MDVIP ownership

[Osteoth]

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Anyone worked with or know anyone that worked with MDVIP?

I have a potential opportunity to take over a practice that is associated with one of a similar practice management groups and I would love to hear their experience. The group I am working with takes 20% of billing to manage the contracts and provides back office/billing support. 20% sounds high...

 

[chessknt]

Anyone worked with or know anyone that worked with MDVIP?

I have a potential opportunity to take over a practice that is associated with one of a similar practice management groups and I would love to hear their experience. The group I am working with takes 20% of billing to manage the contracts and provides back office/billing support. 20% sounds high...

What is back office support? All non-clinical staff? I pay 8% collections for billing/contract/insurance/collection management etc.

 

[end stage fibro]

i dont have any info for you except that the 2 guys i know that work for MDVIP seem to enjoy it considerably more than hospitalist/traditional PCP work. one of them asked me to call him while the patient was in the hospital...was actually a very useful discussion, and i was able to reach him in a couple mins. calling some of the bigbox PCPs is a chore sometimes

 

[sloh]

20% isn’t that high. Over 30% would be high

 

[dozitgetchahi]

I need more information.

What is the specialty.

What exactly is the “opportunity” and why is someone giving it to you? Usually when we hear of someone “getting an opportunity” like this in the context of medical practice ownership, it’s a scam.

In the rheumatology world, these types of practice management groups (Articularis, Bendcare etc) are usually a ripoff. They skim a lot off the top and make it a lot harder for the practice to be profitable.

 

[Osteoth]

What is back office support? All non-clinical staff? I pay 8% collections for billing/contract/insurance/collection management etc.

Nope it seems mainly they handle the billing. They advertise they do "marketing" and such, but nothing that you couldn't do yourself it seems.
And it's actually 9.5%, which for billing a concierge primary care practice seems high with <700 patients.

i dont have any info for you except that the 2 guys i know that work for MDVIP seem to enjoy it considerably more than hospitalist/traditional PCP work. one of them asked me to call him while the patient was in the hospital...was actually a very useful discussion, and i was able to reach him in a couple mins. calling some of the bigbox PCPs is a chore sometimes

Yes seems like a good opportunity, the question for me is if doing the billing myself is worth 9.5%, really the 6.3% delta by which I could buy a software subscription and do it myself

20% isn’t that high. Over 30% would be high

Actually 9.5%, but just for billing...

I need more information.

What is the specialty.

What exactly is the “opportunity” and why is someone giving it to you? Usually when we hear of someone “getting an opportunity” like this in the context of medical practice ownership, it’s a scam.

In the rheumatology world, these types of practice management groups (Articularis, Bendcare etc) are usually a ripoff. They skim a lot off the top and make it a lot harder for the practice to be profitable.

Concierge primary care in a very popular warm town. Old doc is retiring and wants to maintain continuity of care for his patients.
9.5%, but seems like they only do the billing, which I wonder is worth 6.3% of gross billing, which is the delta between doing it myself.

 

[sloh]

Ah yeah 9.5% for just billing is high.

 

[dozitgetchahi]

Nope it seems mainly they handle the billing. They advertise they do "marketing" and such, but nothing that you couldn't do yourself it seems.
And it's actually 9.5%, which for billing a concierge primary care practice seems high with <700 patients.


Yes seems like a good opportunity, the question for me is if doing the billing myself is worth 9.5%, really the 6.3% delta by which I could buy a software subscription and do it myself


Actually 9.5%, but just for billing...


Concierge primary care in a very popular warm town. Old doc is retiring and wants to maintain continuity of care for his patients.
9.5%, but seems like they only do the billing, which I wonder is worth 6.3% of gross billing, which is the delta between doing it myself.

I’m confused.

Usually concierge docs go cash only. I know some will run some part of their charges through insurance for some patients…but that would seem to negate a lot of the benefits of being a concierge doc.

So the question for you is whether you want to be a true DPC/concierge doc, or whether you want to keep doing some sort of weird hybrid thing where you bill insurance too. Letting someone else administrate the billing while you act as some sort of pseudo concierge doc seems really weird, and really unprofitable.

Have you seen the numbers of this practice? Are you being asked to buy this practice?

Also, know that patients are beholden to nobody. If they had a close relationship with a particular concierge doc, they may just go elsewhere when that doc leaves.

 

[VA Hopeful Dr]

I’m confused.

Usually concierge docs go cash only. I know some will run some part of their charges through insurance for some patients…but that would seem to negate a lot of the benefits of being a concierge doc.

So the question for you is whether you want to be a true DPC/concierge doc, or whether you want to keep doing some sort of weird hybrid thing where you bill insurance too. Letting someone else administrate the billing while you act as some sort of pseudo concierge doc seems really weird, and really unprofitable.

Have you seen the numbers of this practice? Are you being asked to buy this practice?

Also, know that patients are beholden to nobody. If they had a close relationship with a particular concierge doc, they may just go elsewhere when that doc leaves.

Nope. Most concierge take insurance on top of their yearly fee just to be a member of the practice.

DPC is entirely different from concierge.

 

[chessknt]

Nope it seems mainly they handle the billing. They advertise they do "marketing" and such, but nothing that you couldn't do yourself it seems.
And it's actually 9.5%, which for billing a concierge primary care practice seems high with <700 patients.


Yes seems like a good opportunity, the question for me is if doing the billing myself is worth 9.5%, really the 6.3% delta by which I could buy a software subscription and do it myself


Actually 9.5%, but just for billing...


Concierge primary care in a very popular warm town. Old doc is retiring and wants to maintain continuity of care for his patients.
9.5%, but seems like they only do the billing, which I wonder is worth 6.3% of gross billing, which is the delta between doing it myself.

Does the 9.5% include contract negotiation (and are the rates actually good) and insurance credentialing bull**** and collection notices/calls? If so I am not sure how much cheaper it gets. Once you scale high enough revenue you can of course just directly hire your own staff but you usually need at least 1.5 million in actual collections a year before that seems like a reasonable idea.

 

[Osteoth]

I’m confused.

Usually concierge docs go cash only. I know some will run some part of their charges through insurance for some patients…but that would seem to negate a lot of the benefits of being a concierge doc.

So the question for you is whether you want to be a true DPC/concierge doc, or whether you want to keep doing some sort of weird hybrid thing where you bill insurance too. Letting someone else administrate the billing while you act as some sort of pseudo concierge doc seems really weird, and really unprofitable.

Have you seen the numbers of this practice? Are you being asked to buy this practice?

Also, know that patients are beholden to nobody. If they had a close relationship with a particular concierge doc, they may just go elsewhere when that doc leaves.

I guess this is actually like a high $ DPC? Monthly fee plus per-visit fee all administered by the office, aka by the concierge management company.

I have seen some preliminary figures but not the official tax returns.
That is very true, but it sure is better than starting from 0...

Does the 9.5% include contract negotiation (and are the rates actually good) and insurance credentialing bull**** and collection notices/calls? If so I am not sure how much cheaper it gets. Once you scale high enough revenue you can of course just directly hire your own staff but you usually need at least 1.5 million in actual collections a year before that seems like a reasonable idea.

They're not insurance contracts, all the company does is college the monthly practice fee + appointment fee from the <700 patient panel.

 

[dozitgetchahi]

I guess this is actually like a high $ DPC? Monthly fee plus per-visit fee all administered by the office, aka by the concierge management company.

I have seen some preliminary figures but not the official tax returns.
That is very true, but it sure is better than starting from 0...


They're not insurance contracts, all the company does is college the monthly practice fee + appointment fee from the <700 patient panel.

Oh wait, what? So this is exactly what I thought it would be - an expensive DPC. They’re charging all that just to collect the practice fees? That’s a lot. I go to a DPC who just uses one of those online payment apps (Square, I believe) to do the same thing. And I can’t imagine they take that much of his revenue to do that.

 

[Osteoth]

Oh wait, what? So this is exactly what I thought it would be - an expensive DPC. They’re charging all that just to collect the practice fees? That’s a lot. I go to a DPC who just uses one of those online payment apps (Square, I believe) to do the same thing. And I can’t imagine they take that much of his revenue to do that.

Just looked square charges 2.6%, which leaves a delta of 7% of gross billing approximately.

 

[dozitgetchahi]

Just looked square charges 2.6%, which leaves a delta of 7% of gross billing approximately.

Yeah, exactly.

What are the terms of this deal? Is this doc just handing over the practice to you, or does he expect you to pay for it? Is there real estate involved? There’s always lots of details in these situations that matter.

 

[Osteoth]

Yeah, exactly.

What are the terms of this deal? Is this doc just handing over the practice to you, or does he expect you to pay for it? Is there real estate involved? There’s always lots of details in these situations that matter.

Payout somewhere between $175-300k for practice and office equipment, no real estate. Payable over 5 years.

I know I know nobody pays for practices anymore, but cash based practices the hardest thing is always to find people, so jumping that line seems worth it to me.

I’ve met people in the DPC space in similar areas who spend years and way more than this building a practice from scratch.

One year overlap where we both work together to make sure everything is copacetic.

 

[dozitgetchahi]

No way in hell would I pay way into the 6 figures for a practice like this. Not worth it in the slightest. If there’s no real estate involved, there is basically nothing of “value” being transacted.

Ballpark, what is his annual revenue and how profitable is he?

Why is price “between $175k and 300k”? What factors make that price variable?

 

[Osteoth]

No way in hell would I pay way into the 6 figures for a practice like this. Not worth it in the slightest. If there’s no real estate involved, there is basically nothing of “value” being transacted.

Ballpark, what is his annual revenue and how profitable is he?

Why is price “between $175k and 300k”? What factors make that price variable?

Value is the patients, total value based on total number of patients who stay 1 year after transition ends. That range is the maximums.

Annual revenue $675-875k
Gross margin 50%

What is the alternative? Start from 0 patients? Who’s to say that’s faster or more cash efficient?

 

[VA Hopeful Dr]

Value is the patients, total value based on total number of patients who stay 1 year after transition ends. That range is the maximums.

Annual revenue $675-875k
Gross margin 50%

What is the alternative? Start from 0 patients? Who’s to say that’s faster or more cash efficient?

Me. I started with zero and was at 80% patient capacity after one year.

 

[Osteoth]

Me. I started with zero and was at 80% patient capacity after one year.

Concierge or insurance based?

 

[chessknt]

Concierge or insurance based?

What makes you think the transition to another provider will retain the majority of members? People paying for this are generally anxious and have a expectation for the fee they pay and won't know if you are going to meet that.

 

[Osteoth]

What makes you think the transition to another provider will retain the majority of members? People paying for this are generally anxious and have a expectation for the fee they pay and won't know if you are going to meet that.

True. Purchase price to be determined by patient retention at the end of a 1 year transition period.

 

[VA Hopeful Dr]

Concierge or insurance based?

DPC

 

[dgdg]

Concierge primary care in a very popular warm town. Old doc is retiring and wants to maintain continuity of care for his patients.
9.5%, but seems like they only do the billing, which I wonder is worth 6.3% of gross billing, which is the delta between doing it myself.

The other factor is what % of your billings you eventually capture compared to a third party. You may perform to a higher percentage.

 

[Osteoth]

DPC

Wow congrats! That's great. The area I am looking at is a suburb of a big warm city and several of the DPCs I have talked to in the area have struggled to gain traction. Growing, but slowly.

The other factor is what % of your billings you eventually capture compared to a third party. You may perform to a higher percentage.

Yeah, the doctor and some others have said that it's just a huge load off their back not to worry about it but is it a $40,000 load? That seems like a stretch.

 

[VA Hopeful Dr]

Wow congrats! That's great. The area I am looking at is a suburb of a big warm city and several of the DPCs I have talked to in the area have struggled to gain traction. Growing, but slowly.


Yeah, the doctor and some others have said that it's just a huge load off their back not to worry about it but is it a $40,000 load? That seems like a stretch.

Marketing is key. When I opened I was getting around 10 new patients per month. I started a big radio ad campaign, within a week I was getting 3-5 new patients per day.

 

[Osteoth]

Marketing is key. When I opened I was getting around 10 new patients per month. I started a big radio ad campaign, within a week I was getting 3-5 new patients per day.

Where are you located? What was the key to your marketing?

 

[MMourousias]

Revenue Cycle Management should cost no more than 6% for office based services and 4% for surgical services. I would highly recommend outsourcing to a US based revenue cycle management company. These companies will usually include 24/7 access to the practice management software. I suggest that you choose your EMR independent of your practice management system. This is where healthcare providers lose revenue. Any company who offers rates lower than what is mentioned above are off-shore companies and you want to stay away from those. You need to set your fee schedule as a percentage of RBRVS in your area. Full-time PCPs should generate collections of $45K-$55K per month. I would seriously look at number of visits rendered over the past three years and not the number of active patients that practice has in order to gauge value. 700 seems low for an IM practice.

 

[VA Hopeful Dr]

Revenue Cycle Management should cost no more than 6% for office based services and 4% for surgical services. I would highly recommend outsourcing to a US based revenue cycle management company. These companies will usually include 24/7 access to the practice management software. I suggest that you choose your EMR independent of your practice management system. This is where healthcare providers lose revenue. Any company who offers rates lower than what is mentioned above are off-shore companies and you want to stay away from those. You need to set your fee schedule as a percentage of RBRVS in your area. Full-time PCPs should generate collections of $45K-$55K per month. I would seriously look at number of visits rendered over the past three years and not the number of active patients that practice has in order to gauge value. 700 seems low for an IM practice.

It's not low for DPC or concierge