Ideal Micro Practice

I’m spending time with two different family doctors in town who recently graduated from my training program. They both run what is called the “Ideal Micro Practice”. This style of medical care is quickly gaining national attention and is becoming something of a national movement.

The basic idea is to return family medicine – any primary care specialty could do this, though – to the days where most of the visit is comprised of doctors working with their patients. The way to achieve this is to cut out ALL middle-men. And I mean everybody. As you might imagine, there are LOTS of people who make enormous amounts of money on doctors. The doc I was with today said that he’s pretty sure M.D. stands for people on whom you can “Make Dough.”

So, here’s how his practice works: He sees patients for anywhere from 30 minutes to an hour. There is no receptionist, no nurse, no medical assistant, no biller. The office is the same room as his single exam room. The computer is connected to a second monitor that faces the patient while s/he sits in a comfortable easy chair and talks about the medical issues they’re working on. Any labs, imaging or handouts are visible on the screen right in front of the patient, and all of them can be printed out or emailed at the patient’s request. The doc is available by email virtually all the time and has data-enabled cell phones that allow them to upload patient information when they are not in the office. Patients make their own appointments on-line. The cost is roughly the same as any doctor.

If the patient goes to the hospital, a staff hospitalist will do the admission and in-hospital care; the micro-practice doc will come see them socially. Both docs will have no more than about 400 patients on their panel, and they know each patient or family personally.

One of the doctors has limited his practice to ONLY the best insurance companies, which according to him is 4 of them. The rest suck. They don’t pay on time, they often don’t pay at all, and generally have no incentive to be honest with how they work with doctors. The flip-side is that he doesn’t have a full patient panel yet, but has no urge to allow anything but exactly the preferred companies because he works part-time for another practice that more than pays his bills. So, he is building his practice slowly and keeping total control over how things progress.  The other doc is subsisting only on his private practice and has thus taken on crappier insurance payers.  He recently acquiesced and hired a biller to deal with the paperwork and administrative overhead those insurance agencies generate.

Both doctors believe deeply in the IMP model.  They’re evangelists for the cause and they believe this will be the wave of the future.  Certainly I can see that they are both making money, although probably not as much as they would if they were pounding through 20-40 patients a day in a high-overhead typical practice.  In general, their revenues are miniscule to the typical family practice, but they keep so much of what they bring in that the differential is negligible.

Everybody’s trying to either fix American medicine, or they’re running scared as fast as they can to other fields.  I applaud these docs for trying to come up with a new world order.  I think the biggest drawback to practicing medicine in America today is the lack of freedom, largely due to influences outside the sacred doctor-patient relationship.  If I have to be kept from spending time with my beautiful children and wife, I would like it to be because I am working with a patient.  Most other reasons – generally some version of paperwork – just aren’t worth it.  IMP’s provide hope that medicine can return to it’s roots – to the days when doctors helped their patients, and nothing more.

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6 responses to “Ideal Micro Practice

  1. As someone who’s been on staff at really big practices (RBG’s) for 12+ years, I can’t get over my fascination of the IMP. Are there physicians that already have full-time IMP’s, that aren’t ‘working for the man’ to supplement their income?

    How long has the doc been working with the companies he considers the best? Are they all national or are they local companies? My experience (with national insurance companies) has been that they all take turns being the ‘bad guy’ and the ‘good guy’. They’ll have a terrible claims and reimbursement module, and garbage for customer service for a few years until enough subscribers leave them- then they clean up their act for several years- until it’s time to cut costs again, etc.

    I wonder if they’re interested in eventually cutting off their dependence on insurance at all? An IMP’s overhead has got to be 20-30% of a typical practice. Why not go completely self-pay and charge 50-60% of what another doctor would? Patients with large deductible plans or flex spending plans would go for it, because they’ll be paying less. And the future of the copay is only up, as well.

    A practice like they’re trying to achieve takes a special kind of physician; I can’t say that I know a lot of MD’s that have an interest in negotiating their own contracts, or personally discharging a difficult patient. I totally applaud these physicians for paving practices in a new direction, one where simplicity and patient care is king.

  2. I also run an IMP, only with my husband, in rural Iowa. We have 2 employees besides the two of us. To break even with overhead, we each need to see 38 patients a week. We both average between 15-20 a day. House calls, nursing homes, hospital work and I still do OB. We won’t get rich with this model, but our stress level plummeted and we are much happier. For more info and our list-serve see http://www.idealmedicalhome.org . It’s not for everyone, but the grass does seem greener over here ;-). Private practice since 1990, IMP since 2006.

  3. This is basically the traditional economic model of private psychiatric practice–minimize expenses and complexity in order to maximize time with patients. Once docs start taking on various insurance contracts and increasing complexity, then they have to increase expense, then further increase revenue, etc until they soon simply can’t afford to spend enough time with patients for any kind of psychotherapy.

    So we have to decide what kind of practice we want and stick to it. One makes more money, the other is more satisfying. I have done both and prefer the satisfaction.

    There is no reason for cash fees to be 50-60% of normal. The medical service is worth what it is worth and the higher level of privacy and customer service is worth even more. One thing that has got primary care docs in the ditch that they are in is undervaluing their services or letting third parties set a value on it. Only the doctor knows what he put into it, and only the patient knows what he gets out of it. Medical care was worth a robust professional fee to patients thousands of years before insurance companies were invented–and still is.

  4. Hello,

    I’m a journalist in Glenview, Ill., putting together a story on the old time family physician who used to make house calls in the ’50s and ’60s and the primary care physician today. How different are their worlds? Are there any docs using Ideal MIcro Practice in the Chicago suburbs?

    • There’s a nationwide collective of IMP’s. Heck, they’re probably scattered across the entire universe. I’m sure there are some in the Chicago suburbs.

      I’ll ask my friend who practices in one about how to tap into the IMP underground and let you know what I turn up.
      -SW101

  5. While there is no IMP underground, it is true that IMPs have been under the radar for most people. But we are trying to change that.

    I maintain an online directory of about 150 such Ideal Medical Practices around the US at this web site: http://www.impmap.com. Lynette above is on the IMP map. The two doctors visited by SW101 are probably on the map, too. I am sure any one of the doctors and healthcare providers on this list would be glad to talk to anyone about their practices.

    For other news articles about IMPs, you can go here:

    http://idealhealth.wikispaces.com/news+articles

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