During the 2017 Direct Primary Care (DPC) Summit, Delicia Haynes, M.D., founder and CEO of Family First Health Center in Daytona Beach, Fla., stresses how DPC physicians need to set boundaries with their patients that allow the physicians to maintain a healthy work-life balance.
Vance Lassey, M.D., knew starting a direct primary care (DPC) practice could be expensive, so he decided to do most of the heavy lifting himself.
He sold off some land he owned and purchased $3,500 worth of materials. Then he spent two months renovating his office space, working around the clock to replace tile, drywall and trim. The result? The renovation was completed without having to take out a loan.
"It's not hard," he told physicians who attended the 2017 DPC Summit held here earlier this month. "It was easier than med school."
Lassey, who opened Holton Direct Care in Holton, Kan., in 2015, participated in a panel of physicians who shared their DPC startup experiences during the June 15-17 summit. The event offered guidance for physicians who might be considering the innovative practice model but are unsure how to proceed.
- Selecting and designing office space are important steps in setting up a direct primary care (DPC) practice, and the physician must be aware of what kind of message the office is sending to patients.
- If a DPC practice can attract 15 to 30 new patients each month, that is considered sufficient growth.
- One area, in particular, where DPC physicians can offer extra value to patients is by dispensing medications.
The startup tips from Lassey didn't end there. When it came to fixtures and supplies, he said he learned that an area hospital kept a supply of items in storage that it no longer used. As a nonprofit, the facility couldn't sell the items outright, so Lassey made multiple trips to the hospital's storage site, loading up his truck with lights, cabinets and exam tables at no cost. And instead of buying other equipment from vendors, he found what he needed online at a much lower price.
Lassey offered discounts on practice membership to the manager of his clinic property, as well as to a local housekeeper, that reduced his rent and kept other expenses down. He adopted the same approach for patients. The area's imaging centers were notoriously expensive, so Lassey obtained a price list from each one, working with them and their competitors to obtain the greatest possible discounts. An advocate of being open about pricing on all services, Lassey also said he wasn't shy about directing patients to drive longer distances if the nearest center was too expensive.
"You've got to negotiate for your patients," he said.
Selecting and designing the office space are important steps, and it's important for the physician to be aware of what kind of message the office is sending to patients. Ryan Kauffman, M.D., founder of Hickory Medical Direct Primary Care in Bellefontaine, Ohio, told audience members he was looking for a "space that fits our story." The small town where the practice is located was undergoing its own renovation, so the goal was to maintain its local charm.
Kauffman's father also was a family physician, and Kauffman wanted his office to maintain that legacy and the local flavor by including antiques as part of its design.
DPC Legislation in Play
Sen. Bill Cassidy, M.D., R-La., recently introduced legislation that would facilitate the expansion of direct primary care (DPC) by allowing patients to use their health savings accounts (HSAs) to pay for DPC services. The IRS currently prohibits use of HSA funds to pay for these services. The bill was referred to the Senate Finance Committee.
The House companion bill was sponsored by Rep. Erik Paulsen, R-Minn.
"You want to have a nice place, but it shouldn't be the best place they've ever seen because then patients think they are paying too much," Kauffman said.
A personal touch was essential when designing the office interior. Kauffman insisted that he did not want computers in the exam room to distract from consulting with patients. And his desk is positioned so that he can see every patient when they enter the office.
"Every office that I have worked in was designed to keep patients away from the doctor," he explained. "In DPC, it's the opposite."
Panelists said a benchmark of between 50 and 100 patients allowed them to break even during their first year. Monthly expenses run between $4,500 and $8,000 depending on whether the physician hired staff. If the practice can attract 15 to 30 new patients each month, they agreed, that is considered sufficient growth.
Another area where DPC physicians can offer extra value to patients is by dispensing medications. Luke Van Kirk, D.O., of Command Family Medicine in Springfield, Mo., said that if patients obtain refills in the physician's office, not only does it save them from having to wait at the nearest pharmacy, it also provides another opportunity to discuss the effectiveness of those medications.
Twenty-seven states allow physicians to dispense medication without a fee or license. Among states that require a license, the fee ranges between $10 and $300. Montana, Texas, New York and Utah do not allow physicians to dispense medication.
Besides managing the account ledger, it is important for the DPC physician to set reasonable expectations regarding their availability to patients, according to Delicia Haynes, M.D., founder and CEO of Family First Health Center in Daytona Beach, Fla.
If you promise 24/7 access to a physician, if a patient calls and the physician does not call back right away, the patient grows frustrated. Instead, Haynes advises that physicians should say they will respond to patients the same day and return the call within two hours. The business mantra, she said, should be to "undersell and overdeliver."
Haynes enjoys rowing in Florida's Halifax River in Florida for two hours at a time, and to safeguard her well-being, she makes sure patients are aware she is not available for consults when she is on the water.
"You have to teach people how to be good patients in your practice," she said.
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