The key to success in holistic & functional medicine is simply to give better care than the other doctors in your area. Given how utterly dysfunctional mainstream medicine is, these days, it shouldn't be hard, quipped Mark Menolascino, MD, at Holistic Primary Care's 6th annual Heal Thy Practice conference.
In the 15 years since he established his now-thriving functional medicine clinic in Jackson Hole, WY, Dr. Menolascino has learned a thing or two about practice models.
To build a successful practice, "Be better than the guy next door. You don't have to be smarter, just give better care," said Dr. Menolascino who is program chairman for Heal Thy Practice 2015, coming up on Oct 16-18, at the Marriott Coronado Island, San Diego, CA.
Here are a few of Dr. Menolascino's practice development insights:
Let Patients Know About HSAs: Health Savings Accounts are an excellent way for people to fund care =outside the conventional box. HSAs put pretax dollars in the bank that can be used for a wide range of services including functional medicine.
"Cash-Pay" vs "Insurance-Free"? How you say things really makes a difference. "I don't like the term "cash pay." We use the term "Insurance-free," and we explain that it means we are free of all the handcuffs, and the decision-making that insurers force on us. I can make a medical decision that's right for you, based on what YOU need and what I can provide, not what's right for the insurance plan."
Opting Out vs Not Taking Assignment: Opting out of Medicare means, basically, you're done. You sign off and every two years you have to opt-out again. Any Medicare patient that comes to you must sign an agreement that s/he is now seeing you as a private-pay patient. "It's a bit of a pain in the butt, but you need to have them do this. We have it in our EMR system," Dr. Menolascino said.
Some physicians choose the "Not Taking Assignment" route as a first step away from Medicare. This means that you are still a Medicare provider, but you charge patients directly, and then Medicare reimburses them. The catch is that the reimbursement is usually 10%-20% less than what Medicare typically pays. It's not an ideal way to interact with patients, he noted.
Be Careful with Hybrid Models: Mixing insurance and direct pay patients in the same office can be dicey, said Dr. Menolascino. "I've not seen that work very well. Under Medicare, you cannot treat any Medicare patient differently from other Medicare patients, so it gets very complicated." If you're choosing the hybrid route, consider having two locations.
"I've seen several doctors who split up their practices, like a friend of mine down in Atlanta who has a regular ObGyn practice downtown, and then got a new EIN number and went to Peachtree City where he does an anti-aging clinic 2 days a week. That revenue quadruples what he makes in the downtown office."
Good Old-Fashioned Housecalls: I have a little black bag, and four times a week I go and do housecalls. People love it. I don't charge them. I get chickens, and elk meat, and all sorts of healthy farm food for my kids. If I was in Medicare I could not do that."
Shut Up & Listen: Speak less, listen more, Dr. Menolascino advises. Let the patients tell their stories. "I have a 14-page intake form that patients fill out before they come in. I read it before the first visit so I know their story. But then I have them come and ask them to tell me their story. I sit and listen, and don't say a thing for 5 or 10 minutes. So many of them say, 'No one's ever given me a chance to tell my story.' If you shut up for long enough, the patient will tell you what's wrong. "
Choose Good Ancillary Services: There are many ancillary services that holistic clinicians can bring into their practices: Holter monitoring, ultrasound, aesthetics, allergy testing, sleep disorder testing, advanced CVD biomarkers....the list is vast. Choose carefully. "I've spent a lot of time looking at these different things. At the end of the day you have to look at your patient population, what you like to do, and what are the tricks of the trade."
Here are a few ancillaries Dr. Menolascino said he's had good success with:
- Bioidentical Hormones: "Thyroid and adrenals are my specialty. A lot of doctors are afraid of hormones, but it's actually really easy."
- Advanced CVD Biomarkers: "We do a 27-part panel, versus the 4-part panel most doctors do. We set a standard far above anyone else in the area."
- HeartMath: "It's a great way to introduce stress management into your practice. The devices cost about $150 and most really enjoy working with it." It's also a great lead in for smoking cessation. Start with the stress management, then tackle the smoking.
- Body Composition Analysis: People are concerned about their weight, but they need to think about body composition. People may be "skinny" but still have a lot of internal abdominal fat. Tools like the InBody scale open a window onto that.
If you are adding an ancillary, make sure you have a plan for how to market it. "I bought a hyperbaric oxygen chamber. It cost $20,000. I thought it was really cool, but patients weren't exactly lining up to get into it. I made no money the first year. So I came up with a plan. I offered free sessions to all the extreme skiers that hurt themselves, all my high performance athletes, and a few cancer patients. Guess what happened? Now we have 5 patients a day using it, and make $80 a pop. We paid for the chamber in a couple of months."
Watch Dr. Menolascino's lecture from the 2014 Heal Thy Practice conference at: www.Holisticeducationexchange.net