Cardiologist Brian Forrest, MD, says he is not a concierge physician. To the contrary, he operates a direct-pay practice, costing each of his patients no more than $500 out of pocket in an entire calendar year. But in exchange for paying nominal fees for practice membership and a la carte services, patients get decidedly VIP-like access to next-day appointments, with up to an hour of face time with providers.
Ten years after launching a business model critics said could never work, Dr. Forrest and his colleagues treat about 6,000 patients at their North Carolina micropractice, which has been identified as one of 28 Cardiovascular Centers of Excellence in the United States, boasting outcomes measures in HgbA1C, average LDL and percent of patients at their blood pressure goals in the top 10 percent nationally.
The keys to making the model profitable, he says, are keeping practice overhead extremely low, while investing in efficiency- and quality-boosting technology. Instead of the typical 4.5 full-time employees per provider, for example, the staffing ratio is more like 0.66 FTEs for each of the practice's providers, which includes two physicians, one full-time nurse practitioner, and one full-time and two half-time medical assistants. At the same time, the practice uses a CCHIT-certified EHR, referral tracking, registries, care coordination, continuous quality improvement, practice redesign, patient satisfaction surveys, electronic patient communication and reminders "and most of the other features that help ensure a patient-centered practice that is financially viable," Forrest says.
To that end, the physician says his model is an example of both the Patient Centered Medical Home and the Idealized Practice from the Future of Family Medicine Report. "Best of all, our model is sustainable since it is immune to the whims of payers," Forrest writes.
The biggest surprise, he adds, is that 53 percent of the practice's patients carry traditional insurance. "It turns out that most patients value the attributes of a direct-pay practice more than the hassle of filing their own insurance," he writes. "Medicare patients frustrated with not being able to find a physician accepting new patients or with the patient mill they have experienced in the past have come in droves."
To learn more:
- read this commentary in Physicians Practice