Direct-pay practice: 3 steps to take before switching

Physicians increasingly explore new practice models to ease their financial strain and restore their satisfaction in medicine, but the process of actually making the switch (or starting a new practice) requires careful planning.

A recent article from Medical Economics provided three key successful transition steps:

  1. Define your model. There are three main variations of direct-pay medicine, according to the article. The first is a straight-cash model, in which patients pay out-of-pocket for services as they receive them. There's also a fee-based model, which covers most office visits and a certain level of physician access. Finally, there's concierge medicine, which generally sets a higher monthly fee in exchange for more comprehensive services, and is the only one of the three types to often accept some forms of insurance.

  2. Set your pricing. "If you charge too much, you won't get enough patients to support your business," said Harry Izbicki, D.O., co-owner of Izbicki Family Medicine, a direct-pay practice in Erie, Pennsylvania. "But if you charge too little, you're leaving money on the table and maybe working harder than you have to." For example, Access Healthcare, a family practice serving clients ranging from the homeless to some millionaires in Apex, North Carolina, charges members $40 per month plus $20 for each office visit. "That covers the variable cost of seeing patients in the office [rather than through telemedicine or e-mail,]," said Physician Leader Brian Forrest, M.D. "It's the right amount to keep patients from coming more than they should, while not causing them to delay any necessary care."

  3. Make staffing decisions. In an effort to keep overhead low and adjust to less administrative work for employees to do for smaller patient panels, direct-pay practices may be able to downsize to a smaller team of highly patient-focused staff. In many cases, however, employees who will not be a good fit for the new model de-select themselves once the practice announces the change. Alternatively, "some physicians, if they have a particularly tight-knit staff, will decide to keep everyone initially, and wait for attrition to pare down the staff," Rob Lewis, of consultancy SpecialDocs, told Medical Economics.

To learn more:
- read the article