Considerations for a Multidisciplinary Practice

Four years ago, Thom Lobe, MD, a Los Angeles-based pediatric surgeon, enrolled in an executive MBA program. As part of the program, Lobe had to complete a thesis. He turned to a subject he’d been thinking about for a long time, a multidisciplinary practice, developed it on paper as his thesis, and handed it in.

“The professor said, ‘This is really too good not to do,’” Lobe recalls. “So I said, ‘Great.’ ” Then he set about to make it happen. Two years later, in January 2009, Lobe opened the doors to the Beneveda Medical Group, a multidisciplinary practice based in Beverly Hills, Calif.

Beneveda's practice provides patients with a "one-stop shopping" alternative medicine experience. In addition to two licensed medical physicians, Beneveda's staff includes two chiropractors, two naturopathic physicians, life counselors and nutritionists, and even a shaman.

“Healthcare is broken,” he says. “We all appreciate the fact that the way it’s delivered now isn’t working. [Beneveda] is really a unique kind of practice.”

Now he’s spreading the word.

With Uniqueness Come Challenges

Lobe explains that just as he opened the doors to Beneveda, the economy took a nosedive, so getting the new practice up and running was not easy. “But the fact of the matter is, it’s what people want,” he maintains. “And it’s really just a matter of letting people know we’re here. Because once they find us, they say, ‘”Wow, this is great.’ ”

In that respect, Lobe says he probably should have done more marketing and public relations early on, because the only challenge he’s encountered is letting people know what the practice does, and how it differs from a traditional medical practice. “It’s been a struggle for us to hit the right message,” he explains. “It’s not your 30-second elevator speech. It’s really a longer dialogue.”

But people are listening, and the practice continues to grow. The practice staff includes two medical doctors, two chiropractors, two naturopathic physicians, life counselors and nutritionists, and even a shaman. “We’re evolving; we’ve learned what works and what doesn’t work,” Lobe says. “And we really have a unique way of practicing that patients seem to like.”

Benefits Outweigh Disadvantages

Asked about the benefits he’s experienced over the two years since opening Beneveda, Lobe laughs and responds with a question: “How many hours do you have?” There’s tremendous personal satisfaction in having created something that people like, Lobe explains, and that enables him to help people, which he says is his passion. But he also points out that financially his multidisciplinary practice is not yet a thriving model.

“We’re getting closer every day, and we’re just about profitable to a level that I’m content with,” Lobe says. “And part of that is my fault.” He explains that he’s in the process of expanding -- establishing similar facilities both regionally and out of state. He’s even spoken with investors who want him to put a similarly structured practice in Manhattan and another in the Midwest. “So, part of the reason I’m not profitable is because we’re growing,” he says.

Lobe believes the multidisciplinary medical practice will be a successful model in the future. As such, he plans to launch a training program in early January 2011 -- a one-week, intensive course on how to set up a multidisciplinary practice. “For a relatively small up front cost you can totally change your model, and be profitable quickly without having to learn what it took us two years to learn.”

The Legal ConsiderationsMark Lutes is a senior healthcare attorney at the international law firm of Epstein Becker & Green P.C. The first step in setting up a multidisciplinary practice, he says, is to make certain that all the healthcare professionals involved have a common vision.

“There’s a great deal of business planning that needs to be reflected in the organizational documents of the practice,” Lutes says. “There needs to be a lot of thought given to what could happen. People retire, people die, people get divorced -- and you want to make sure that your structure can absorb all of that going forward.” He also raises the issue of designing the practice’s internal compensation plan. “In the future, we could live in a mixed model where we have fee-for-service incentives, but we also have a managed care capitated or other types of incentives,” he says. “Compensation in the future will be even more challenging than it has been in the past.”

Despite the challenges, Lutes believes that when done right a multidisciplinary practice could experience significant success. “There are opportunities to do better in managed care contracting, in part because you’re a significant economic force and thus have greater bargaining leverage,” he says. “There are many drivers that would suggest that, even just in terms of basic economics and functioning of a practice, there’s a greater likelihood of being able to absorb costs efficiently and stay competitive in a larger group setting than there is in a smaller group setting.”