Small practices embracing alternative, counter-culture models

Despite the rapid trend toward physician employment and healthcare consolidation, practice management insiders are seeing a counter-culture emerge among "single shingles," who are increasingly looking at new ways to sustain a more traditional-feeling practice.

According to Manage My Practice author Mary Pat Whaley, her consulting practice has seen an uptick in offices looking for help creating the following practice models:

  • Retainer, boutique, direct-access or other fee-based practices: characterized by a membership fee for extra services, often bypassing insurers.
  • Micropractice or ideal medical practice: usually considered to be a solo physician performing many practice duties him- or herself in an extremely lean practice model with a smaller patient panel, offset by low overhead.
  • Virtual practice or telepractice: taking advantage of technology allowing physicians to consult with patients mostly or totally remotely.
  • House call practice: catching on in popularity as insurers put more emphasis on keeping patients out of hospitals and are beginning to reimburse for transitions in care.

Minnesota physician Merlin Brown is an example of a doctor who is bucking the employment trend and transforming his practice into a direct-pay model, which will no longer accept payments from insurance companies other than Medicare, the Pioneer Press reported.

According to the newspaper, Medicare and non-Medicare patients will be subject to various options for levels of service at different price points. For example, Medicare patients will pay an extra $300 for personalized services, such as phone consultations, family conferences, email, texting and Skype communication. Non-Medicare patients can select from three options, ranging from paying as they go to paying a $2,500 annual fee that would cover all non-emergent primary care they may need from the practice.

"We believe that insurance companies are making it increasingly difficult to practice patient-centered medicine," the doctors wrote to patients this month.

To learn more:
- read the post from Manage My Practice
- see the story from the Pioneer Press

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