Shifting Practice Model of Some PCPs

In the United States, physician practice acquisitions were on the rise over the past few years as healthcare reform incentivized hospitals to do so.  During this time, however, studies have questioned the relationship between physician employment and quality of care.  Physicians of all specialties have been impacted by healthcare reform legislation and the subsequent acquisitions, perhaps most notably are the primary care physicians.  Consequently, there has been an increase of these physicians converting their practices into concierge medicine or direct primary care.  A recent study by Kareo and the American Association of Private Physicians sought to study key trends in some independent medical practices.  Rob Pickell, Chief Strategy Officer of Kareo, notes:

“The majority of Americans continue to receive their care from independent medical practices due to the superior combination of patient focus, healthcare outcomes, and lower costs. Emerging practice models such as direct pay and concierge medicine represent exciting new ways to preserve and enhance the independent practice model.”

The survey targeted physicians who are adding or converting to a direct primary care or other membership model for payment rather than a conventional fee-for-service practice model.  Here are some brief points found in the survey:

70% of respondents reported they wanted to spend more time with patients; 41% wanted to improve their work/life balance; 40% wanted to separate from the insurance payer system

65% of respondents using some variation of a concierge medicine membership model reported their cost for membership was under $2,000 per year; 32 % have one quarter of their patients in membership; 30% have all their patients in membership

58% of respondents are out-of-network with health plans; 57% participate in Medicare; 54% participate in health plans in network


Virtual care has its place in many practices currently and is certainly gaining momentum, though there are many things to consider before jumping in with both feet.  This survey also demonstrated the growing use of telemedicine.

23% of respondents currently use telemedicine

42% plan to grow and expand the use of telemedicine

Conventional vs Concierge/DPC

Along the lines of different practice models, Rob Pickell stated:

“These newer models also address patient and physician demand for more proactive care, care coordination, and wellness programs. For these reasons, these new practice models should be of interest to both healthcare professionals and patients.”

The survey also shines some distinguishing light on the different models.

79% of physicians employing concierge medicine membership or direct primary care payment models spend an average of 30 to 60 minutes or more on each patient visit

75% of physicians in conventional fee-for-service practices spend 30 minutes or less with each patient

60% of physicians in conventional fee-for-service practices have a patient panel of over 1,000; nearly all of physicians employing concierge medicine membership or direct primary care payment models have a patient panel of less than 1,000

38% of the direct primary care private practices call recruiting new patients their single biggest hurdle

35% of conventional practices said their biggest challenge is remaining financially viable

The survey can be downloaded here.


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Generational Attitudes About Healthcare

Millions of Americans are starting to become more engaged with how they manage their health and wellness, but each generation approaches medical care quite differently.  The changes to the healthcare industry are increasingly focused on addressing patients as consumers. Such a change means that providers must of course emphasize quality and work toward price transparency, but they must also seek to determine what patients desire most.  In a recent national survey by Vitals, researchers explained great differences between Baby Boomers, Generational X, and Millennials.  For the purposes of this survey, Millennials were classified as 18-34 years old, Generational X as 35-54 years old, and Baby Boomers as 55-70 years old.  Here is an overview of the survey’s findings:

35% of Millennials have a Primary Care Provider; 64% of Generational X have a PCP; 83% of Baby Boomers have a PCP.

25% of Millennial patients reported using an urgent care center when they are sick.

25% of Generational X patients reported having lost trust in a physician or healthcare organization in the last 2 years.

83% of Millennials trust physicians with their personal information; 77% of Baby Boomers do as well; only 64% of Generational X patients do.

Baby Boomers seek out a physician based on a referral, whereas Millennials look at online reviews.  Generational X patients tend to use a combination of these two approaches.

Millennials tend to trust their physician and follow the medical advice provided, whereas only 50% of Baby Boomers do.  Generational X patients are quite the skeptics, believing that physicians “pretend to know” when in reality the physician is not sure.  Additionally, Generational X’ers are inclined to wonder “if docs really know what they’re doing.”  Consequently, Baby Boomers are open and honest with their physicians and quite agreeable to a team approach to medical care, whereas Generational X patients hold back information from their providers.  Millennials are quite open, but (as with other facets of their daily lives) they will often challenge a physician’s diagnosis.

Vitals also references a study from JAMA Internal Medicine, noting

“Baby Boomers have higher rates of chronic disease, more disability and lower self-rated health than members of the previous generation at the same age.”

This research supports what I often tell clients as we engage in strategic growth initiatives.  To grow your healthcare practice, the group cannot stereotype all patients, but rather must thoroughly understand the unique differences of the particular patient demographics that they serve.  This, combined with understanding your market, can help to differentiate your practice and set it on a path of continued future success.


Contact ABISA for healthcare consultancy support or speaking engagements.

Telehealth for Chronic Disease Management

Diabetes, arthritis, hypertension, lung disease, and other chronic diseases can make life difficult to manage for millions of older adults, often forcing them to give up their independence.  Telehealth has proven to increase access to care and reduce costs via teleconsultations and remote patient monitoring.  Evidence shows that telehealth can effectively improve care with patients with chronic conditions, such as was demonstrated in a fourteen year study published in 2014.  Telehealth platforms can be used to more effectively educate patients and their families, develop and share care plans, monitor symptoms, and manage medications.  West Corporation, a global provider of communication and network infrastructure services, recently conducted a survey of nearly 1,000 patients and healthcare providers in the United States.  The survey (Strengthening Chronic Care) specifically targeted patients that have at least one chronic health condition and have been hospitalized as a result of a chronic illness.  Their goal was to identify some of the problems surrounding chronic care, and what it will take to address those issues.  Here is an overview of some of their findings:

91% of patients reported needing help managing their disease.

70% of patients reported wanting more resources or clarity to help manage their chronic health condition.

66% of the patients surveyed claim they do not get valuable personalized information from their provider, but rather they receive very general information.

60% of patients feel they spend more time discussing their symptoms with healthcare providers than ways to manage their condition.

58% of patients believe two-way, at-home monitoring devices are very useful to interact with their healthcare provider, rather than a more basic one-way at-home device.

54% of patients feel a weekly or twice weekly check-in from their provider would be valuable.

50% of patients feel an at-home medical device that measures their health using sensors and sends information back to providers for an evaluation would be extremely beneficial.

39% of patients need the most help managing their condition at home and in daily life.

21% of patients feel they need 24-hour assistance managing their chronic condition.

16% of patients reported feeling motivated to make changes to improve their health after being admitted to the hospital because of chronic medical condition.

12% of patients insist their provider is doing a good job of delivering information tailored to their specific needs and condition. (Only 12% in this survey!)

There is no such thing as a standard telehealth program.  Consequently, it is extremely important to take the time to develop a telehealth strategic plan first, as there are many nuances to consider as they relate to your particular business.  Interested in in advancing your global telehealth initiatives?  Visit


Contact ABISA for healthcare consultancy support or speaking engagements.

The Components of Your Medical Practice Plan

When creating a medical practice plan, all planning must be based with sensitivity to the time available you have to enact the plan.  If sufficient time is available and there is no advantage to be gained by acting more quickly, you must be deliberate.  Deliberate planning is performed well in advance of expected execution and relies heavily on assumptions about circumstances that will exist when the plan is implemented.

If your time is short, or there is an incentive to act quickly, you must enact rapid planning.  Whereas deliberate planning relies on significant assumptions about the future, rapid planning is generally based on current conditions and is therefore more responsive to changing events.  Rapid planning tends to be less formal than deliberate planning.  While distinct in concept, deliberate and rapid planning form a continuum and complement each other in practice.  Early in the planning process, if appropriate, we may perform deliberate planning.  As we near the day of execution, we move into rapid planning.  Deliberate planning thus forms the basis for rapid planning, while rapid planning often amounts to the revision of earlier deliberate plans.

Regardless of other characteristics, every medical practice’s plan usually contains several basic categories of information.  Each plan should have a desired outcome, which includes the intent for achieving that outcome.  The desired outcome often includes a time by which the mission must be accomplished.  This element of a plan is essential because it forms the basis for the other components of the plan.  Goals and objectives may be general, in which case they are defined by relatively few criteria and offer broad latitude in their manner of accomplishment, or they may be more specific, in which case they are defined by numerous criteria and are more narrowly bounded.

We should recognize there is a critical distinction between general goals, which may be good and vague ones, which are not.  While general goals have relatively few defining criteria, vague goals lack any usable criteria by which we can measure success.  In an industry that’s as complex as healthcare, few things are as important or as difficult as setting clear and useful goals.  This is a skill requiring judgment and vision.  The reality is that, given the nature of healthcare reform, we will often have to act with unclear goals.  Unclear goals are generally better than no goals, and waiting for clear goals before acting can paralyze a medical practice.

Every medical practice’s plan includes the actions intended to achieve the desired outcome.  Most plans include several actions, arranged in both time and space.  These actions are usually tasks assigned to subordinate elements.  Depending on circumstances, these tasks may be described in greater or lesser detail over farther or nearer planning horizons.  Every plan should also describe the resources to be used in executing those actions, to include the type, amount, and allocation of resources as well as how, when, and where those resources are to be provided.  Resource planning covers the personnel assigned to different tasks and other resources such as supplies or funding.

Finally, a medical practice’s plan should include some control process by which practice managers can supervise execution.  This control process includes necessary coordination measures as well as some feedback mechanism to identify shortcomings in the plan and make necessary adjustments.  The control process is a design for anticipating the need for change and for making decisions during execution.  In other words, the plan itself should contain the means for changing the plan.  Some plans are less adjustable than others, but nearly every plan requires some mechanism for making adjustments.  This is a component of plans which often does not receive adequate consideration.  Many plans stop short of identifying the signals, conditions, and feedback mechanisms that will indicate successful or dysfunctional execution.


Contact ABISA for healthcare consultancy support or speaking engagements.

Last Year’s Healthcare Breaches

Hacking healthcare is trend that is likely to continue for the foreseeable future, so no one should be surprised about patient data breaches.  And despite the often valiant efforts of healthcare organizations to protect patient data, IT security vulnerabilities have existed as is evidenced by the healthcare data breaches that came to light in 2016.  A report by TrapX Security shows that healthcare cyberattacks in the United States increased 63% from 2015 to 2016 and that such attacks now account for 31% of all major HIPAA data breaches (which is a 300% increase in just three years!).  Here are the top ten healthcare cyberattack breaches in the U.S. last year:

  1. Alliance Health Networks had one of its patient databases accessible to the Internet, resulting in 42,372 patients’ protected health information being exposed for 30 months.
  1. Urgent Care Clinic of Oxford had its systems breached, impacting 64,000 patients.
  1. Medical Colleagues of Texas had its systems breached, impacting 68,631 patients.
  1. Southeast Eye Institute, P.A. dba Eye Associates of Pinellas had its systems breached, impacting 87,314 patients.
  1. Central Ohio Urology Group suffered a cyberattack impacting 300,000 patients.
  1. Peachtree Orthopedic Clinic had its systems hacked, resulting in 531,000 patients’ protected health information being compromised.
  1. Valley Anesthesiology Consultants reported they suffered a cyberattack which possibly impacted 882,590 patient records.
  1. 21st Century Oncology had its systems breached, impacting 2,213,597 patient records.
  1. Newkirk Products (a service provider that issues healthcare ID cards for health insurance plans) suffered a cyberattack which possibly impacted 3,446,120 patient records.
  1. Banner Health had its systems breached, impacting 3,620,000 patients.

The full report from TrapX Security can be accessed here.  (Although, after reading through all of the above, you may be a little leery about clicking on this link, right?)


Contact ABISA for healthcare consultancy support or speaking engagements.

Medical Administrator Recruitment

Undoubtedly a talented administrator will help to ensure a medical practice operates efficiently, is profitable, and has great employees.  Finding such an administrator, however, can sometimes be challenging since your practice is not the only one attempting to recruit that stellar candidate.  So, if you like gambling in casinos and/or have plenty of time to spend interviewing countless candidates, then you should put an advertisement in your local paper or online.  Otherwise, your time and money would be better spent using a recruiter to find an experienced administrator who you will value for years to come.

A good recruiter will weed through the candidates and give you just a few (no more than three) who appear to be a good fit for you and your practice.  Of course, when it comes time to interview, there are several items you need to ensure are covered.

Top Characteristics

Here a few things that you should ensure the candidates have when you are conducting your interview:

  • Appropriate education level (Do they need a high school diploma? Specific type of college degree? Master’s degree?)
  • Business acumen (This is your business person, so don’t skimp on this criteria. You are not hiring them to perform surgery; you are hiring them to keep the practice in order.)
  • Leadership capabilities (Are they motivating? Can they delegate?)
  • Healthcare administrator qualities (Do they communicate well? Are they empathetic?  Do they have a sense of attention to detail?)

Warning Characteristics

Recruiters should be interviewing candidates in great detail before they ever send them your way.  It is their job to be acute and to have a thorough selective process.  Even the best of recruiters may miss something when they screen candidates, so here are a few red flags you should be on the lookout for when conducting your interviews:

  • Did the candidate ask about salary upfront? (Actually, when using a recruiter, the candidate should not even bring it up since the recruiter should have already covered the salary range, benefits, etc.)
  • Did the candidate ask about long hours?
  • Did the candidate slam their former co-workers?
  • Does the candidate appear to have poor people skills?
  • Does the candidate appear to miss the point about patient care? (This can sometimes be the case if this will be the first job they have in a medical practice.  Obviously, patient care is a priority.  The candidate that does not get that, will not do a job well since they will be unable to relate to the tasks the clinical staff perform on a daily basis.  The candidate does NOT have to have clinical experience to do a great job as an administrator.)

This position is crucial member of your staff and critical to the success of your practice.  Finding the right administrator is not easy, but being open about your needs to a recruiter can help to facilitate the search for a perfect fit.


Contact ABISA for healthcare consultancy support or speaking engagements.

Market Assessment for Medical Practice Competition

For healthcare organizations, a competitive analysis is a means to assess who your competitors are, what value they provide, understanding their (and your) strengths and weaknesses, and where your practice fits in. A good competitive analysis is a scouting report of the actual market terrain that your practice must navigate in order to be successful. While analyzing the competition is an essential component of your strategy, most medical practices don’t conduct this type of analysis systematically enough. However, a thorough competitive analysis is indispensable.

  • First, begin by compiling a list of your practice’s competitors. Most of the time, such a list is comprised of who your practice considers to be its chief competitors. However, there may be other healthcare organizations that indirectly compete with yours, perhaps ones outside of your catchment area that offer services such as telemedicine or niche treatment modalities that are aiming for the same patients. You will also want to include information on healthcare entities that may be entering your market in the coming year. Once you have compiled the list, you can highlight those practices that will be the greatest challenge.
  • Second, analyze the competition’s services in terms of features, value, and target patients. How do they market them? How do patients see your competition? How do referring physicians view your competition? Take an honest look at their offerings. Is your quality commensurate? Do you have similar offerings? What is the unique value you provide that competitors don’t or can’t? Emphasize these benefits in your marketing.
  • Third, compile a list of competitor strengths and weaknesses and remember to be objective. You’ll do your practice no good if you allow bias toward your own physicians, staff, and services to cloud your judgment. Try to see the competition’s practice as though you were them. What makes their practice so great? If they are growing rapidly, what is it about their practice that’s promoting that growth?
  • Fourth, observe how your competitors market themselves through advertising, collateral material, and perhaps the use of physician liaisons. You will have to go to many different sources to get a complete picture. It takes practice and a little shrewdness on your part to piece together a complete picture of strategies and objectives, so the use of a qualified consultant may be to your benefit. Focus on the facts, be persistent, and trust your intuition to help you.
  • Fifth, what are the market demographics for your practice like now? Is it growing? If so, then there are likely quite a few patients left to go around. If on the other hand the market is flat, then the competition for patients is likely to be fierce. Your practice will find itself scrambling to win market share. The outlook portion of your analysis may seem like forecasting, but it’s really a measure of trends. By the time you’ve done most of your research, you’ll have enough information to determine what the outlook really is.

By evaluating yourself against your competition, you’ll likely find new ideas for your practice. While compiling a competitive analysis is an interesting piece of work, it can indeed be challenging. Consequently, you may want to seek the help of a healthcare consultant to guide you through this process. You’ll learn a lot about your market and in the process become a more valuable resource for your patients and referring physicians.


Contact ABISA for healthcare consultancy support or speaking engagements.