This is a realm of marketing that is commonly overlooked… typically botched… and arguably the highest return marketing activity a company can invest in. Literally… Infinite Return Marketing when executed properly and consistently.

Yesterday I had breakfast with the owner of a small service business. As is typically the case, he is not only the owner and manager of the business, but the chief client relationship manager and evangelist for the firm.

The topic of referrals came up, and I was struck by a confession he made. So much so that I wanted to quickly offer up this brief post for anyone else who may also be hindered by his fear.

As you may recall from previous posts, I’m a strong believer in enlisting clients as ambassadors for a business… teaching them how to refer others… extinguishing their anxiety over making referrals… rewarding their referring efforts… AND enlisting them in your growth plans.

Until yesterday, no one had ever pointedly confessed to me their fears of discussing growth aspirations with current clients.

His fear was essentially this. “If I share with my clients my aspirations to grow, they will assume that (if I’m successful) my attention will be diluted, and the personal service they now enjoy will erode in the future.”

If your client has enjoyed good service from you to date, this is a baseless fear. If you struggle with this self-consciousness over your growth plans in the company of current clients – stop.

If you’re really worried, include in your description of your growth plans a dedicated effort to maintain or enhance quality as you grow.

But absolutely do not be afraid to enlist your clients in your future growth. Petty jealousy aside, people are generally attracted to others who are growth minded and want to help their cause.

Then they want to be thanked for their help and kept abreast of how their contribution has impacted the business. Try it.

Here’s the form you’ll need: CMS-855I

And a little about the new regulation and how to be in compliance:

Publication 100-2, Chapter 15, Section 40.13 of the Internet Only Manual (IOM) outlines the Centers for Medicare and Medicaid Services’ (CMS) instructions with respect to physicians and non-physician practitioners who have never enrolled in the Medicare program. This section basically outlines that eligible physicians and non-physician practitioners are not required to “enroll” in the Medicare program, however, they must obtain a valid opt-out record in the Provider Enrollment, Chain and Ownership System (PECOS) [42 CFR § 424.507(b)(iii)]. Because of these requirements, individuals that have not submitted a Medicare Enrollment within the past 5 years, including thosewho are currently opted-out, need to submit their Medicare enrollment information even if only to remain opted-out of the program.  To view a detailed explanation of the historical and current can be found in the Federal Register: May 5, 2010 (Volume 75, Number 86) or by reviewing www.cms.gov/MedicareProviderSupEnroll and clicking on the “Provider Enrollment Regulation” tab on the left side.

Medicare providers and suppliers can find out information about their enrollments (or lack thereof) by contacting their Medicare Enrollment Contractor or viewing their information via Internet-Based PECOS. Contractor information can be found at the website mentioned above, by scrolling down to the bottom of the “Overview” page and clicking on “Medicare Fee-For-Service Contact Information”.   One of the best tools for the Medicare contractors in regards to information dissemination is their website.

In order to submit enrollment information, individuals can either choose to fill out the appropriate CMS-855 enrollment applications, or submit their information via Internet-Based PECOS. All of the information regarding Medicare enrollment can be found using the previously mentioned link. More specifically, all of the information pertaining to Internet-Based PECOS is separated out on its own page which can be found by clicking on the link on the left hand side of the overview page.

Lately I’ve found myself involved in a number of new branding initiatives. New companies seeking to create a compelling brand… and existing firms trying to become more compelling by investing more thought in the branding exercise.

The topic of color comes up frequently in these projects. Does color actually matter? Is it a significant variable in the persuasion formula?

The answer is, yes. Color does matter.

Our brains are wired to associate specific feelings with certain colors. Most of us are aware that colors can evoke certain emotions, but it may surprise you to learn that color accounts for 60% of a person’s acceptance or rejection of another person or object.

Color is actually a particularly useful instrument of persuasion. Because we don’t perceive its influence over our decision making, we don’t develop a resistance to it.

The problem for marketers is that colors each carry multiple meanings. Take the color red for example. It’s probably the best attention grabbing color, but consider its various meanings.

To some it represents “stop.” I therefore advise marketers never to use the color red for buttons on web sites that they want clicked by their audience. To many, red represents danger. In financial circles, red represents a loss (as opposed to black for profit).

Red can represent anger and aggression, boldness, or blood. So, as you can see, when developing your brand, how you use color is a matter worthy of serious consideration.

For your next branding project (or when picking colors for your home or office), I offer this color trigger reference…

• Red: strength, power, anger, aggression, excitement, financial loss, blood
• Blue: truth, integrity, coolness, loyalty, harmony, serenity, devotion, relaxation
• Yellow: intelligence, wisdom, hostility, cheerfulness, loudness, brightness. Yellow is the first color to register in the brain and causes you to be alert and watchful.
• Green: peacefulness, tranquility, youthfulness, prosperity, growth, money, endurance, hopefulness
• Orange: sun, warmth, bravery, radiation, communication, brightness, unpleasantness, invigoration
• Purple: royalty, passion, authority, stateliness, integrity, dignity, mystique
• White: purity, plainness, coldness, cleanliness, innocence, hygiene
• Black: desperation, wickedness, futility, mysteriousness, death, evilness. In financial contexts, black may represent profit and exclusivity (e.g. the exclusive American Express Centurion card)
• Gray: neutrality, nothingness, indecision, depression, dullness, technology, impersonality

The following is a logo developed by the Private Medical Marketing Group for a company in the business of providing clinic-based wellness services for employers.

The design team chose the central color, blue for the purpose of communicating integrity to participating employees.

People who are encouraged to participate in sophisticated wellness programs sponsored by their employer are often suspicious of how information will be managed with respect to their personal privacy and whether there are ulterior motives for the employer to meddle in the health affairs of employees. Failure to address this concern can impair the effectiveness of the program.

This particular wellness offering is built on a sophisticated technological platform – communicated through the use of the color, gray.

And in this instance, the designers elected to incorporate red to draw the eye to the center of a highly symbolic icon and infuse a touch of energy and invigoration into the brand. Their belief, and I’m inclined to agree, was that the negative connotations of the color red will compensated for by its literal application in coloring an apple – a widely recognized and very positive symbol of disease prevention. (An apple a day….)

So if you thought that logo design and color selection was random…

Blogger: Tom Blue, Executive Director, AAPP

Contemplating how we got to ObamaCare brings to mind the L. Frank Baum classic Wizard of Oz. Both require the complete suspension of disbelief in favor of magical thinking and the bestowing of God-like abilities to mortals.

The Yellow Brick Road to OzbamaCare is paved with empty promises, boldfaced lies, and…..price controls. The people are promised access to high quality healthcare at little or no added cost; the proverbial free lunch. All will be “covered” regardless of pre-existing illness, and insurance premiums will actually go down!  The government will decide what policies will be offered, and dictate the price.  Somehow, private insurance companies will survive.  This is as believable as a tin man getting a heart, a scarecrow a brain, and a cowardly lion, courage.  The medical profession (well, some of us) go along, naive as Dorothy, though most doctors dream of going home to Kansas, where medicine is practiced between patient and physician, without third party intrusions.

Price controls, administered by public and private third party payers, have already gone a long way towards destroying the world’s best healthcare. Wage and price controls instituted by FDR during World War II set the stage for tax-subsidized, employer-sponsored health insurance. This tornado uprooted people from individual control of healthcare and started us down the road.

Medicare and Medicaid, enacted by LBJ and a Democrat-controlled Congress in 1965, gave the federal and state governments huge toeholds into the health industry. Both programs have grown exponentially, due in no small measure to heavy-handed price controls. Choosing to pay physicians next-to-nothing for seeing Medicaid patients led to ER abuse and skyrocketing costs, which are bankrupting many states.  Medicare price controls, especially on doctors, have also fueled massive spending. Less money for office visits leads directly to more spending on tests, consultants, and hospitals, with lower quality care.  Medicare is bankrupt and will implode over the next ten years as baby boomers sign up, doctors opt out or retire, and half a trillion dollars is cut from its budget.

The trip to Emerald City ends badly for most of the players. Brave Toto pulls down the screen revealing the Great Oz to be a snake oil salesman. He gives the tin man a cheap watch, the scarecrow a meaningless diploma, the lion a  brass-plated medal, then absconds in a hot air balloon.

Dorothy comes to understand she has always had the power to return home. We, too, have the abilty to click our ruby slippers, get out of third party arrangements, and return to the unfettered practice of individualized, high quality medicine. But we need the support of millions of patients who realize that all-powerful wizards are a fiction and that only the free market can actually deliver on promises.

The sweeping health care reform legislation enacted on March 23, 2010, known as the Patient Protection and Affordable Care Act (the “PPACA”), as amended on March 30, 2010 by the Health Care and Education Reconciliation Act of 2010, has significant implications for “concierge” or “boutique” medical practice business models. Most significantly, the PPACA limits ordering of durable medical equipment (“DME”) and home health services for Medicare beneficiaries to Medicare enrolled physicians or eligible professionals.  This limitation applies to all written orders and certifications made on or after July 1, 2010.  In addition, the Secretary of the DHHS has the authority to expand this requirement to other health care items and services prescribed or referred by a physician.  This will impact all concierge physicians who have opted out of Medicare by serving as a de facto mandate on enrolling in Medicare, notwithstanding the American Medical Association’s claim that it was successful in eliminating mandatory physician participation in Medicare and Medicaid.  If a DME supplier or home health agency processes an order for said services from a physician who is not enrolled in Medicare, the DME supplier or home health agency will now be deemed to have received an overpayment upon submission of the claim.  Therefore, physician practices that have opted out must re-examine their business model and determine if one or all physicians must enroll in Medicare.  In addition, such practices should analyze their current practice-patient contracts and restructure as appropriate.

Additionally, the PPACA’s focus on preventative care has resulted in expanded coverage for Medicare beneficiaries, including coverage for an annual wellness visit each year commencing in 2011.  Many concierge medical practices are established utilizing the so-called parallel practice model whereby one entity is established to bill third party payors and Medicare, and another entity is established to bill for membership fees for non-covered services [under Medicare] and amenities, which customarily include one comprehensive annual wellness exam each year.  As a result, these parallel practice models will need to be re-examined and perhaps restructured, along with their current practice-patient contracts.

On behalf of our concierge physician clients, Blalock Walters is developing tailored solutions to the issues discussed in this article, based on such factors as the number of physicians, patient population and current business model.  There are additional implications under the PPACA for concierge medical practices that are not discussed in this article.  If you would like to discuss the impact of the PPACA on your practice, please do not hesitate to contact Robert S. Stroud, a Principal with the law firm of Blalock, Walters, Held & Johnson, P.A., with offices in Sarasota and Bradenton, Florida.  Mr. Stroud represents health care providers and entities nationwide.  He can be reached at 941.748.0100 or rstroud@blalockwalters.com.

Now that the Senate version of ObamaCare has become the law of the land, we need strategies to safeguard the doctor-patient relationship from government intrusion.   The most effective approach is for both patients and physicians to opt out of the third party payment system.

From the patients’ perspective, opting out makes sense.  Insurance companies will not be allowed to deny care for pre-existing conditions.  Thus, even if the individual mandate is not thrown out on constitutional grounds, it will be smarter to pay the penalty, not buy insurance, and put as much money as possible into a health savings account.   Prompt excellent medical care can readily be found in the burgeoning free market.   Prices should be transparent to facilitate comparison shopping.

Physicians have an ethical obligation to use their skills and training for the betterment of our patients, and to pass this art to the next generation.  For those who choose to remain in practice, opting out of third party payment will be an increasingly attractive option.

Accepting payment directly from the insurer is a relatively recent aberration in the long history of the profession.   There was never a crisis in access to doctors’ services in the pre-Medicare/Medicaid era.   Physician fees were usual, customary, and reasonable.  Doctors charged well-heeled patients a bit more and those less well off a bit less.   Pro bono care was a part of every practice.  There was, and still is, competition between physicians for patients, and this restrained charges.  Patients valued the doctors’ time and vice verse.  Doctors worked exclusively for the patient and were their strong advocates.  There was a high degree of trust and medical care was used selectively.  Direct third party physician payment changed all of this for the worse.
Initially, doctors “accepted assignment” as a courtesy.   Medicare eventually required participating physicians to agree to this.  Over the years, it became the norm.  This was, in some ways, convenient to patient and physician. But by insulating both from the true costs of care, it led to overutilization and massive increases in health care spending.  Payers responded with price controls and attempts to micromanage medical decision-making such as managed care, and its new version, pay-for-performance.   Price controls on physicians drove volume increases that resulted in overall spending escalation.  Higher volume inevitably impacts quality of care.   No “quality improvement” measures can adequately compensate for this.

Widespread opting out of the third party payment system will lead to lower utilization with huge cost savings.   There is no more efficient model than direct pay since it eliminates the middleman for the majority of charges.   Office costs are dramatically reduced when third party billing is abandoned.  By setting their own rates, doctors will be in control of their time and patient volume would decrease.  Quality of care would improve, again saving money.  The doctor-patient relationship, arguably the essential ingredient to cure and comfort, would be strengthened.

The immediate objection to opting out is that not everyone can afford to pay at time of service.  The same argument could be made for dental and legal care (Note the absence of crises in the delivery of cosmetic surgery, dental, veterinary, and legal care—all outside third party systems).   We have simply become accustomed to having “someone else” pay (see “A Right to Healthcare? Wrong!”).

Another frequent objection is that some patients will not go for needed care if they must lay out money.   This is easy to assert and impossible to disprove, but should bureaucrats make these decisions?  This, plus unsustainable overuse of the system, are the inevitable alternatives.

Universal coverage will complete the move toward centrally-controlled care.    Practice will be directed (i.e. rationed) by federal committees using practice guidelines, “pay-for-performance,” and the electronic health record.  Individualized care and medical confidentiality will slowly disappear.  Importantly for the administration and Congress, more citizens will become dependant on government largesse.  Doctors and other providers will become government employees, and be subject to its whims.

It is now left to individual physicians and patients to act in their own interests, and to defend the medical profession and doctor-patient relationship from government intrusion, and ultimately, destruction.
It is time to opt out.

Doctors, sign the Physicians’ Declaration of Independence.

Richard Amerling, MD
Associate Professor of Clinical Medicine
Albert Einstein College of Medicine
Director, Outpatient Dialysis
Beth Israel Medical Center, NY
Director, Association of American Physicians and Surgeons

This is a work in progress, and we would welcome any corrections, comments, or additions.

1996: Dr. Howard Maron and Scott Hall, FACP established MD2 (pronounced MD squared) located in Seattle, Bellevue, WA and Oregon and charged an annual retainer fee of $13,200 and $20,000 per family.

1999: Medical Professionalism Project-consisting of members of the internal medicine community, including representatives of ACP and the American Board of Internal Medicine, set out to draft a charter that could serve as a framework for understanding professionalism.

1999: Institute of Medicine releases the now famous report of medical errors, patient safety, and professional integrity that caused further probing in physician exam rooms.

2000: Virginia Mason Medical Center in Seattle, WA began operating concierge medical services within its facilities and used some of the profits from the 5 physician practice to subsidize other programs and indigent care services.

2000: MDVIP, founded by Dr. Robert Colton and Bernard Kaminetsky, in Boca Raton, FL. A brand of concierge medicine practice and management firm which has set-up more than 300 concierge medical practices with offices from Arizona to Rhode Island.

2001: American Medical Association writes PRINCIPLES OF MEDICAL EITHICS concierge physician guidelines.

2002: ACB Foundation , ABIM Foundation and the European Federation of Internal Medicine defines ethical principles and responsibilities contracts between patient and physician, which is in a language that suggests both parties have equality,, mutual interest and autonomy.

2002: Medicare addresses concierge medicine and retainer fees.

2002: Centers for Medicare and Medicaid, CMS, outlined its position on concierge care in a March 2002 memorandum.  The memorandum states that physicians may enter into retainer agreements with their patients as long as these agreements do not violate any Medicare requirements.

2002: Pinnacle Care establishes patient care with a one-time membership fee for access to VIP service.

2002: The AMA counsel on medical service issued a report in June 2002 on Special Physician-Patient contracts.  It concluded that retainer medicine was very small phenomenon.

2003: American Society of Concierge Physicians, was founded by Dr. Johon Blanchard. The association later changed its name to SIMPD, Society for Innovative Practice Design.

2003: AMA issued guidelines for boutique practices in June 2003.

2003: Department of Health and Human Services rules the concierge medical practices are not illegal and the federal government takes a decidedly hands off approach and the OIG, Office of the Inspector General.

2003: American College of Physicians writes doctors struggle to balance professionalism with the pressures of everyday practice.

2003: June 2003 the AMA Council on Ethical and Judicial Affairs outlines guidelines for “contracted medical services”.  The AMA House of Delegates approves these guidelines.

2004: GAO, General Accountability Office writes 146 concierge physicians in the U.S.

2004: Harvard University study finds that 55% of the respondents are dissatisfied with their health care, and 40% of that 55% agreed that the quality of care had worsened in the previous 5 years.

2005: The AOA, American Osteopathic Association adopts not to recommend and official policy on concierge care.

2006: MDVIP, a concierge physician practice management firm, reports that 130 physicians within their network treat up to 40,000 patients worldwide.

2008: Boasting an estimated 35 concierge physician practices, Orange County, CA appeared to be a leading hub of concierge medicine.

2008: Concierge Physician of Orange County (CPOC)– a non-profit group of existing concierge physicians was founded.

2010: SIMPD reorganizes, expands its vision, and rebrands itself the American Academy of Private Physicians.

2010: American Academy of Private Physicians forms first local chapter in Orange County, California called AAPP,OC (formerly CPOC)

If you have even a passing interest in the shifting demographic composition of our country, you’re certainly aware of the generational tsunami that is beginning crash on our shores at this very moment.

If you consider the health care consumption of people as we age, the above chart (now ten years old) offers insight into the health care supply & demand crisis that patients like the one featured in the Washington Post are beginning to feel. Of course, this problem is magnified by the simultaneously shrinking ranks of medical students with an interest in a career in primary care.

Clearly this phenomenon will serve to drive the growth of private physician practices. And these statistics make yet another argument for patients to secure a relationship NOW with a private physician.

If you are a private physician that is still accepting new patients, you should acquaint yourself with this simple tale of supply and demand and use it in your presentations to patients and employers.

No one can argue with these numbers.

Post by: Tom Blue

In his article, “More Doctors Giving up Private Practice,” March 25, 2010, Gardiner Harris talks about a “quiet revolution” taking place across America that is changing the paradigm of healthcare delivery.  Indeed, for good reason, doctors are wanting to do anything but succumb to working for the government, and some are finding their answer by selling their practice to a hospital or foundation and becoming an employee.

Unfortunately, many of those doctors have found that after their “transition,” they are put in a position where their interests are conflicted with the patients they had hoped to serve.

The real revolution that is thundering across the country is the transformation back to the days of Marcus Welby where doctors serve their patients directly and privately outside the system of insurance hassle and government paperwork.

Data is emerging to demonstrate that direct practices or what has been called “the concierge practice” are providing patients with less expensive high quality care.  Contrary to some of the media, these practices have sprung up in every financial demographic from Beverly Hills to urban America.  Patients are demanding privacy that cannot happen if the doctor is trading data for stimulus dollars and the direct practice is the best opportunity for patients to find a doctor able to advocate solely for the patient while protecting the sanctity of the privileged patient-doctor relationship.