Yesterday, I was privileged to accept a Small Business Award from SCORE Lancaster/Lebanon. Through SCORE, I have been privileged to work with a mentor, Hugh McMaster, who has guided me through the inception of CovenantMD and its growth along the way. I shared the stage with six outstanding innovators and entrepreneurs, owners of Beck Care Managers, The Candy Factory, The Fence Experts, and VITA of Lancaster County. The following is the text of my acceptance speech. -- Dr. Rohal
Thank you, SCORE, for this great honor. Thank you, Hugh, for guiding me and my business endeavor along the way. And congratulations to my fellow award winners. It’s an honor to share this stage with you.
My story has many similarities to the others you’ve heard and will hear today. I too had staked out some segment of our society to make my mark. In my case, it was as a primary care physician. And I too was dissatisfied with the status quo and yearned to make a better way. There had to be a better way to DO primary care. I found I was working on a treadmill, seeing 20-30 patients a day, and all the while feeling like I was delivering a product that treated patients as commodities. And as for my patients, they suffered from long waits to see me. They only had 10-15 minutes to spend with me. I could never predict how much the lab tests I ordered, or the medications I prescribed, would ultimately cost them. I was continually asking myself what happened to the vision I had of the general practitioner before I entered medical school? When I’m talking about CovenantMD in the community, I often show a picture of Marcus Welby, and say that is my vision for primary care.
I was not the first doctor to implement the Direct Primary Care model. DPC has demonstrated a lot of success in other markets around the country. But when I first heard about it in 2007, when I had just graduated from my family practice residency, I knew this was the wave of the future, and I dreamed of someday opening my own DPC practice. Now fast forward to March of 2015. By then I had experienced eight years working in busy primary care practices. I was tired and disillusioned. But meanwhile, with the passage of Affordable Care Act six years before that, and with skyrocketing health insurance premiums and high deductibles becoming a mainstay, Direct Primary Care had hit its stride. I knew then that it was time to put flesh on the bones of my dream of a DPC practice. But “dreams” only get us so far. I know I needed to actually start a business. And how does a family doctor do that? They didn’t teach me that in medical school. I knew I needed lots of sound business advice. And that’s what I got, and what I continue to get, through SCORE. And the amazing thing is that its free. When I came to my first meeting with my mentor Hugh McMaster, CovenantMD existed only as a rough draft of a business plan. In that first meeting, we revised my business plan and we planned next steps. Through subsequent meetings, Hugh guided me through the ins and outs of hiring employees, and helped me to stay true to the mission of my practice while growing. Apart from these tangible benefits, I always walked away with some intangibles. Like reassurance -- at first that I wasn’t crazy for attempting this endeavor in our local market, and then later, and even now, that I was still on the right track.
At our opening in January 2016, after 4 months of marketing, we had 77 patients, it was just me and my nurse, Hannah, who is here today. Just two weeks ago, we signed up our 1000th patient. We now have two full time doctors and two full time nurses. At the turn of this year, patient sign-ups began coming in too fast, so we had to start a waiting list, and this list is currently out to October. We are working on plans to expand the practice. We have been blessed with success so far, and SCORE has been there every step of the way.
So what exactly is Direct Primary Care and CovenantMD? DPC has one main tenant, and that is that health insurance, though it is needed to help protect us from the high cost of medical uncertainties, nevertheless is a poor way to pay for the less expensive and common things we know for CERTAIN will happen. I think we’re no longer paying for health insurance, but for prepaid healthcare. By the same logic, imagine handing Geico a boatload of your money and asking them to pay for your gas and your oil changes. If you did that, I doubt they would continue saving you 15% or more on car insurance. And you’d have to drive around forever to find your in-network gas station.
Direct Primary Care asks the question, what is possible if our patients pay for their own primary care? At CovenantMD, our patients pay us a monthly fee, from $20/month for kids up to $85/month for seniors. A young family can enjoy comprehensive primary care for about the price of cable. They then reserve their health insurance for the uncertainties. Our patients enjoy unlimited visits without copays, that includes office, home, and worksite visits. We offer them same or next day visits and extended time with the doctor. We are on call for our patients 24/7, including evenings, weekends, and holidays. Procedures are free, including stitches and skin biopsies. We offer discounts on medications that we dispense from an in-house pharmacy. It’s not unusual for patients to leave our office with a supply of a chronic medication that costs them $2/month. And we offer comprehensive annual labwork for $14. These same four tests typically cost $300 in the “system.” How are we able to offer such substantial discounts? Well, amazing things can happen when a doctor is not bound by insurance contracts.
And from the doctor’s side, and from the nurse’s side, Direct Primary Care is a dream come true. We now see only 5 to 10 patients a day, allowing us ample time to make our care patient-centered instead of disease-centered. And we cover a greatly reduced patient panel, which gives us the opportunity to know our patients well. Because there no third parties involved, we no longer have to calculate esoteric codes in order to facilitate that third party paying for the visit.
We’ve certainly seen individual patients and families embrace this model, but we have also seen businesses embrace it. CovenantMD partners with 13 local businesses to provide primary care for their employees. These range from a business of five employees that offers us as their only health benefit, to larger businesses that pair our services with a high deductible health plan. More recently, we’re helping a large employer plan a nearsite Direct Primary Care clinic for its employees and family members.
So we’ve seen happy doctors, happy nurses, happy business owners, and most importantly, happy patients. We’re discovering anew the patient/doctor relationship.
Again, thank you Hugh, and SCORE, for your continued help along the way. If there are any budding entrepreneurs that are here today, if you have a dream or an idea that can improve even a little facet of our society, I would encourage you to pursue that dream, and get good free advice from SCORE along the way. Thank you.