Appalenia Udell, CEO of the Poza Network, will talk about the legal do's and don'ts of starting a Direct Care practice, and provide a strategic framework to manage and optimize your transition.

1. Alternative Practice Model
Bootcamp
12 Things You Didn’t Know You Needed to Know That Will Make All the Difference
Presented by Appalenia Udell, Esq., Founder of Poza, Inc.
Hint Summit 2018

2. Phase 1
•Evaluate
your
professional
philosophy.
•Which
practice
models
match your
professional
philosophy
today?
•Over the
next 5 years?
Phase 2
•Identify your
ideal
patient.
•How value
sensitive is
your ideal
patient?
•What are
your ideal
patient’s
pain points?
Phase 3
•What is your
budget
including
salary?
•What are the
tax
implications?
•What are the
legal
implications?
Phase 4
•Align your
professional
philosophy
with the
pain points
of your
target
market.
•Align your
budget.
•Find your
sweet spot.
the Poza method
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restoring the joy of medicine
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3. Phase 1: Physician, Know Thyself
Identify Your Professional Philosophy
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4. HAPPY
DOC
Hybrid
Pre-Paid
Packages
DP
C
DPC +
Public
Payor
DPC +
Public
Payor
Membership
Concierge
Boutique
FFS
•Par
•Non-Par
•No
assignment
HMO
crafting
your
ideal
practice
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5. concierge decision tree
Are most of
my services
DHS?
No
Are any of
my services
DHS?
No
Concierge OK
Yes
Can I
separate DHS
from NCS?
No
No Concierge
Yes
Concierge
Possible
Yes
Are all of My
services DHS?
Yes
No Concierge
No
Can I
separate DHS
from NCS?
No
No Concierge
Yes
Concierge
Possible
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6. Phase 2: Know Your Market
Identify Your Ideal Patient
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7. target market analysis
How value sensitive is your
ideal patient?
subspecialty
market size
& trends
location
Location: specific zip codes
Market Size:
• total population
• age & gender
• average household size
Market Trends:
• growth over past 10 years
• families, DINKs, retirees
• ratio of property value to
median household income
• asset rich & cash poor?
Subspecialty:
who is your ideal
patient?
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8. patient pain points
Colorado 45 yo single female
AGI: $65k
Max Expense: $17k
HCS ratio: 26%
California family of 4
AGI: $150k
Max Expense: $36k
HCS ratio: 24%
but less elastic due to family dynamic
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$ $
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9. help
me!
employer plan
exchange plan
grandfathered
plan
Medicaid
Medicare
HCSMgo bare
urgent care
E.D.
bankruptcy
???
what is
your ideal
patient’s
alternative?
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10. Phase 3: Know Your Needs
Financial, Tax, & Legal Considerations
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11. budget
Rent: $27k
Operating Expenses: $21k
Staff (no benefits): $15k
Physician Salary: $200k
Total Budget: $263k
Average Pt. Fee: $57
Patient Panel: 385
Ramp-Up: 16 pts/mo
Target Achieved by Month 24
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12. how much should you pay yourself?
FMV budget blend
Budget: based on historic need
over the past 2-5 years +
upcoming needs (teen drivers,
college tuition, aging parents,
etc.)
Fair Market Value:
1) Compensation Survey Data
(includes the value of benefits)
Emergency Medicine $312k
Hospitalist $278k - $285k (Family
Medicine)
Urgent Care $239k - $272k (Family
Medicine)
Internal Medicine $247k
Pediatrics $231k
Family Medicine (no OB) $230k
2) Plan B Income
Blend budget and FMV
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13. start-up planning
 Start-up expenses ~$60,000 including consulting and legal fees.
 How are you going to finance start-up?
 Avoid expensive build-outs.
 Add amenities as your practice proves itself in the market.
 Establish benchmarks
 Success
 Financial
 Happiness
 Reconsideration
 What is Plan B?
 When do you trigger Plan B?
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14. medicine & taxes
 Tax Cuts and Jobs Act of 2017 disproportionately affects physicians and will
remain in effect until 2025.
 Itemized deductions are reduced or eliminated and replaced by a 20%
standardized deduction on pass-through income.
 For physicians, 20% deduction is capped on pass-through income at $315,500
(married filing jointly) and $157,500 (single filer).
 Beginning in 2027 pass-through tax cuts become net increases.
 Corporate tax cuts are permanent, potentially making health systems a more
efficient competitor.
 PLLC is the preferred entity form because no compulsion to pay officers
(make sure to file 2553 with the IRS for S-Corp tax treatment).
 S-Corps, talk to your accountant about limiting officer wages and maximizing
distributions rather than W-2 income.
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15. legal considerations
1. Underestimate the risk of enforcement.
2. Be hyperbolic in your marketing.
3. Link any form of concierge model to
extra time spent with patients or
practice administration.
 Access fee
 Administration fee
 Annual physical
 Same or next day appointments
 Dedicated support personnel
 “Around the clock” physician availability
 Prescription facilitation
 Coordination of care; expedited or coordinated
referrals
 Other amenities at the physician’s discretion
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16. Phase 4: Align
Find Your Sweet Spot
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17. life is short
be happy
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