/opening a small office space for 3k
What about marketing, having a person to handle admin/scheduling? billing? takes more than 3k i'd think...

 

[VA Hopeful Dr]

Pam Wible started her clinic on $3000. Admittedly, she is very whimsical and her practice model won't necessarily fit everyone. But the idea that starting a practice has to cost tens or hundreds of thousands of dollars just doesn't stand up to scrutiny.

Sent from my SM-N910P using Tapatalk

I'd be very curious to see those numbers broken down. I don't think you always need 50k, but I'm pretty sure actually doing it for 3k is tricky at best.

 

[VA Hopeful Dr]

Who is she and what's her practice model like?
I don't mind finding/opening a small office space for 3k
What about marketing, having a person to handle admin/scheduling? billing? takes more than 3k i'd think...

With the AtlasMD EMR, you don't need an admin/scheduling/billing person. If I could draw blood worth a damn, I might not even have my CMA.

That said, as I mentioned, I'm a bit dubious about a cold start for 3k.

 

[Promethean]

I posted the file where she explains what she is up to. Her office is in a wellness center, rent $300/mo. She sends people out for labs and imaging and refers to the health department for vaccines, so that she doesn't need refridgeration. She gives her 400 patient panel her personal cell phone, and has no office staff, so, her overhead is round 7%. Made her own EMR using a laptop she already owned. Handles her own billing, doesn't send anyone to collections, and gets most of her claims paid. Takes most insurances. Seems to be more fee for service than subscription.

She designed her clinic with input from the community she serves, collecting their commentary at town hall meetings and putting it into action in 1 month.

She is happy to share her numbers and her model. She does run seminars for people who want the deep details, but she sends out info like the document I attached for free, and her contact info is at the bottom of the document. You can call her. I have. She is a delight to speak with and very generous with her time and info.

Sent from my SM-N910P using Tapatalk

 

[Doctor4Life1769]

With the AtlasMD EMR, you don't need an admin/scheduling/billing person. If I could draw blood worth a damn, I might not even have my CMA.

That said, as I mentioned, I'm a bit dubious about a cold start for 3k.

Heck, I could draw blood off most folks and place an IV on my own if needed. Prior training experience and all that jazz. Plus, if I had 30-60 mins per patient, it's not like placing an IV or drawing blood would cut into my bottom line.

Do you have a receptionist at least? Who does the vitals?

 

[Doctor4Life1769]

I posted the file where she explains what she is up to. Her office is in a wellness center, rent $300/mo. She sends people out for labs and imaging and refers to the health department for vaccines, so that she doesn't need refridgeration. She gives her 400 patient panel her personal cell phone, and has no office staff, so, her overhead is round 7%. Made her own EMR using a laptop she already owned. Handles her own billing, doesn't send anyone to collections, and gets most of her claims paid. Takes most insurances. Seems to be more fee for service than subscription.

She designed her clinic with input from the community she serves, collecting their commentary at town hall meetings and putting it into action in 1 month.

She is happy to share her numbers and her model. She does run seminars for people who want the deep details, but she sends out info like the document I attached for free, and her contact info is at the bottom of the document. You can call her. I have. She is a delight to speak with and very generous with her time and info.

Sent from my SM-N910P using Tapatalk

I'm interested in this self-made EMR.
I read the document, didn't make much sense to me.

 

[Doctor4Life1769]

Is that physician in a small town? 300/mo is like 1/4 of my apt rent including utilities.

 

[Doctor4Life1769]

With the AtlasMD EMR, you don't need an admin/scheduling/billing person. If I could draw blood worth a damn, I might not even have my CMA.

That said, as I mentioned, I'm a bit dubious about a cold start for 3k.

How much is this EMR?
Are there yearly "updates"?

 

[VA Hopeful Dr]

Heck, I could draw blood off most folks and place an IV on my own if needed. Prior training experience and all that jazz. Plus, if I had 30-60 mins per patient, it's not like placing an IV or drawing blood would cut into my bottom line.

Do you have a receptionist at least? Who does the vitals?

My CMA does vitals, though I easily could. We take turns at reception. If she's doing something else, I'm there. Otherwise, she does that too.

 

[VA Hopeful Dr]

How much is this EMR?
Are there yearly "updates"?

$300/month, cloud based, updates whenever they want to add something.

https://atlas.md/

 

[deleted480308]

Is that physician in a small town? 300/mo is like 1/4 of my apt rent including utilities.

I believe she rents a room and not an entire office

 

[VA Hopeful Dr]

Is that physician in a small town? 300/mo is like 1/4 of my apt rent including utilities.

I saw as cheap as 13-15/square foot/year so an 800 square foot office would run you 625/year. Not too shabby.

 

[VA Hopeful Dr]

I believe she rents a room and not an entire office

Yeah, my understanding is that she does more of the micro-practice type thing compared to a regular practice just no insurance that Atlas and I do.

 

[Doctor4Life1769]

Yeah, my understanding is that she does more of the micro-practice type thing compared to a regular practice just no insurance that Atlas and I do.

To take it even a step further, one could theoretically be a mobile doc and simply just do home visits without actually having an office. The gas mileage would suck, so would driving around to see patients.

The EMR looks intriguing. $300/mo doesn't sound bad.

I do have patients in my residency clinic who keep asking if I'll stick around in the area... and honestly, I wouldn't mind having them jump ship to join me. Most of these are attending patients, and some aren't.

 

[deleted480308]

Atlas and Va, another question.....

Do you only contract with individuals or do you ever do a deal with small businesses (the size not required to offer standard plans) where they pay you directly for their employees memberships? (i.e. a small preschool could could pay you $350/month and use "free primary care" as an employee retention tool)

 

[VA Hopeful Dr]

Atlas and Va, another question.....

Do you only contract with individuals or do you ever do a deal with small businesses (the size not required to offer standard plans) where they pay you directly for their employees memberships? (i.e. a small preschool could could pay you $350/month and use "free primary care" as an employee retention tool)

Both. Offering to pay for a clinic like ours is a nice perk for businesses to offer, and it saves money on their end if they do provide insurance.

 

[cbrons]

I have a CMA who draws blood. We then send to Quest, which gives us a big cash discount. CBC $4, CMP $5, TSH $7.

I have a local imaging place that offers big cash discounts. Extremity XR with read, $30. CXR $40. CTs are around 3-400, MRI around 5-600.

My wife had to peel me off the floor. Did i read that right on those lab tests? 4 dollars as in american dollars for a CBC?

 

[deleted87716]

My wife had to peel me off the floor. Did i read that right on those lab tests? 4 dollars as in american dollars for a CBC?

Those are likely wholesale prices, which he isn't marking up.

 

[VA Hopeful Dr]

Those are likely wholesale prices, which he isn't marking up.

Bingo. Though I do mark up a little bit - basically I round up for anything over about 15-20 cents, makes for rounder numbers which I like. I think the actual CBC price Quest charges me is like $3.76.

 

[VA Hopeful Dr]

My wife had to peel me off the floor. Did i read that right on those lab tests? 4 dollars as in american dollars for a CBC?

The really impressive part (once again, shamelessly stolen from Atlas) is the medications. Many states will allow physicians to dispense medications to their patients. I do this at wholesale plus 10% (to cover label and bottle costs, basically).

I put together an Excel spreadsheet comparing my prices to the wal-mart $4 list. I beat them on everything except women's health (OCPs, estradiol, and provera).

Lisinopril, coreg, norvasc, lasix, metformin, prozac, and flexeril are all under a dollar for a month, cozaar, plavix, amiodarone, lexapro, neurontin, phenergan, zantac, and levaquin for less than $4. I'll get the actual spreadsheet on Monday when I'm back at work.

I have one diabetic patient who has $9 copays on all his meds, so a pretty good drug plan. I save him just shy of $40/month just on drugs. Do you think he minds having a net loss of $10/month to see me every week to titrate his insulin?

 

[AtlasMD]

Those are likely wholesale prices, which he isn't marking up.

correct, wholesale + 10% to cover supplies and merchant service costs

 

[AtlasMD]

I have one diabetic patient who has $9 copays on all his meds, so a pretty good drug plan. I save him just shy of $40/month just on drugs. Do you think he minds having a net loss of $10/month to see me every week to titrate his insulin?

we have an excel too of our inventory at www.atlas.md/starter

 

[AtlasMD]

Atlas and Va, another question.....

Do you only contract with individuals or do you ever do a deal with small businesses (the size not required to offer standard plans) where they pay you directly for their employees memberships? (i.e. a small preschool could could pay you $350/month and use "free primary care" as an employee retention tool)

yes we definitely work with small businesses = $50/employee/month for the membership

 

[JustPlainBill]

How did you get labcorp to agree to these rates? When I called them they basically told me that they had a rate and that was it, no negotiation. Also, any hints on what to do if you're in a state that doesn't allow physicians to dispense meds -- i.e. Texas?

 

[AtlasMD]

How did you get labcorp to agree to these rates? When I called them they basically told me that they had a rate and that was it, no negotiation. Also, any hints on what to do if you're in a state that doesn't allow physicians to dispense meds -- i.e. Texas?

competition baby! fight for your patients For starters, you need to ask for "client bill" which means they bill you for everything and you pay for everything - no insurance / red tape / coding / etc.

our prices for quest are online at www.atlas.md/starter and we're finishing our contracts with labcorp.

I promise if you tell them you're going to go with quest b/c you can quote my quest prices, then all of the sudden they'll become willing to negotiate.

Rx - I'd find a pharmacist who's willing to oversee your wholesale medication process.

 

[VA Hopeful Dr]

we have an excel too of our inventory at www.atlas.md/starter

Mine is a little simpler (I made it for giving out to potential corporate groups). Not so much inventory as a pure price list.

 

[FiveRivers]

Similarly to how residents have had the opportunity to "buy into" private practices in the past, if there an opportunity for residents to "buy into" a DPC practice? Has this happened yet? If so, what's the typical buy in cost?

 

[AtlasMD]

Similarly to how residents have had the opportunity to "buy into" private practices in the past, if there an opportunity for residents to "buy into" a DPC practice? Has this happened yet? If so, what's the typical buy in cost?

we actually bring doctors on at no cost

 

[mabinante]

I was just wondering where I could put this file that Dr. Pamela Wible emailed me this morning, with the numbers and logistics of how her ideal medical clinic works...

DPC, Ideal Medical Care, whatever you wanna call it... Relationship based medicine is the solution to the "health care crisis." Happy patients, happy docs... The only people who suffer are the ones who have made an industry out of physician exploitation.[/

 

[Red Lobster Actual]

Who is she and what's her practice model like?
I don't mind finding/opening a small office space for 3k
What about marketing, having a person to handle admin/scheduling? billing? takes more than 3k i'd think...

A primary care doc over in Eugene, OR. I started following her after reading her stories on physician depression and suicide, how she was grounded down to depression and near suicide by assembly line medicine and how she broke free. Very interesting and inspirational.

Her model is actually 80% fee for service while the remainder is more like DPC. However, her overall practice approach is very similar to DPC. She refuses to take Medicare and basically doesn't take poop from any other insurance companies because she'll just drop them. She explains she is able to have that sort of power by not having a high overhead. So to get to your question...

Staff for marketing, admin, scheduling, etc.? Nope. The only paid employee of that practice would be you, the doctor. A patient panel that is around 500-600 people that pays cash or carry no BS insurance the need for staff diminishes so that cuts out $50k/year of overheard right there.

I'm interested in this self-made EMR.
I read the document, didn't make much sense to me.

It is Dr. Wible's fancy way of saying a Microsoft Word document and an Excel Spreadsheet. I imagine by the time we become attendings we can make our own charting system after years suffering through Epic or some other Satan spawned EMR created by egg heads that cannot comprehend the notion of patient care. She mentioned in that FAQ for security her hard drive is not connected to the Internet and she backs up it up to an external and all encrypted.

Yea her FAQ actually contains quite a lot of spiritual and emotional self-actualization before you hit some of her more business oriented morsels of information but her heart is in the right place.