MedLion: Help to Set Up a Cash-Based Medical Practice

Previously, I wrote about doctors starting their own cash-only medical practice that offers inexpensive and affordable primary care to the general public (see AtlasMD and Access Healthcare). But what if you are not business savvy? What if you do not want to deal with the headache of setting everything up from scratch? You may not want to deal with the law, to set up a payment collection system, nor to do any marketing. Some people just want to be a doctor in their own cash-based medical practice. Nothing more and nothing less.

If that is the case, you may want to take a deeper look at MedLion.

What is MedLion?

The easiest way to describe MedLion is that it is like a medical McDonald’s. McDonald’s will help set up a restaurant. It will give the franchisee (the person who wants to set up a McDonald’s restaurant) the menu, the supplies, the decorations, and almost anything else that makes it McDonald’s. That is why McDonald’s restaurants are largely the same no matter where you go. In return, it charges an annual fee and possibly a percent of the revenue or profits.

In the same way, MedLion will help you set up a cash-based medical practice in return for a yearly fee. MedLion refers to this type of practices as Direct Primary Care (DPC) practices.

But unlike McDonald’s, MedLion is not a franchise but instead offers you a license.

As a franchisee, you are under a great deal of control by the main company. It will control how you manage the entire operation, A to Z. There is very little independence and everything has to be cleared by the franchisor (the person offering the franchise).

As a licensee, which you would be under MedLion, you will receive a license to use the main company’s services, image, and more. There is more independence. Basically, you can get everything that makes a MedLion practice successful without the loss of control of your practice.

According to its website, this is what you get by joining:

MedLion’s experienced team thoroughly analyzes your practice for possible conversion to a DPC model. With the strongest legal team in the industry, MedLion performs a detailed study of your geographic area to ensure compliance with relevant laws pertaining to DPC practices. Once on board, MedLion handles all membership, billing, and collections for your DPC practice. MedLion’s proprietary EMR also allows patients to schedule their own appointments and decrease overutilization of services. Our PR firm and internal marketing department continuously drives patients to your MedLion practice to ensure success. In the near future, our nurses will actually take business hours and overnight call for you, triaging and advising your patients as necessary.

As you can see, it does make it easier for you to have your own DPC practice.

MedLion’s Beginnings

Dr. M. Samir Qamar, M.D. and his wife, Dr. Hisana Qamar, M.D. started their MedLion practice in in Monterey, California in June 2009. At the time, it was not known as MedLion but went by a different name, Access Primary Care.

Their goal for MedLion was to provide affordable healthcare for the general public. “As physicians we have a responsibility to the uninsured and underinsured,” remarks Dr. Hisana Qamar. “If affordable primary care through a quality private practice can be offered as a choice to the community, it is a noble thing.”

Within seven months of starting, they were able to make a profit. By having the patients pay them directly instead of having insurance companies make the payments, the doctors were able to reduce overhead by around 35 percent and increase profits.

Before starting MedLion (or at the time known as Access Primary Care), Dr. M. Samir Qamar operated a traditional concierge medicine practice, catering to the wealthy. Based on the concierge model but by eliminating house calls and other luxury services, he was able to lower the cost of service and offer primary care even those who are not wealthy. And by increasing the number of patients, he was able to make a decent profit.

Within two years since starting the first MedLion practice, Dr. Samir and Hisana Qamar opened a second practice.

As of June 2012, there are five MedLion practices listed on its website.

How Does MedLion Work for the Patients?

MedLion offers primary care, prescriptions, labs, and imaging for a very affordable cost.

To get treated, a patient must first become a member. The price of a membership varies depending on the age of the patient:

  • adults, 22 years to 64 years: $59 / month
  • senior adults, 65 years or older: $39 / month
  • children, 21 years or younger: $19 / month

Upon each visit, the patient will then pay a $10 fee. So as long as a patient is a MedLion member, each visit to the doctor is $10. A patient can expect to receive up to 30 minutes with the doctor for each visit. The wait time for an appointment is only 15 minutes.

It is advised to schedule an appointment if you want to visit the doctor, but a few slots are left open each day for emergency visits.

Because it only provides primary care, patients are advised to get catastrophic insurance in case hospitalization or specialized care is needed.

MedLion in the News

Dr. M. Samir Qamar Talks About MedLion

Interview with Dr. M. Samir Qamar

1. Please tell us about yourself. How and why did you choose family medicine?

I am the son of an United Nations diplomat, so I grew up all over the world. Home was always in the US or in Italy, and I had a chance to experience medical care on a global level. I chose Family Medicine, like my wife, to serve as a primary physician for patients. I enjoy learning about many different subjects, and family medicine allowed me to cover more than one medical area.

2. How is MedLion different from its competitors, such as MDVIP and Qliance? Basically, why sign up with MedLion over someone else?

This is a loaded question. MedLion serves three different markets: 1) consumers and patients, 2) employers, and 3) primary care physicians. For patients, we provide affordable primary care services at costs far below insurance and even government standards. For employers, we help lower health care costs by combining our primary care rates with catastrophic insurance plans – we also keep employers happy by providing telemedicine and wellness services. For primary care physicians, we return the joy of private practice to our doctors who see fewer patients, generate higher incomes, and enjoy caring for an underprivileged population.

MDVIP is a model that caters to the well-heeled, and most patients who join have higher incomes than our patients. The MDVIP model is a concierge medicine model, a model that has been debated for its ethical grounds since its inception. MedLion, a direct primary care (DPC) model, is different from MDVIP in that our fees are around a third (or less) of MDVIP fees, and thus targets a different patient demographic. We are similar to MDVIP in the way we license our MedLion model to existing physicians who wish to continue to practice independently.

Qliance, like us, is a DPC model. Unlike us, Qliance prefers to hire salaried physicians. MedLion is different because it gives independent physicians autonomy within their own practice, and gives most of the MedLion-generated revenues back to the physician. This creates immense earnings for MedLion physicians (over 500K in a full practice). Another major difference is that Qliance relies solely on Direct Primary Care / cash income. At MedLion, we believe that a hybrid practice is key, particularly in the beginning, to minimize risk. MedLion physicians can see PPO, HMO, and Tricare patients, in addition to MedLion patients. As the MedLion patient population grows, the participating doctor can choose to let go of troublesome insurance contracts or elect to transfer those patients to another physician or mid-level in the same practice.

3. In your website, you mentioned that MedLion handles the billing and collecting for the doctor’s practice. How does the doctor get paid? Is the doctor an employee of MedLion? If not, how soon is the money collected by MedLion passed onto the doctor?

For doctors joining MedLion, MedLion provides billing, collecting, legal counsel and clearance, business advice, customer support, membership support, marketing, advertising, and public relation services. In practices joining MedLion, doctors receive roughly 70% of all MedLion fees, and keep 100% of their insurance-based reimbursements. Currently, MedLion is launching a promotion where doctors receive 81% of all MedLion fees. Doctors are paid twice a month. Although MedLion does not currently have employed doctors, this is expected to occur in the future in addition to our current structure.

4. How much does joining MedLion cost? Is it a flat fee per year? Is it based on a percentage of revenue?

There is no cost to joining MedLion. See above for details on how MedLion doctors are reimbursed.

5. How much does a MedLion doctor make per year?

Adult memberships are $59/month; adults make up the majority of our patients. At our limit of 1,500 adults per doctor, at 81% reimbursement, our doctors can gross over $800K for a full practice. This does not include any insured patients, which could be another source of income for our doctors.

Alex’s note: According to KevinMD.com, under the MedLion’s model, physicians take home pay is at parity with specialists which is often double an average primary care practitioner. It seems that a MedLion doctor take home roughly $300,000 per year, which is not too bad.

6. If a doctor opens up a MedLion practice, what help, if any, does MedLion offer in negotiating with external services providers (specialized work, labs, imaging, etc.) for reduced fees? How does MedLion help its doctors find good catastrophic insurance plans to recommend to patients?

MedLion offers constant support for all reduced-fee services in the immediate area of each clinic. Agreements are already in place with national labs with nationwide locations. MedLion also has agreements with insurance agents who help patients find good catastrophe plans.

7. Once a practice has been fully converted to the direct primary care model, what incentives are there for a practice to remain with MedLion?

The amount of work behind the scenes is tremendous. Constantly-changing legal hurdles, billing and collections, patient turnover, and customer service can lead the physician astray from the practice of medicine. Furthermore, because the majority of revenues are returned to the doctor, it makes little sense for the doctor to take on immense responsibilities for a small amount. Staying with MedLion gives existing and new patients the satisfaction of knowing they are taken care of by a nationally-recognized company, and the doctor benefits from staying on board. In summary, patients join MedLion, not the doctor.

8. At full capacity, how many patients would a MedLion doctor see a day? How many patients does a MedLion practice have?

At full capacity, a doctor can see as many as 12-15 patients a day (regular business hours, 9-5PM). Because telemedicine is heavily utilized, patients come in less if simple ailments can be taken care of by phone or email, which is often. MedLion limits adult memberships to 1,500 per provider, which is significantly lower than the national average of roughly 3,000 patients per primary care provider under a traditional medical practice.

9. Are the patient fees fixed? For example, could the price per visit be $15 or $5 instead of $10? Could the membership fee be $69 instead of $59 per month?

The MedLion business model is consistent in all our locations. Patients always know what the fees are in advance. Furthermore, MedLion patients can “visit” other MedLion clinics and only have to pay their $10 visit fee. The fees cannot be changed or customized to a physician’s practice.

10. According to Forbes, MedLion recently opened a practice catering to farm workers. Is that true? Were the farm workers receptive of this service? Is this practice profitable yet?

MedLion has launched two locations, Watsonville, CA, and Salinas, CA to cater to the local agricultural communities in those areas. The doctor at those locations speaks fluent Spanish, as many migrant farm works lack access to quality care. Farm workers are still surprised that fees charged are lower than what they pay at local community clinics, and we are slowly gaining acceptance. These practices were just opened, are growing at a fast rate, but are not yet profitable.

11. What percentage of patients decides to remain with your MedLion practice each year?

Remember we are not even two years old – in the first year we had a 90% retention rate. Those who left where uninsured patients who managed to find insurance through new employment or via Medicare.

12. Is there anything you would have done differently?

No.

13. In 10 years, what will MedLion look like?

In 10 years, MedLion hopes to have hundreds of MedLion-participating doctors across the country, practicing independently, generating tremendous revenue for themselves, and incentivizing new graduates to strongly consider primary care as a career. As insurance rates climb, more and more employers are expected to contract directly with DPC companies like MedLion for primary care, and market needs will increase. In addition to helping uninsured/underinsured patients and cost-conscious employers, MedLion is also hoping to resuscitate primary care.

14. Is there anything you want us to know about MedLion that was not previously mentioned?

MedLion is helping new internal medicine, family medicine, and psychiatry graduates start their own practices. Incentives are strong, including loan repayment and choice of location. A major paradigm shift is about to occur, and this is a great time to be in primary care.

Concluding Thoughts on MedLion

If you are interested in the cash-based / direct primary care practice model, but do not wish to set up everything yourself, MedLion is a very viable option. It offers you a lot of resources to get your DPC practice up and running.

This enables you to provide primary medical care to a wide range of people, while at the same time, allows you to make an outstanding salary as a primary care doctor.

If you want to know more, you may visit its website at www.medlion.com.

Sources

1. MedLion

2. Access Primary Care Develops Low-Cost Primary Care Model [January 2010]

3. MedLion Clinic Opens in Mountain View – Silicon Valley / San Jose Business Journal [May 2011]

4. ‘Direct Primary Care’ Practice Cuts Costs – Mountain View Voice [May 2011]

5. MedLion Provides Affordable Medical Services to Uninsured Patients – The Paly Voice [June 2011]

6. Overcoming Barriers to Building a Direct Primary Care Practice – KevinMD.com [September 2011]

Attention! Do you want to make more money as a doctor? Do you want more freedom? Are you sick of all the useless, time-wasting paperwork? Do you wanna learn how to set up and run a profitable practice that only takes cash, from someone who has “been there and done that?” If yes, check out My Cash-Based Practice: Essential Knowledge for Creating a Successful Private-Pay Physical Therapy Practice — the best book I have found on starting and running a cash practice.

At the very least, check out the book review.

This article is part of the Money in Medicine series. Click on the link if you want all the money-making secrets available to doctors.

Comments

  1. W.R. Montiel, md says:

    Would this model work for a solo interventional/medical pain management office based practice? Not in an area where concierge medicine has caught on, but the need to ease suffering is ever present. Very interested in reinventing affordable pain care outside of insurance influence.

    • Hi Dr. Montiel,

      I believe the cash model, especially one that makes it affordable for most patients, would work for a pain management office. Pain is something that needs immediate attention. People were paying good money (without using insurance) for medical marijuana. Another doctor I heard of treat drug addicts at $250 per session — cash.

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