Building Out New Lines Of Business For Your Primary Care Practice

Are you delivering the same services day in and day out? It’s easy to stay stuck in the routine of ‘sick and well’ particularly if your practice is busy and financially healthy. Most of us like routine. We like to know what to expect from our days, and frankly, ‘fixing what isn’t broken’ doesn’t land very high on anyone’s priority list.

I’d like you to reconsider. I’m asking you to take a good look at what is going on in the market around you. We have moved into ‘value based care’ where the emphasis is on creating better outcomes and a producing higher quality at less cost. It’s the era of convenient care, where better patient experiences are the focus and both patients and employers are looking for more; and you, dear doctors, are the ones tasked with providing it.

I’m not suggesting that you let them squeeze you until you have nothing left to give — I am talking about opportunity.  From my perspective, with ‘patient centeredness’ comes real opportunity for you to EXPAND your services. Building out your practice’s services is about offering more to your patients while at the same time strengthening your practice through additional income streams, increased patient loyalty and retention, as well as attracting new patients. 

Don’t just do it for your patients.

If you want your practice to thrive, you have to grow and out-compete the market forces around you. If you think your fellow specialists and hospitals are your competition, you are not seeing the forest for the trees and it’s time to take a closer look at the big picture. Retail based clinics are expanding services; urgent care companies are a growing trend and significant threat to your ‘sick care’ business. Add to that innovative healthcare disruptors springing up all over the country, utilizing everything from virtual visits to telemedicine and mid-level home visits to bring better services to patients.

Adult primary care and pediatric practices are being tasked with becoming medical homes: practices that are able to coordinate care better, manage patient care plans, educate and encourage the patient to ‘self-manage’ their own care, and generally be as available as possible to patients when and how they need them. Easy, right? Of course it isn’t. It takes a lot of work and a significant investment of time, energy, resources and money to transition to that type of model. But once that transition is made, we find that our clients rarely stop there.

Bringing New Services Into The Medical Home

The ‘no brainer’ move is to bring those services that commonly get referred out back inside the practice instead. It’s not as hard or as risky as you may think. First, look to see what services can easily be expanded. Create ‘clinics’ within your practice to meet your patients’ needs. For pediatrics practices, that might simply mean developing areas of medicine that are already being tackled daily, such as asthma, obesity and teen issues. By developing defined programs for these areas, you can better allocate resources and create defined ‘services’ for those patients that need them. Examples of clinics includes:

Asthma clinics: (pediatrics and internal medicine)

Develop existing staff by training them to become Certified Asthma Educators that can assist with:

• Treatment, education and management of asthma including medication monitoring and compliance.
• Asthma control and action planning.
• Spirometry and nebulizer treatments.
• Patient centered goals and objectives related to control of the disease.

Nutrition clinics: (pediatrics and internal medicine)

You don’t have to hire a nutritionist in order to bring these services in-house. Provide on-site nutritional health evaluation by an independently contracted counselor instead. They can assist with:

• Treatment and counseling services for individuals, families and groups.
• Tie in with community based weigh-ins and ‘weight watcher’ program at the local YMCA.
• Scheduling alongside follow up visits for patient convenience.

Adolescent clinics: (pediatrics)

You can do so much more to address your teenage populations by creating a more ‘teenage-friendly’ environment for them. Here are just a few ways in which you can make your teenaged patients feel more comfortable:

• Set aside specific hours for teens (certain days & hours)
• Change up exam rooms to create décor geared towards teens (not ‘kiddie’)
• During special teen hours, show teen-specific programming on the TV in the waiting room and put out teen magazines and toys (puzzles and games, not necessarily screens) that appeal to their demographic.
• Develop a program around teen screens and additional services.

Once you’ve established programs that are a natural extension of your practice, and can see the profitability and benefit of providing them, you might consider building out entirely new areas of your practice. New business lines may include:

Lactation/Breastfeeding Center (pediatrics)

The Center can reside within your pediatric practice or in a separate location altogether. Some practices designate exam rooms as special nursing rooms, fitting them with a baby scales, changing tables, rocking chairs and recliners and even soft lighting and relaxing music or nature sounds. Breastfeeding consults are scheduled in conjunction with the newborn visit for patient convenience. You can utilize a trained employee or contract with an independent agent to provide these special services. It’s a great practice builder and new Moms love the newborn/nursing rooms!

Behavioral Health Center (adult medicine and pediatrics)

Use the space you already have or if you have none to spare, consider expanding to a site close by for patient convenience. If your practice population supports it, you can staff it with an employed behavioral health psychiatrist or social. If you don’t have someone in-house, you can contract independently or lease some of your space to a therapist or social worker that is looking to build their practice. This allows you to operate under defined hours with your practice staff managing the schedule and setting up appointments. Your patients will appreciate the convenience, more immediate access, improved coordination and follow-up as well as the reassurance of familiarity that comes with in-practice services and programs. You don’t need to launch a full behavioral health program — even starting with an ADHD program and a qualified/trained nurse is enough to get things started.

Urgent Care/After Hours (pediatrics and internal medicine)

This business is typically located in a separate space, adjacent to or co-located with your practice, with a dedicated entrance in order to differentiate it from your practice (often a requirement under Payer contracts). Existing providers and staff operate the After Hours & Urgent Care Clinic — when you close your regular practice at 5pm, you simply shift the team and all after hours care over to the clinic. For some small practices, having your after hours practice available to them can help reduce

call burden and for you to be their preferred referral choice when they are closed (make sure to provide excellent follow up and pass back their patients and you should be able to enjoy on-going business from them). Not only will you be making better use of your space (you are paying for it 24/7 after all!) but you’ll also be competing directly with retail-based clinics allowing you to retain your patients in your practice as well as attracting new ones. Many Payers offer separate contracts for Urgent Care and often pay a set amount for an urgent care code. Note: higher copays for patients are likely!

Patients prefer that you, their trusted & familiar practice, provide these services and better access to them. Why would they go elsewhere when they can get what the extended care and programs they need all in one place? Don’t just take my word for it: ask your patients what they want and need! You have a captive audience of hundreds of patients coming through your practice doors – ask for their feedback by inviting them to share their opinion in a short survey! Keep it short and simple and poll them often. Surveys of no more than 3 questions have proven to be very successful.  Your patients will be happy that you asked and you won’t be sorry for asking, either.

Happy building!