readysetgo! · • forrest: 100 x daily volume & 200 pts=overhead • mdvip = 500...
TRANSCRIPT
Ready...Set...Go! How to start your own DPC practice in 60 minutes or less
Julie K. Gunther, MD, FAAFPspark|MD
Learning Objectives•Understand the basics of the three most common 'DPC' business models
•Formulate the outline for a start-up business plan•Have a basics understanding of the economics of a small business practice
•Construct a timeline for their own DPC 'start up'
Activity DisclaimerThe material presented here is being made available by the DPC Summit Co-Organizers for educational purposes only. This material is not intended to represent the only, nor necessarily best, methods or processes appropriate for the practice models discussed. Rather, it is intended to present statements and opinions of the faculty that may be helpful to others in similar situations.
Any performance data from any direct primary care practices cited herein is intended for purposes of illustration only and should not be viewed as a recommendation of how to conduct your practice.
The DPC Summit Co-Organizers disclaim liability for damages or claims that might arise out of the use of the materials presented herein, whether asserted by a physician or any other person. While the DPC Summit Co-Organizers have attempted to ensure the accuracy of the data presented here, these materials may contain information and/or opinions developed by others, and their inclusion here does not necessarily imply endorsement by any of the DPC Summit Co-Organizers.
The DPC Summit Co-Organizers are not making any recommendation of how you should conduct your practice or any guarantee regarding the financial viability of DPC conversion or practice.
Faculty DisclosureIt is the policy of the DPC Summit Co-Organizers that all individuals in a position to control content disclose any relationships with commercial interests upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflict of interest (COI), and if identified, conflicts are resolved prior to confirmation of participation. Only those participants who had no conflict of interest or who agreed to an identified resolution process prior to their participation were involved in this CME activity.
All faculty in a position to control content for this session have indicated they have no relevant financial relationships to disclose.
The content of this material/presentation in this CME activity will not include discussion of unapproved or investigational uses of products or devices.
Introduction
Agenda• Entrepreneurship• Having a vision• The emotional journey of anything great• The 20 steps to OPEN• Pearls• Resources (handout)
Why are we here?
Let’s start with entrepreneurship
“Entrepreneurs are the only people who will work 80 hours a week to avoid working 40.”
Lori Greiner
EntrepreneurshipMelinda Emerson, “SmallBizLady”
1. Are you just UNHAPPY?2. Do you have a passion to solve a problem?3. Can you tolerate RISK?4. What motivates you?
(control, freedom, money, problem solving and creativity?)1. Is the time right?2. Do you have a financial plan?3. Do you have support?4. Do you have stamina?
https://www.forbes.com/sites/mattsymonds/2015/01/15/how-to-know-if-youre-ready-to-be-an-entrepreneur-in-2015/#2ad35f57692a
Vision: Step 1: What is your vision?
What did you set out to be?
And...what do you want?
Vision
my vision: sparkMD
Start Up: Haves & NeedsStep 2: Budget
https://www.daveramsey.com/budgeting/how-to-budget/• Write down total income.• List ALL of your expenses (every dollar).• Go to cash for ALL elective expenses for 3 mos.• Readjust.
How much do you have to contribute financially in the next 1,2 & 3 years for your family to stay afloat?
Educate Yourself
Start Up: Haves & Needs
Start Up: Haves & NeedsStep 4: Barriers & Skills
• Restrictions? non-compete, bonus payback• Can you leverage anything and keep your ‘day job’?• How can you make money or get funding?
Phil Eskew, DO, JD, MBA has a superb summary of many DPC-friendly ‘make it work’ jobs at www.dpcfrontier.com
Start Up: Haves & NeedsStep 5: What do you need?
• Money?, Time?, Autonomy?• WHERE TO GET MONEY: SBA, bank loan, your own
bad-ass self, savings, lines of credit, business credit cards, small business loans, specialty grants, venture capital funding, pre-registration, turn DOWN your debt, HELOC on your house, 401K…
Start Up: Haves & Needs
½ of start ups fail in year 1½ that remain fail in year 2
Of the ¼ that remain, ½ of those fail in year 3
If you make it past year 3→ you’re (usually) golden!
Start Up: Haves & NeedsStep 6: Get a mentor
• Facebook- DPC Docs for MD/DO’s only• Regional Alliances• Hint Community• DPC Coalition• AAFP MIG• www.atlas.md• www.dpcfrontier.com mapper & phone a friend
Start Up: Haves & NeedsStep 7: Build a team
• Mentor(s)• Spouse/partner• Business accountant• Commercial real estate agent• Lawyer• Business banker/financial planner (or both!)• Business Networking International
Start Up: Haves & Needs
Be very mindful about your business planKEEP YOUR OVERHEAD LOW
LISTEN to those who’ve gone before you. PLAN FOR 2-3 YEARS without income from your practice.
This is how you make it.
When do you start acting like a DPC doctor?
(now)...
Business: Building a BrandStep 8: A brand is a PROMISE.
What is your promise?
(This goes back to vision)What does your vision look like in the real world?
Business: Building a Brand
“Don’t write the story you know, write the book you want to read.”
Build the clinic where you want to be a patient.
Business: Building a BrandStep 9: What shall you call yourself?
• Your name may be the best name• (Buy your name URL. Right. Now.)• Go out for coffee and ‘brain dump’.
Business: Business PlansStep 10: Location, location, location
• choose a location • determine approx sq foot• lease or own?• permitting?• start shopping around for options
Business Basics: Pricing & VolumeStep 11: How many and how much?• Forrest: 100 x daily volume & 200 pts=overhead• MDVIP = 500 pts/$1500/year• Medlion = <1000 pts/$75/month• AtlasMD = 600-800 pts/yr avg $59/month• Eskew - national DPC average = $77/mo/adult
sparkMD two models- income backwards model & ‘how much you wanna work?’ model (attached)
Business Basics: ServicesStep 12: What’s included?
• Labs, imaging --> wholesale pricing• Procedures, wellness, urgent care, technology visits.• After hours? Weekends? Home visits?• Medications? (check state law!!)• Cosmetic services, counseling, OMT, FDM, massage,
supplements, classes, business partnerships?The more you can offer, reasonably, the more value you add.
Business: Business PlansStep 13: Write a business plan
• go back to your vision• turn that into 3 bullets = your mission statement• simplify it further to your slogan• and from that, you begin to have your logo
http://thedailypositive.com/write-killer-business-plan-one-week/https://www.entrepreneur.com/article/247574
Business: Business Plans
Get it all done, take a break and ask yourself:
Does it make sense?
Bricks & MortarStep 14: Floorplans, design
• Planning & zoning (state specific)• Your medical license is (usu) your operating license.• Office size 600-2900 sq feet. (11x11 is about right..)• 1 exam room/provider, a lab, a small waiting
room/check in space, break room, doc office, spot for pharmacy.
Bricks & MortarStep 15: Planning your transition out and in
• Giving notice• Notifying patients- letters, web, bus. cards• Townhalls!• Incorporation• Get a disability policy/business coverage• Malpractice Insurance• Notifying insurers & Opting Out (or not)
Bricks & MortarStep 16: Getting the goods
• EMR, billing and dispensing tools• Suppliers (rep &/or GPO)
• Get a business credit card that ‘gives back’.
(see list of resources provided)
NetworkStep 17: Marketing your practice
• Master your elevator pitch• Talk to EVERYONE• Set goals• Town halls!• Facebook• BNI (www.bni.com), local business chamber,
church groups, radio >newspaper>TV• Brilliant!! Letter to small business owners.
Protect YourselfStep 18: Making it all legit
• Medicare opt-out• HSAs• HIPAA-• State law• CLIA (yes, you need a waiver)• OSHA, dispensing laws, business licenses, taxes
www.dpcfrontier.com www.dpcare.org
Final TouchesStep 19: Getting to open
• Generate practice documents• Make sure things WORK• Stock the clinic• Get lab supplies delivered & set up• Begin scheduling• Test run!• Ribbon cutting.
Yay!!!!Step 20: Growing & Trimming the Bansai
• Be hungry and SET boundaries• Build the practice you DREAM of• “Rules of the Roost”• Medication contracts• FIRM policies and routines around billing• ~30% of people who join WILL NOT STAY
(do not take this personally).
Dr. G’s Pearls• Keep it Simple, Keep it Simple, Keep it Simple• Charge a registration/sign-up fee• Be mindful about how you set up communication trees
when you open• Terminate after 30 days without pay• Go to as many DPC events as you can. They’re priceless.• Don’t pay lawyers or consultants (with rare exception)• Just keep moving forward
And remember...
You are enough.
(Just how you are).
