Is it possible for a physician to operate without revenue from insurance, without the safety net of being a part of PPO networks? It’s got to be some kind of April’s Fools joke, right? Well, one physician did start this new model on April Fools – but it’s no joke. In an article for Physician’s Practice, Brian Forrest, MD says he researched different models of healthcare delivery before designing a structure that addressed care for the uninsured, but allowed him a lighter patient load so he wasn’t trying to cram visits into every working hour to keep his practice afloat. In essence, he created a low-overhead, direct-pay practice model that has about 6,000 patients (His micropractice has two physicians, one full-time nurse practitioner, and one full-time and two half-time medical assistants.) Forrest claims his model of care saves uninsured patients about 85 percent on their outpatient healthcare costs.

Here’s how it works, according to Forrest

Patients can either pay a la carte from a posted menu of services in the waiting room or they can pay $29 per month and $20 per visit. On the a la carte menu, the most expensive visit is $49. Ancillary services such as labs, splints, and injections are charged at nominal fees like $25 to $36. Patients can actually add up their own bill before they are seen if they know what they will need.


Forrest says he’s never had a patient spend over a grand out-of-pocket in a year. That includes diabetic patients, patients that are hypertensive, etc. He says the key to this model is keeping the overhead low.

The key to making a direct-pay model work is keeping overhead low. If you are charging 85 percent less, then your collections need to be near 100 percent (99 percent for us) and your overhead needs to be much lower than the traditional 50 percent to 60 percent. My practice overhead was about 25 percent last year. There is a lot of planning and efficient use of resources that goes into that.

Read his full column in Physician’s Practice here

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