By Tobi Elkin
A physician’s most precious asset is their relationship with their patients. What matters is not who you know but how you are known to them. This is especially true in private practice when you are not only running a business but also a practice at the same time. Dr. Pamila Brar is president of The American Academy of Private Physicians (AAPP), a trade organization for medical doctors who are in private practice. The organization serves as an advocacy and educational resource on behalf of its 400 members who are seeking to grow their practices, transition existing practices to new models, gain a better understanding of regulatory and legal matters, and improve their use of public relations and marketing.
Dr. Brar is an internist who has worked in large group practices, concierge medicine, and private practice. Since July 2015, she has served as medical director for Human Longevity’s Health Nucleus, a technology and data startup specializing in precision medicine and genome sequencing. She aims to use her experience in all forms of medicine to collaboratively grow a disruptive precision medicine delivery model. Dr. Brar discusses the issues facing doctors in private practice.
Tobi Elkin: How would you describe the AAPP’s mission and your role in the organization?
Dr. Pamila Brar: Our mission is to promote the direct relationship between doctors and patients and the ability to create a relationship that’s independent of insurance regulations or reimbursement-related issues.
My role, first and foremost, is to empower doctors and to offer business education. We also advocate at the state and national levels for alternative reimbursement strategies. Over the last few years, there have been attempts at the federal level to improve reimbursement conditions — for example, getting reimbursement codes for patients with chronic conditions who doctors see regularly.
We believe that if you look at the data, patient outcomes are better in private medicine.
We believe that if you look at the data, patient outcomes are better in private medicine. We advocate for this type of model and strategies to build it into Medicare reimbursement. In addition, we show the ways to both collect a fee for memberships in concierge practices and to bill costs to insurance.
My hope is that by example, I can show how our members can transition from a traditional model to a solo practice in concierge-style private medicine or another model. AAPP helps members with everything from contracts, compliance issues, and how to purchase vaccines on their own, to managing performance reviews, marketing to prospective patients, and patient retention strategies. We have conferences, and we’re looking for different ways to engage with our membership through webinars and other forms of online education.
I see myself as a connector and hope to pass along strategies from what I learned from being in private medicine. For example, what is the pay relationship? Is there an annual retainer? I quickly learned that billing people monthly is a much steadier way of managing cash flow and resources.
Tobi Elkin: What are the key issues for physicians in private medicine?
There are so many, but the big one, frankly, is how do you make a living when you’re being asked to see more patients and spend less time with them.
Dr. Pamila Brar: There are so many, but the big one, frankly, is how do you make a living when you’re being asked to see more patients and spend less time with them. The concept of pay for performance in large healthcare systems and how physicians are being graded are big issues, along with reimbursements.
The rules and standards keep changing. How do you get used to all the new requirements with respect to meaningful use? AAPP members may be disillusioned as they spend less time with patients and have more responsibilities around EMRs [electronic medical records] and documentation. There’s a feeling of being a rat on a wheel and that they didn’t sign up for this.
Tobi Elkin: During a time of uncertainty and change in healthcare, how does the AAPP advocate for physicians?
There are different scenarios, but no matter the model our members are working in, no one is reimbursed well.
Dr. Pamila Brar: There are different scenarios, but no matter the model our members are working in, no one is reimbursed well. You have people considering going into a concierge model, then others who are in it and looking to improve their marketing, management of employees, and use of social media to grow their practice.
We’re also starting to see concierge medicine expand from primary care to specialties like pediatrics and cardiology, so we try to improve education to support this expansion. Concierge medicine has different types of business models, and one of my goals as president is to be more inclusive about the different models. Concierge medicine isn’t only for the wealthy. There are direct primary care vs. higher-end models and others on a wide spectrum. We try to educate physicians about the options and help them decide where they want to be on the spectrum.
Tobi Elkin: What’s the difference between concierge medicine and private medicine?
Dr. Pamila Brar: Concierge medicine is a practice where someone is charging a membership fee, which is above and beyond insurance. It offers 24-hour access, longer visits, same-day visits, coordinated hands-on care.
Private medicine and concierge medicine are, in some ways, interchangeable. But private medicine encompasses the entire spectrum of business models and includes direct primary care and concierge medicine.
Tobi Elkin: What do you envision for the future?
we need a team-based approach for equitable reimbursement — the reimbursements don’t necessarily align with the work. Everyone’s frustrated — the patients and the clinicians.
Dr. Pamila Brar: I’m a big believer in a team-based approach. We need to tap physician assistants and nurse practitioners to work with physicians and nurses to provide the patient with a team that supports them. And we need a team-based approach for equitable reimbursement — the reimbursements don’t necessarily align with the work. Everyone’s frustrated — the patients and the clinicians.
Tobi Elkin is a veteran content creator and consultant who enjoys crafting compelling narratives for diverse audiences. Based in New York City, her writing has appeared in newspapers, magazines, and on websites including Advertising Age, AOL, the Associated Press, CMO.com, Narratively, Robb Report, The Huffington Post, and many others. She has consulted on thought leadership, marketing, and content strategy for technology firms, consumer brands, and non-profit organizations.