Converting a practice to a no insurance accepted model

Not long ago, I was working for a pain management firm with 19 clinics scattered throughout three states. I was fast approaching my three year mark as the travel PA and more recently, the compliance officer. Little did I know that my career path was about to go off-road, into a new world of clinic ownership coupled with the unchartered territory of no-insurance accepted.

What a difference a few months can make. I was approached by our family physician to take over his practice as he was considering taking a full time job with the VA. He had been deployed to Iraq twice with the Reserves in the last few years and his practice had suffered for it. My initial deer-in-the-headlights reaction gave way to a growing enthusiasm to create an affordable, slower paced practice where I could enjoy medicine again. Thus, the idea for a clinic based on the motto of Modern Medicine the Old Fashioned Way was formed.

After extensive research on the self-pay, no insurance accepted model, it became abundantly clear this was the only way to go. But I’m not going to tell you it has been easy. My 24 years of military training helped foster my don’t-give-up attitude. From the time I took over the practice until we launched three months later as completely self-pay, it was a whirlwind of non-stop work from website building to cosmetic updating, new system implementation, vendor negotiations, employee retraining, EMR initiation, existing patient education, price setting, etc., infused with many moments of self-doubt.  There is no manual to go by when deciding to deviate from the traditional system. No organized network of seasoned mentors to call upon for sage advice.  I have relied heavily on prayer, ideas bounced off my wife and what little scraps of information I could glean off the web.

Much of our efforts have been geared towards cutting overhead costs. With a self-pay model, every penny counts. Fortunately, my wife has taken on the role of office manager and is very frugal.  We negotiated our labs down to unheard of prices by offering to pay them directly for all tests at the end of each month.  We charge our patients a modest mark up (still the lowest cost for them around) and they pay us directly at time of service. No insurance means savings for everyone, including our lab.

Unfortunately, we did have to let some of the existing staff go as our patient count has dropped since initiating our transition to self-pay.  This is typical from accounts by other providers around the country that have converted their practices, some as much as a 75% drop in patient count.  We now have an office manager, a full time receptionist and a part time nurse practitioner who sees most of our female patients for their paps/wellness exams. We will need to add a part time Medical Assistant as we grow but we will still keep our labor costs lean. This necessitates that we all pitch in to help where needed with answering phones, scanning records, negotiating referrals, etc.  Since we only schedule two patients per hour, I have the time to do my own blood draws, shots and vital signs, and personally call patients with their lab results. These tasks give me more contact with my patients, which they appreciate.

We are now six weeks into our new model and have had some amazing results. Our first month was almost break even with only seeing 75 patients. I am able to spend more time with each patient than any other time in my career. My patients really appreciate it and I am excited about going to work every day.  Best of all, I am able to fully focus on my patients, with the weight of a thousand government and insurance rules, regulations, and restrictions lifted off my back.  And I do not intend to go back.

Robert Tomsett is the owner of GracePointe Healthcare in Franklin, TN         

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