New Concierge Startups Could Devastate The Cosmetic Medicine Market

Futuristic new startups in concierge medicine could really put the screws to competitors as they expand their offering.

Silicon Valley is rife with startups looking to disrupt all aspects of healthcare, moving from traditional approaches to entirely new delivery systems and business models. The result is a number of new, well financed competitors that don't have the baggage of traditional methodologies and can easily adopt new methodologies and could bury existing competitors. Here are a couple of examples.

Forward is a new tech concierge medical start-up San Francisco that is focusing on reinventing the primary care clinic. With something of a clean look that founder Adrian Aoun describes as something aking to an Apple store crossed with Star Treks next generation sick bay. Physicians have access to some really cool gizmos, from a wall-sized screen to visualize and show patient data to automated speach recognition that transcribes converstaions in real time and adds them to patient records. Patients can get their prescritions filled in the on-site pharmacy and can text staff around the clock (with 30 second response times).

But the biggest value is not the glass and white walls, it's the removal of trivial tasks that prevent clinicians from operating at the top of their license. According to a 2016 study in the Annals of Internal Medicine, physicians spend more than half of their time on paperwork, compared to a measly 27% interacting with patients. (Read the study here)

Forward is using technology to ruthlessly elimiate waste and improve physician productivity while also delivering what patients are asking for with whiz-bang tools. They currently don't taken insurance - although they have plans to change that - and charge patients $149/month all in.

Of course Forward is joining a number of other primary care and concierge competitors.

One Medical is another that already has a number of locations. It's not quite as technically cool but it's also getting traction by delivering what patients want  - same day appointments, online access, and 24/7 virtual care - at the even more affordable price of $149 per year.

And that brings us to telemedicine and what's happening there.

Read the 2015 Telemedicine Report from Medical Spa MD

In a poll asking dermatologists if they were to use telemedicine in their practice, 41.84% were opposed to the idea of adopting it. Only 38.1% were in favor in using telemedicine, but that may be changing.

In a study by Wilson and Maeder (2015), teledermatology has produced positive outcomes with user satisfaction and uptake, and hopeful in the idea of improvements with healthcare. Another study mentions the benefits of using teledermatology, which could serve as an educational tool.

Despite study findings about telemedicine’s ability to diagnose illnesses, it is still met with resistance. In another study referenced by the authors, it seems that while it can screen and diagnose illnesses, it faced a challenge with an accuracy. Bashur et al., (2015) also suggest the same finding that inaccuracy could be a common challenge when using teledermatology.

According to the Wall Street Journal, the American Telemedicine Association expected the number of physicians using telemedicine to rise approximately 30% more. Healthmine has conducted a poll saying that out of 1500 physicians, only 15% employed telemedicine.

What does this mean for cosmetic / aestheitic practices?

These new startups are going to be under increasing pressure to find ways to generate revenue Forward, for example, has already raised $30m from venture capitalists and needs to get to a value of more than $100m to raise additional funding.

The likely result is that they, like others before them, will see that cosmetic medicine is primarily a cash fee-for-service business that will need little additional investment to add. Since these new competitors are built to deliver such extrodinalry patient satisfaction it will be more than just a little challenging for stand-alone clinics to compete.

Of course their success is not yet assured and they could implode if they can't meet their revenue needs.

If they can, there will be a period of adoption but they will be riding the wave of transformative care that is coming.

TruClinc Finally Brings A Real Telemedicine Solution For Concierge & Cosmetic Clinics

Telemedicine for small (cosmetic and concierge clinics) is finally getting off of the ground with TruClinic.

Very different from the doc-in-a-box model of other telemedicine players, TruClinic is the first truly embedded technology that closely fits how providers already work, and increases the ability of both physicians and physician-extenders to see more patients.

TruClinic has been built into a full telemedicine platform with a knack for tackling hard integrations, bottom-up user growth, and jaw-dropping uses. TruClinic’s cloud-based portal gives providders and patients access to each other from anywhere. All they need is a computing device, Internet connection, and a webcam, smart phone or tablet. From remotely wiring every home on the Goshute Reservation to facilitating interactions between a mother and her newborn child in an ICU to hosting surgical followup appointments, the uses of an always on, instantly connected telemedicine platform are only starting to be realized.

TruClinic is already being used actively by both small individual physician clinics, and larger hospital and clinic chains like the University of Utah Health Care that serves 5 surroundings states in a referral area encompassing more than 10 percent of the continental US and where TruClinc helps the U to reach their clients better, particularly in fields that mostly require communication, like mental health or post-surgery follow-up.

The University of Utah Health Care System is a thought leader in telemedicine. Here's a video:

One of the places that this is likely to be addopted first by individual physicians is around concierge or cosmetic medicine, where a very high-touch interaction at a distance can really have an effect on an ability to scale and interact with more patients in the same amount of time drives real revenue.

You can request a demo of TruClinic here.

Concierge Medicine

By Greg Bledsoe MD

One of the most rapidly growing clinical practice models in the US these days is Concierge Medicine.

In Concierge Medicine, a physician cuts out third-party payers and contracts directly with his or her patients.  The patients pay a retainer and the physician agrees to limit the practice size so he or she can provide exceptional access to these patients.

While this model has become very popular with a certain segment of the population and many physicians, it is not without critics.  I wrote a recent article on Freelance MD about the ethics of Concierge Medicine and the arguments for and against this model. 

Since we've received so many inquiries about Concierge Medicine, I decided to post some resources here about the subject.  In addition, for those of you who will be attending the Medical Fusion Conference this November, you'll be able to hear one of the leading experts on Concierge Medicine, Dr. Steven Knope, discuss the subject personally (and have the opportunity to sit down with Steve individually at our Accelerator sessions).  Steve is the author of the book, Concierge Medicine: A New System to Get the Best Healthcare.  

Here's a video interview with Dr. Steven Knope describing Concierge Medicine:

 Here's another interview with Dr. Knope that appeared on FOX Business:

Here's a short video in which I describe Concierge Medicine and how we'll be discussing Concierge Medicine at the Medical Fusion Conference.

Learn more about the Medical Fusion Conference

Concierge Medicine, Social Justice & Sex at 100

By Steven Knope MD

Some of my medical colleagues who champion the cause of “social justice” bristle when they learn that I practice concierge medicine. 

They fervently believe that it is somehow more noble to practice Soviet-style medicine in America than it is to take professional responsibility for delivering excellent, individualized medical care to their patients.  One of the benefits of being sanctimonious about private doctors who practice in a capitalist model is that you can blame some of the crappy medicine you deliver on your benevolent, utopian system, which claims to be “fair” to everyone.  How convenient.  But what are the consequences of focusing on clinical algorithms, electronic medical records, and the forced “fairness” that comes down from the Politburo?

Today I saw a 99-year-old patient in my office who is on my indigent medical care program.  She pays me $5 per visit, just so that she’s got some skin in the game.  (Quiet…I don’t want my social justice critics to know that I actually see people who can’t afford to pay my concierge fees.)  This elderly woman has diabetes and has been in the ICU twice over the past year with urosepsis, on the sepsis protocol.  Last week she was taken to a local ER at a hospital where I do not practice.  She had a recurrent kidney infection, despite receiving rotating prophylactic antibiotics and intravesicular gentamycin given to her by an expert urologist.  I was never called by the ER physician, because I am merely the patient’s attending physician – a point that is irrelevant to most ER physicians, given that virtually every patient in the ER is now admitted to the “hospitalist team.” 

Instead of admitting this frail, 99-year-old diabetic for IV antibiotics and careful monitoring, the ER physician opted to treat her as an outpatient with generic Keflex.  This would not have been my approach, but I have to agree that it certainly was “cost effective.”  Fortunately, my patient survived this “UTI algorithm.”  The doctor also opted to treat her hyperkalemia with equal efficiency, giving her a single dose of oral Kayexalate, which she promptly vomited after arriving at home.  Luckily, she did not have a cardiac arrest from her hyperkalemia, especially in light of the fact that they did not bother to hold her ACE-inhibitor, which was contributing to her elevated potassium.

As my patient left the ER, the medical team dutifully handed her the ubiquitous, and always helpful, discharge instruction sheet.  This document no doubt met all hospital and governmental regulations for educating people about pyelonephritis and hyperkalemia.  Although my patient is legally blind and cannot read standard print, I’m sure she found this 4 page document very comforting.  More importantly, the purveyors of social justice can rest assured that they followed all of the guidelines set forth by the Politburo and did their duty to deliver the same level of care to everyone, regardless of income, ethnicity or social standing.   

Had my 99-year-old patient been able to read this information sheet, I’m sure she would have found it helpful to know that she should “refrain from having sexual intercourse until after all of her kidney infection symptoms had resolved.”  I don’t know about you, but there is nothing that irritates me more than seeing a non-compliant, centenarian who continues to have sex while being treated for an active pyelonephritis.  The only way to prevent these elderly nymphomaniacs from reseeding their genitourinary tracts is to put it in writing!

What we are now seeing is just the beginning of medicine by administrative committee.  If you think I am misusing the term “Politburo”, just wait until you see what happens under the Department of Health and Human Services in the name of ObamaCare.

About: Dr. Steven Knope runs a concierge medical clinic and blogs at http://FreelanceMD.com

Physician Entreprenurs & Cosmetic Medicine

The Medical Fusion Conference was held this last weekend in Las Vegas.

A number of the physicians that I've interviewed on the Medical Spa MD Podcast were there as speakers, and a number of physicians that I met at the conference are going to be on the podast.

The Medical Fusion Conference is still relatively small. I think there were less than 100 physicians attending.

(There were a few Medical Spa MD Members that I got to say hello to which was very nice. I didn't come close to going bankrupt with my offer to pay for a month of Frontdesk SEO oursource marketing services which I think of with somewhat mixed blessings.)

I'd attended the conference for a number of reasons; Medical Fusion is one of our Select Partners, I wanted to find out what value the conference held for physicians, and I wanted to guage the reaction of the physicians who attended.

Across the board it was all positive. Every physician I spoke to gave the conference two thumbs up and described it as an excellent overview of potential options in non-clinical medicine that had the wheels spinning. One of the take-aways was that every physician is looking for what the military world calls 'actionable intelligence', ways to put these strategies and information into action.

As a result, I'm launching a new site for physicians that want to gain more control of their career, income and lifestyle.

Medical Spa MD Podcast: Concierge Medicine

In this episode from the podcast, Dr. Steven Knope brings up-to-speed on Concierge Medicine. We discuss how to open and operate a concierge medical clinic.

Concierge medicine, retainer medicine, direct medicine and boutique medicine are all terms used to describe a new form of medical service in which patients contract directly with their doctor for medical services. By removing the third-party payer, your physician acts as your advocate, with no interference or conflict of interest from outside parties.

Internist Steven D. Knope, M.D., a pioneer in creating patient-centered care for optimal health and wellness, is the first physician to offer this comprehensive, personal approach in Tucson.

Dr. Knope’s concierge patients pay a one-time annual retainer fee ($6,000 for individuals; $10,000 for couples) that includes everything from “true health care optimization to ICU care for medical catastrophes” to house calls, 24/7 access, same-day appointments, and hospital admittance by the physician. They also receive a two-hour physical, nutritional analysis with an onstaff dietician, and fitness analysis with a personal trainer in his in-office gym.

Dr. Knope is a board-certified internist and sports medicine expert. He completed his premedical studies at Columbia University and graduated with honors in internal medicine from Cornell University Medical College in 1988. He completed his residency training at UCLA, where he was awarded the first Sherman Melinkoff Teacher of the Year Award. He has served as Chief of Medicine, Chairman of the Department of Medicine, and Director of the ICU in the Carondelet system in Tucson, Arizona. He is a pioneer in the field of concierge medicine, opening one of the first concierge practices in America in December 2000. He authored the first book on concierge medicine entitled, Concierge Medicine; A New System to Get the Best Healthcare (Praeger, 2008).

Knope has received local and national media attention for his work as an uncompromising patient advocate and opponent of the HMO industry. He has been covered in the Arizona Daily Star, Moneymagazine and The Wall Street Journal. In his fight against a local HMO, Nobel Peace Prize Laureate and inventor of the cardiac defibrillator, Dr. Bernard Lown, praised Knope as “courageous” and “deeply principled.”

The New Medical Spa MD Podcast

Medical Spa MD now has its own podcast for physicians and medical spas and the first couple of episodes are now live.

I've been looking to start a podcast for Medical Spa MD for a while now, and we've finally launched.

With each new episode, we'll talk about cosmetic medicine, plastic surgery, cosmetic lasers, clinic operations, management, marketing, sales, treaments, cost controls and everything else you'll want to know. We'll be asking (and hopefully answering) the tough questions. How do different cosmetic lasers compare? Which IPL company provides the best service? How should you compensate and motivate your staff? How to market your clinic? Where to spend your advertising budget? How to get started. How to grow. How to compete. Finally, what does that mean for your business and lifestyle?

To start, we're interviewing physicians who discuss their own concept of personal brand and how they've managed their careers outside of clinical medicine. 

In the first episode we talk to Dr. Greg Bledsoe about the Medical Fusion Conference and his desire to help physicians control more of their career. Greg's speaking from experience here. He's a leader in expedition medicine and organizes his other businesses to facilitate the lifestyle and income that he wants.

In episode 2 we're talking with Dr. Elliot Justin of Swift MD about telemedicine and the efficient delivery of medical services remotely. Elliot talks candidly about Swift MD and how company got started and functions operationally. He's also got some views on the state of US healthcare that resonate with almost every other physician I know.

We've already got another few episodes being edited and a long list of physicians and others who are scheduled to appear. My goal is to get out at least one every other week for the foreseeable future.

This new podcast will focus on providing relevant information for physicians, with a special emphasis on cosmetic practices, techniques, marketing, operations and just about everything you'll want to be aware of the field of nonsurgical cosmetic medicine. While we'll have plenty of physician interviews, we'll also be talking to technology companies, marketing gurus, and others about what it takes to run a successful medical practice, and exactly how to use these tactics and operations inside your own clinic. We'll be providing broad overviews as well as delving down into specific treatments and 'how tos'.

The Medical Spa MD Podcast is a permenant addition. You can find it by clicking on the link in the main navigation at the top the page. You'll also be able to subscribe to the RSS feed directly or subscribe via iTunes as soon as they index the feed.

Please leave a comment and let me know what you think. What topics would you like us to cover in the future? What guests would you like us to interview?

Concierge Medicine Blog: Housecalls & cell phones.

Starting a concierge medical practice? So's Conciergedoc.

Of course he's less than thrilled with the thought of doing laser hair removal as this post attests:

Removing hair from unmentionable parts of ladies in Westchester County is how my friend Jerry spends a good part of his week. Not that there's anything wrong with that, except Jerry (not his real name) is a cardiologist, trained at one of the finest medical programs in the country. Trained to save lives. His expertise is the complex and delicate management of congestive heart failure, but he gets paid a lot more to do a laser Brazilian...

At least I can say I'm practicing what I wanted to my entire life, what I trained for my entire life. I wonder how the "ethics" talking heads would answer this question?

Concierge Medicine: Prepaid Emergency Care.

Via Medical Economics: Concierge Emergency Care?

These days, the soft-spoken, but formidable family physician is mixing it up in the role of healthcare reformer. Three years ago, Wood began advertising that his clinic would provide unlimited primary and urgent care for a monthly fee of $83 for an individual, $125 for a family. Wood immediately ran afoul of the state insurance commissioner, who warned him that he was operating as an illegal insurer, a felony punishable by up to five years in prison. For the next three years, Wood pushed for legislation—and got pushed back by the insurance-industry lobby—that would legalize his experiment. Now instead of prosecuting Wood, West Virginia is replicating his bargain-basement version of concierge medicine in a pilot program. The goal—to make healthcare more affordable in one of the poorest states in the nation.

Concierge Medicine: Another physician gives insurance companies the finger.

Is concierge medicine the way to get out from under insurance companies?

Remove $300,000 in overhead every year?

At his old practice, he estimated his overhead at $350,000, and he believes that most of it went toward meeting the needs of health insurers. He needed experts to read his charts and plug the right insurance codes into his bills. He needed staff to secure prior permissions for prescriptions and procedures. He had one employee who worked 40 hours a week just arranging patient transfers to specialists.

He also calculated that he needed to see 25 patients a day just to cover his overhead. In order to make his salary, he often saw 35 or 40. And he never could spend as much time as he'd like with them. According to his wife, Gena, practice employees had developed a ruse to keep Stein from talking to patients for too long. When a patient visit ran over, someone would knock on the door and tell him that another doctor was on the phone.

"You can't take care of 25 or 30 patients a day," Stein said. "That's not possible. What you're doing is running a cattle drive."

His new practice, he said, has an annual overhead of $50,000, and that number includes the flat screen television and leather couches in the waiting room, the Starbucks coffee brewing behind the reception desk, the electronic record software and the high-tech diagnostic equipment that Stein bought when he opened his doors...

...The key to his financial model, he said, is that he doesn't sign contracts with insurance companies, which means he's not bound by their reimbursement rates and not subject to their rules. He can decide what tests to perform or drugs to prescribe without having to make phone calls or fill out forms. He also doesn't have to worry about laws governing health insurance or Medicare fraud. Since he doesn't bill the companies, he doesn't have to follow their rules.

Via Kevin MD

Boutique & Concierge Medicine: Doctors on retainer.

Marketwatch: Boutique & Concierge Medicine

Boutique Medicine: Patients pay a flat annual fee to a primary-care doctor who caters to a smaller group of patients.

There has been a lot of media attention on the supposed rush into concierge medicine by unhappy docs. I haven't seen much of a rush. There are a few doctors I know that have discussed or investigated this as a possibility but I can't think of any that I know personally that have tried this.

From the article: Dr. William Plested, president of the American Medical Association and a thoracic and cardiovascular surgeon in Santa Monica, Calif., said doctors making the transition to a retainer practice are obligated to ensure the patients who don't join find a reasonable alternative. "The idea is certainly not to leave a patient in the lurch. The idea is to improve the type of service you're providing -- improve it for yourself and for your patients."

He and Caplan agree that boutique medicine is likely to stay a niche practice.

"It's a tiny drop in a huge ocean," Plested said. "The economic reality and demographic reality is there aren't that many areas that will support this type of practice."

Still, retainer practices point to an uncomfortable truth, Caplan said. "It undermines one of our favorite myths, which is same quality of health care for all. That's never been true, but this rubs our nose in it as a society."

Any one have experience with or thoughts on this? 

Retail Medicine: Why do doctors want to open medical spas?

No end to physician problems:

-- The top five factors contributing to low morale were identified by the survey respondents as: low reimbursement, loss of autonomy, bureaucratic red tape, patient overload and loss of respect.

"I think that it is safe to say that no physician is optimistic about the future of medicine at this point," one participant wrote. Others seemed downright hopeless: "One thing that rarely gets mentioned is that, unlike other industries that are cyclical, the practice of medicine continually gets worse and worse, more intolerable, more onerous, with absolutely no hope or reason for any optimism either in the near or remote future."

The free-market is forcing doctors to extend office hours

Extended office hours are now the norm.

"Suddenly, faced with less compliant patients and unexpected competition, more and more doctors are doing the unthinkable: changing their hours to accommodate potential customers."