DPC using Lifestyle medicine

(Yashoda Bhaskar) #1

Hello everyone,
I am debating starting a DPC/micropractice mainly doing Lifestyle medicine consultant work. I am an Internist who practised as a hospitalist for 16 years. Is this a viable model? Anyone doing something similar? TIA for any words of advice!

(Jason Larsen) #2

I’m answering as a non-physician (business / CEO of our practice), so take this with a grain of salt…

I think there could be a market for you, depending on our location. However, where the real money is saved in the healthcare system is on same-day and acute care visits. That’s at least where people end up realizing the value of membership - getting access to someone without extra charges (or much extra) compared to other places (urgent care centers, emergency room, etc.). Yes, you can argue that people should take care of themselves through preventive measures, but we can’t always avoid injury or sickness.

The lifestyle medicine could come as a benefit and added value to what you’re doing (and could even be the driving force of your practice), but rescuing someone from a $5,000 emergency room visit because you’re available for stitching up their chin is pretty valuable.

If you’re worried about being on call (which you shouldn’t be, as the call schedules for DPC aren’t bad at all), you could always make acute / urgent care medicine a different pricing tier.

I hope that helps! Best of luck to you!


(Brianna Wilson) #3

Is this similar to functional medicine??


(Yashoda Bhaskar) #4

No, it’s actually not functional or integrative medicine. The American College of Lifestyle medicine is now offering board certification. This is very much evidence based, the premise being the robust science behind recommending a whole food, plant based diet to prevent and in some cases, even reverse, chronic medical conditions such as DM, HTN, CAD and inflammatory conditions such as MS, IBS, RA etc. There is a ton of research and science behind this, but for reasons that I do not understand, somehow has not made it into mainstream medicine. They also incorporate other issues such as stress reduction, sleep hygiene and exercise in the whole care of the patient. ( I know, getting back to the basics?? What a concept!!!). As you can see, this would be time intensive and therefore not very well compensated in our current model. But that is why I would think it would be a perfect set up for a direct care type of practice.
The pioneers of this movement include Dr. Dean Ornish, Dr. Esselstyn, Dr. Colin Campbell ( who is not an MD but a nutritional biochemist) etc.

(Yashoda Bhaskar) #5

Thanks Jason. Those are some good thoughts around this as I go forward.

(Karen Betten) #6

James Maskell with Functional Forum has been promoting this concept for Functional Medicine providers who offer consultations. Because so much time is spent with the patient on intake and implementation, it’s recommended that patients purchase a set amount of time, such as 6 months for a certain cost with the option to add on more months if needed. Like with DPC, this frees up the provider to take care of the patient, while it commits the patient to invest the time and effort to make lifestyle changes and hopefully see results.

(Cory Carroll) #7

I agree with your overreaching idea of teaching people the true cause of disease. In my case, DPC created a sustainable financial model since I was losing money with fee for service (FFS) insurance game when my patients’ health improved. I teach all my patients that moving to a whole foods plant based diet (WFPBD) will improve their health and “cure” some of their chronic diseases. Having 50 type 2 diabetics will, combined with an in house A1c machine, generate $2.5 to $3K of monthly income with FFS. Help them understand the WFPBD and encourage that behavior change will cost you money since you can’t justify frequent visits and A1cs when their type 2 dm resolves. DPC fixes that and I remind my patients that my motive for not only my profession as a physician but my livelihood is now aligned with their being healthy.

Whether you can make a living at it depends on signing up patients. When I moved to DPC (about three years after supporting the WFPBD lifestyle) I had roughly 20% of my insurance panel sign up. I did a hybrid model and kept the medicare and medicaid on FFS. The initial move to DPC was in January of 2016 and the hybrid was barely keeping me financially afloat. In Oct 2016 I dropped medicare and medicaid and was pleasantly surprised when 50% of my medicare patients joined (unfortunately, CO requires docs caring for medicaid to accept the state’s FFS so it would be illegal to sign up those patients). I have just under 350 patients and am very happy.

Since you don’t have any existing patients (assuming that since you were a hospitalist) you will need to market yourself to your community. Of the new patients I’ve signed up many found me from Lifestyle/Vegetarian/Vegan websites - https://www.plantbaseddoctors.org/, https://www.plantbaseddoctors.org/ and local vegan groups. If you are a member of American College of Lifestyle Medicine they have a “find a doctor” link. Those sites will bring in some patients but you will need to reach out to the community with your unique practice goals and share how the DPC model can provide significant benefit if they want to get and stay healthy.

The second issue that will make you successful is having a low overhead. There are DPC docs who have no staff and you may need to do that if you are starting from scratch. As your practice builds you can increase overhead. One way I’m reducing overhead at this stage of my career is to move my office to my home (I’ve been practicing family medicine for 26 years.) Much of what I do doesn’t require face to face visits and I’ll be able to continue to examine and do minor procedures in my home office at a fraction of the cost.

Good luck and you can always give me a call if you want (970-221-5858).

(pouya bahrami) #8

I learned a lot just reading all the answers. Thanks to everyone.

I would think having a flat rate of $400 for complete evaluation and consultation would be more appropriate for this type of practice. This would be similar to Functional Medicine. Additionally, you could connect to other traditional practices to get a small portion of their patients to consult.

I think the 6 months membership idea that someone mentioned was also great.

(Leigh Siergiewicz) #9

This is much more like naturopathic medicine than functional medicine. I think a membership plan makes more sense than the above mentioned $400 for evaluation, because if you’ve ever done this kind of thing before, (I’m a naturopathic physician), you know people need hand holding and trouble shooting. Telling them to change their diet and sending them out the door with a list of instructions for dramatic changes needs frequent follow up.

(Yashoda Bhaskar) #10

All great ideas!! I was leaning towards the same thing. Creating a package
program for about 6 months with option of a lower priced ongoing program
for maintenance for those who may feel they need it.