Profitability: A concept few want to talk about and just about all of us are concerned about.
Whether you are just starting out in practice or have reached a point of fatigue and burnout, “how” as well as “how much” you are compensated for your considerable efforts helping patients is extremely important. Regardless of our motivations for entering the medical profession, all of us have some expectation for personal income we can or should attain . For many of us, the actual income achieved has fallen short of expectations. According to an Institute for Functional Medicine survey, the average personal income of a functional medicine practitioner is roughly $130,000 per year. This would qualify as the lowest income among all medical specialties.
To help combat this income gap, here are four ways to implement an economic model in your practice:
Core of tests vs. individual testing: 2019 will mark my 20th year in functional medicine, and the cases never get easier. In the last three years, my patients and I have benefitted greatly from running a comprehensive core of four or more lab tests at the outset, rather than individual tests one after another. We’ve seen better clinical outcomes in a shorter period of time, and everyone likes that! The unintended effect was the weeding out of those patients who could not or would not invest in themselves sufficiently to give me the diagnostic data I needed to help them. The resulting patients are among the most committed I have ever worked with, and our clinic’s effectiveness–and profitability–has never been higher. Incidentally, my mentor, the late Dr. William Timmins, once told me that lab testing drives profits. Whether you can mark up the cost of the lab test to your patients or not is less important than the follow-up office appointments and supplement sales generated. In fact, our monthly revenues as a clinic are often comparable to the amount of dollars generated with our lab orders.
Personalized care plans: We provide each new patient interested in health transformation a written, personalized plan of care before we accept them as a patient. This “Estimate of Care” specifies the functional tests we intend to run, an estimate of the number of office visits, supplement costs, time spent with our nutritionist and other possible services it will take to reach the patient’s health goals. It is merely an estimate and not a binding contract. In my experience, it is better to ask a patient to make one large financial decision rather than a series of smaller ones. When patients agree to this estimate, they rarely, if ever, stop their care plan due to a lack of financial resources. The average plan costs the patient between $6,000 and $8,000 for the 10 to 12 months they work with us. Our average profit is between $4,000 and $4,500. In order to secure payment for the plans, we take an initial down payment for a bit more than the total cost of lab testing and then divide the remainder by 12 months. This monthly amount covers only those costs that are not billable to insurance (supplements, nutrition therapist and “Functional Medicine Fees”).
Functional Medicine Fees (not concierge fees): These are fees we charge for all extra time spent by me and my staff outside the exam room on behalf of the patient. These fees pay for our investment of time answering a patient’s email questions, reviewing complex test results and writing comprehensive care plans before the patient’s next appointment and even time spent in learning new concepts in formalized training (IFM modules) or informally (PubMed searches). There is a flat fee that is applied based on the case complexity of each patient. It is understood that the fee will be charged to the patient with no billing to insurance, as there is no billable code for this fee. It never made sense to me that we in functional medicine would do more for the patient and achieve better results, yet receive the standard reimbursement. So, we accept the discounted rate insurance pays for the time in the exam room, and we ask the patient to pay for what insurance does not.
Group Visits: Otherwise known as shared medical appointments, we hold evening classes to discuss hormones and stress, eating and intestinal health, detoxification, and other topics. Class sizes vary from four to 12 and we bill each patient’s insurance for a 15-minute office visit for this 90-minute class. This has increased our clinic’s patient volume, our revenue, and opened valuable time slots on our daily schedule. It is not only the most profitable time of my week, but also the most fun!
Finally, regardless of strategies implemented in the clinic, I came to the realization that I had confused my compassion for patients with a “poverty complex” I carried. For years, I did not see my worth as a clinician and felt guilty charging higher fees/prices for my services. Only in the last few years have I really focused on the life transformations that we as clinicians achieve and contrasted them with other options out there that cost more and deliver less. If you want to receive more income for the excellent work you do, raise your prices—you have tremendous value as a healer.
