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If 500 patients pay $1,500 apiece, that's gross revenue of $750,000 for the practice. Many concierge doctors also bill Medicare and private insurance for services not covered by their retainer.

 

Patients and family members say the fee is worth it.

 

read more here...

 

 

Anyone consider starting a PA owned "Concierge Practice"...???

 

If the PA can secure a minimum of 250 patients paying $100/month ($1,200/yr)... they can gross $300,000/yr.

 

If the practice is primarily housecalls from a home-based office with tablet computers, electronic faxes and a fuel efficient vehicle... and they can keep the "SP" fee to $1000/week ($50k/yr) your "taxable" gross could be ~$190-$200k... :wink:

 

100 patients = $120k... 200 patients = $240k... 300 patients = $360k

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The AMA ain't the "boogy-man"...

 

As long as there is a legitimate PA-physician team, all the regulatory forms are filled and filed and there is appropriate supervision in accordance with state law... the "AMA" can't do Jack...

 

The AMA is to physicians what the AAPA is to PAs... or the ANA/NLN is to Nurses. It is simply a lobbying organization that most physicians don't even belong to. So I'm kinda perplexed as to why you seem to think that the AMA has some kinda magical power that would somehow supercede Illinois state law.

 

Contrarian

 

P.s... before you respond please keep in mind that I am from Illinois, have experience in that practice environment, and am VERY familiar with what goes on there.

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Yes I do know you're from IL, but didn't you primarily practice in the Chicago area quite a long time ago....the Chicago area for PAs is still really good. I tell PA students to stay there if they can, most do. Rural it's different. I do know what you're talking about, a PA in NC is doing what you're talking about. Doing "house calls" out of her van...IM, worried about the cuts to medicare. Good business if you can establish a base and the AMA didn't send letters to all the docs in that state degrading midlevel.....sounds like a boogyman to me....

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I believe Ohio has a regulation that a PA can only practice in a facility in which their SP "regularly practices". This is why the NP's are the midlevels working in the "minute clinics" in the drugstore chains in Ohio. I believe this would preclude the PA's making house calls, but hope an experienced PA in Ohio could comment.

 

The idea intrigues me, because in my current (for 4 more weeks) occupation, all of my patients are "house calls".

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Here in Maine, the Licensing board (BOLIM) recently issued guidelines which stated that PAs could not employ their SP which would probably preclude this type of arrangement. I feel like every year the noose tightens a little more for PAs while the other non-physician providers enjoy ever broadening horizons?

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Agreed. This is a proposal from the BOLIM which is seeking to revise the regulatory chapter on PA practice in Maine. In its current form, it has not been enacted (yet) although, interestingly, the Osteopathic Board (separate licensing entity) has had a regulation barring greater than 49% PA ownership for many years. It would have wide ranging impacts on the ability for PAs to provide care to the more rural parts of the state. I posted info about this in the Maine state-specific forum. Feel free to look.

 

Sorry to hijack the thread, C.

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I love the idea of concierge practices and see them as a great benefit to patients tired of subsidizing the rest of the country not only with money, but with time as well, which is just as valuable as money. Got tired of patients seeking "la clinica" when I was doing rotations at the county hospital. Down here in Texas the only way to ensure paying patients and turn a profit would be to have a concierge practice, a cash only practice or limit insurance carriers to a select few.

Regardless of what you were told in school, medicine is a business and "social responsibility" is a new term that only recently became popular when the lefties became so obnoxious about shoving their agenda in peoples faces. If you don't make money, you won't be employed for long...

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Here in Maine, the Licensing board (BOLIM) recently issued guidelines which stated that PAs could not employ their SP which would probably preclude this type of arrangement. I feel like every year the noose tightens a little more for PAs while the other non-physician providers enjoy ever broadening horizons?

 

Both the SP and PA would be employees of a Limited Liability Corporation. This Corporation would have shareholders and a "managing director" which could be anyone... including the PA who holds majority stock, or the PA's significant other (Spouse, Child, Uncle, etc)... or the PA could hold 40%... the PA's significant other (Spouse, Child, Uncle, etc) could hold 20-30% ...

 

Gotta be smarter than the average bear to get the "pic-A-nic basket"...:wink:

 

Just creative ideas off the top of my head...

 

Contrarian

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Both the SP and PA would be employees of a Limited Liability Corporation. This Corporation would have shareholders and a "managing director" which could be anyone... including the PA who holds majority stock, or the PA's significant other (Spouse, Child, Uncle, etc)... or the PA could hold 40%... the PA's significant other (Spouse, Child, Uncle, etc) could hold 20-30% ...

 

Gotta be smarter than the average bear to get the "pic-A-nic basket"...:wink:

 

Just creative ideas off the top of my head...

 

Contrarian

 

 

 

Excellent!!!!! When someone puts a barrier in front of you, figure a way under, over, around, or through it. I would call the state PA assoc and see if this is doable, they might not know, but if so....this is the way to go!!!! Awesome brainstorming Contrarian...

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have seen arrangements like that before. some states say pa may not own > 49% and an md must be a partial owner. so a buddy of mine opened a practice. he owns 49%, his wife owns 49% and they have 2 sp's with 1% each. if the sp's leave they are required to sell back their shares.

in another state with similar rules 3 guys opened a practice and own 33% each(so 99% pa ownership but none has >33%) and sp gets 1%(also required to sell back if leaves).

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I dream of a day when everyone (meaning the medical establishment ) is only interested in high quality, affordable, accessible medical care and not about who dropped the biggest turd in the sandbox. I own 99% of my practice and it is silly that I can't own 100%. But the federal payers require that no PA owns 100%. I gave 1% to my SP for appearance sake (could have been my wife). I've been playing these games with so many people for the past six months and it seems that none of them (quality assurance committees, banks, malpractice companies, on and on) gives a rat's *** about quality care, just appearances and filling out the forms correctly. So, PA ownership does not fit into any forms. If you don't fill the boxes out correctly, what should have taken a week ends up taking months. I never could color within the lines very well.

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Both the SP and PA would be employees of a Limited Liability Corporation. This Corporation would have shareholders and a "managing director" which could be anyone... including the PA who holds majority stock, or the PA's significant other (Spouse, Child, Uncle, etc)... or the PA could hold 40%... the PA's significant other (Spouse, Child, Uncle, etc) could hold 20-30% ...

 

Contrarian

 

Excellent. I love a good end run.

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  • 4 months later...
Anyone consider starting a PA owned "Concierge Practice"...???

 

If the PA can secure a minimum of 250 patients paying $100/month ($1,200/yr)... they can gross $300,000/yr.

 

If the practice is primarily housecalls from a home-based office with tablet computers, electronic faxes and a fuel efficient vehicle... and they can keep the "SP" fee to $1000/week ($50k/yr) your "taxable" gross could be ~$190-$200k...

 

 

So, any more research on this. A group of PAs in my area want to look into starting this type of business? Just curious is anyone out there is really doing it besides that chick on Royal Pains?

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I did some research on conceirge medicine a year or two ago. It seems that another barrier (apart from actually owning the practice, which as been covered) is that when customers/patients pay for this service, they tend to want "Doctors" rather than mid-levels. While this may not be a problem if everything is good, it may lead to more malpractice suits if "service" isn't up to the patient's standards (i.e. they don't like what they hear or if their chronic illness is not "cured").

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One thing that has surprised me is how little patients are willing to pay for (at least specialty) practice. Group Health Cooperative has boycotted my practice because it is PA owned. Previously I was following about 600 GH patients. Here is the puzzling part, they 1) deeply appreciated what I've been able to do for them. Many are calling in tears saying that no one else in our region can help them, 2) Some of these people are rich, living in multi-million dollar homes in the San Juan Islands, 3) I've offered them a 20% cash discount, still almost none have opted to pay out of pocket and come to me. They go to whom GH tells them to, then they call me and tell me how horrible their care was, but they do not come . . . at least not yet. So, I'm not sure what the thinking is behind this and there seems to be a psychological barrier as they keep saying, "I'm not allowed to see you."

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