Friday, May 9, 2014

Direct Primary Care: Transition to Hybrid- Challenges and Pitfalls IV

Balance between Traditional and DPC enroute to Hybrid may be elusive.  One strategy is to go "all in" and take no new patients other than DPC which allows focus on the marketing and office protocols for new patients.

Allowing a continuation of new patients in the Traditional track is easier for office staff.  "So and so wants her sister's family to be patients here, too.  They have insurance and don't want the DPC track.  Can we take them?  They're really nice people."

If a practice is "all in", they should remember WHY they are "all in".  Traditional overhead of 65-70 % versus DPC overhead of 30%.  Having a satisfying practice which allows adequate time to establish meaningful patient-physician relationships delivers better opportunities for mutually agreed to "quality" outcomes.  Having "quality relationships" that deliver deeper, outcome sensitive goals affords more opportunities to re-define Family Medicine as a human centered specialty.  Human centering allows alignment with patient AND physician values, goals and dreams.  Understanding of, and commitment to, the human condition allows hope for human wholeness, a commitment to an interconnected, imperfect existence of wholehearted appreciation.

Another strategy is to allow the dysfunctions to bubble up via empowered staff who undermine the Hybrid goal of practice owners.  The dysfunction of most significance may come from physicians.  Passionate people may intend well, but harm the practice financially if their passion is secret.  Meetings dripping with honesty, self revelation, passion, intensity, wisdom, humor and human vision become important.  Follow-up meetings with similar openness become important for clarification.  Physicians should understand that a gradual commitment to Hybrid may result in changing relationships, even splitting of partnerships or "split the question" types of new practice agreements or business relationships.  Remember the creative juices that must flow when physicians go through practice transformations.

Another strategy is to start a new DPC practice parallel to the Traditional one.  This allows co-existence of Traditional and DPC which may merge later into "full" Hybrid.  It also may allow a gradual splitting of a partnership via the "DPC fanatic" going "all in" on DPC new patients only while the more reluctant for DPC physician continues as Traditional only with continuing new patients in the traditional track.  The cross coverage may become challenging to afford an opportunity for the Traditional physician to be paid by the DPC fanatic for seeing their patients when DPC fanatic is not available.

The split, two practice strategy makes it easier on the DPC side to accept all patients who enroll, without consideration for dual charging of government paid patients that plagues the Hybrid practices.  In the DPC only practice, it functions like a "pure" DPC practice with no insurance relationships honored or considered. The logistics of operating parallel practices cold get complex on issues like practice identity, answering the phone, stationery, professional business cards, etc.  Competition between the two models may generate a friendly or pathologic co-existence.

Yes, it's confusing.  If it wasn't complex, it wouldn't be so much fun.  More later.

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