Appalenia Udell: Alternative Practice Model Bootcamp Restoring the Joy of Medicine

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. the Poza method 1 restoring the joy of medicine Copyright © 2018 - Poza, Inc.

3. Phase 1: Physician, Know Thyself Identify Your Professional Philosophy 2 Copyright © 2018 - Poza, Inc.

4. crafting your ideal practice 3 Copyright © 2018 - Poza, Inc.

5. concierge decision tree 4 Copyright © 2018 - Poza, Inc.

6. Phase 2: Know Your Market Identify Your Ideal Patient 5 Copyright © 2018 - Poza, Inc.

7. target market analysis 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? 6 Copyright © 2018 - Poza, Inc.

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 7 $ $ Copyright © 2018 - Poza, Inc.

9. what is your ideal patient’s alternative? 8 Copyright © 2018 - Poza, Inc.

10. Phase 3: Know Your Needs Financial, Tax, & Legal Considerations 9 Copyright © 2018 - Poza, Inc.

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 10 Copyright © 2018 - Poza, Inc.

12. how much should you pay yourself? 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 11 Copyright © 2018 - Poza, Inc.

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? 12 Copyright © 2018 - Poza, Inc.

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. 13 Copyright © 2018 - Poza, Inc.

15. legal considerations Underestimate the risk of enforcement. Be hyperbolic in your marketing. 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 DO NOT 14 Copyright © 2018 - Poza, Inc.

16. Phase 4: Align Find Your Sweet Spot 15 Copyright © 2018 - Poza, Inc.

17. life is short b e happy 16 Copyright © 2018 - Poza, Inc.