Private Practice Model Perspectives 2015 Survey

Conducted by Kareo & AAPP

Agenda

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Agenda

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• Methodology• Respondents• Motivations & Realities of

Practice Models• Key Trends in Private

Pay/Membership Medicine

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• Approximately 100,000 physicians surveyed yielding 862 respondents• 206 Private Physicians

• 477 Conventional or Fee-for-service Providers

• 179 other

• Compared private physician respondents to conventional, insurance-based practice respondents across all common questions, and used statistical testing to determine where significant differences existed

• Reported on questions specific to either private physician practice respondents or insurance-based practice respondents

Methodology

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About Respondents

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Gender

Conventional Private

40%47%

60%53%

FemaleMale

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Age

21-29 30-39* 40-49 50-59 60 or older

7%

21%

24%26%

21%

4%

14%

29%

32%

20%

ConventionalPrivate

* Denotes statistically significant at a minimum 95% confidence level

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Professional Designation

DO MD NP PA

10%

74%

14%

2%

8%

80%

10%

2%

ConventionalPrivate

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Board Certification (MD/DO)

Conventional Private

14% 12%

86% 88% YesNo

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• Conventional physicians: 19.6 years• Private physicians: 19.9 years

Years in Practice

10

Group Size

Solo practitioner*

2-5 practitioners*

6-10 practitioners

11+ practitioners

Health system or academic medical

center

40%

36%

10%

7%

7%

55%

26%

8%

8%

3%

PrivateConventional

* Denotes statistically significant at a minimum 95% confidence level

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Comparing Motivations & Realities Between Private and Conventional Physicians

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Are you currently using a concierge, direct pay, or other membership model in your

practice?24%

76%

Yes No

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What is the likelihood you will transition to a concierge, direct pay, or other membership

model in the next 3 years?

54%32%

14%

Not likelySomewhat likelyHighly likely

Primary care MDs and DOs

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Top 2 Motivations for Transitioning to Private Medicine

Earn more money*

Spend more time with patients*

Improve work-life balance

Practice lifestyle, functional, or integrative medicine*

To separate from the insurance payer system

Other

39%

42%

35%

22%

41%

4%

26%

65%

42%

38%

46%

8% PrivateConventional

* Denotes statistically significant at a minimum 95% confidence level

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Average Length of a Patient Visit

15-20 minutes* 30 minutes* 45-60 minutes* Other (please specify)

49%

27%

18%

5%

19%

39%

33%

9%

Conventional

Private

* Denotes statistically significant at a minimum 95% confidence level

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How many days of the week do you see patients in the office?

Once a week 2 days a week 3 days a week 4 days a week 5 days a week 6 days a week* 7 days a week*

2%4%

10%

23%

61%

0% 0%2%

10%8%

19%

52%

8%

1%

ConventionalPrivate

* Denotes statistically significant at a minimum 95% confidence level

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What is your maximum daily visit volume?

* Denotes statistically significant at a minimum 95% confidence level Graph distributes “Other” respondents from previous question into “< 10” and “> 30” categories

<10* 10* 15* 20* 25* 30* > 30

1%

12% 13%

21%

17%

23%

13%

9%

39%

25%

9%

4% 5%

8%

Conventional

Private

Patient Panel Size

Conventional

< 500 501-1000 1001-1500 1501-2000 >2000

24%

14%

12% 11%

39%

Private

< 100 101-200 201-300 301-400 401-500 >500

26%

13% 13%12%

7%

29%

The average private medicine provider

works 42 hours a week while the average traditional provider works

47 hours per week.

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% Clinical Time vs. Administrative

Conventional Private

71.8

76.0% Clinical Time

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Sources of New Patients Ranked by Importance

word of mouth physician* online* advertising employer* other

1.7

2.3

3.3

4.1 4.1

4.8

1.5

3.12.8

3.9

4.5 4.5ConventionalPrivate

* Denotes statistically significant at a minimum 95% confidence level

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20% of practices—conventional or private—spend less than $800 a month on

marketing.

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Top Challenge Faced by Practice

Choosing and implementing new technology

Finding and keeping qualified staff*

Managing regulatory compliance

Recruiting new patients*

Retaining existing patients

Staying financially viable

11%

19%

18%

16%

2%

33%

10%

7%

15%

39%

2%

27%

PrivateConventional

* Denotes statistically significant at a minimum 95% confidence level

Private Pay Practice Trends

The average practice has been concierge or direct pay for 8 years.

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How did you start your concierge or direct pay practice?

47%

53%

Converted from an in-surance-based practice

Started the membership practice from scratch

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How do you describe your practice?

37%

33%

30%Cash Practice

Concierge

Direct Primary Care (DPC)

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Billing models for cash-based fee for service practices

29%

71%

Based on visit time (i.e., # of minutes)Fixed fee by service type

The average annual membership fee is $2,025.

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What membership packages or payment plans do you offer? Check all that apply.

Monthly payment plan Quarterly payment plan Annual payment plan Discounts for couples/families

Discounts for children

65%

44%

61%

42%36%

Note: categories are not mutually exclusive and will not sum to 100%

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Of your total patient panel, what percentage are members?

37%

10% 6%

19%

28% <25

26-50%

50-75%

75-99%

All patients are members

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If you accept insurance, please check all that apply to the status you have with the following payer types:

Medicare non-participating

Medicare opt-out

Out of network with health plans

17%

23%

45%

Note: categories are not mutually exclusive and will not sum to 100%

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Services Offered (Select all that apply.)

Remote monitoring - Sleep tracking (i.e. using a FitBit, or other sleep monitoring device)Carotid IMT

Remote monitoring of activity (i.e. using a FitBit or similar device)Remote monitoring of biometrics (i.e. blood pressure, weight, glucose) using a monitoring device

Home sleep testingHospital admission

Mobile apps for patient managementNutritional supplement dispensing using an online dispensary and direct shipping

Nutritional supplement dispensing in the officeGenetic testing (e.g., 23andMe)

Body Composition Assessment (BIA)Exercise program design

Pharmacogenomics testingHormone replacement therapy

Patient education using seminarsHospital visitation

Weight loss programHouse calls

Nutrition assessmentPersonalized, documented health management plan for the year

Nutrition consultationNavigation and coordination of care with specialists

On-site lab drawingHealth Coaching

Virtual consultations via phone, text, email, and/or video chatPre-negotiated cash prices for office services and/or labs

Annual health evaluationOngoing Management of acute and other primary care needs

7%8%

10%13%

15%17%18%

22%23%24%

27%28%29%30%

32%36%

38%39%40%

45%46%47%48%

53%55%

59%68%

72%

Technology

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Private pay practices are more likely to use telemedicine, kiosks, and practice

marketing platforms.

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Top Software Features• When asked about top software features…

• Private pay practices were more likely to want online scheduling, patient portals, online billing & payments, and credit card on file.

• Traditional practices were more likely to want improved claims management, financial reporting, and specialty EHR features.

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In conclusion…There are challenges and benefits for both private and conventional practice models. However, despite varying workflows and

processes, a common need for all independent practices is the right technology, tools, and

support.

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