Direct Pay Primary Care

[overthehorizen]

I was interviewing for a Primary Care position that takes mostly Medicare and noticed on background checking the firm, that one of the doctors who previously worked there had left to start a "Direct Pay Primary Care" practice. I looked into this more and found there is a growth in doctors who simply refuse to take insurance anymore; more commonly in primary care but also in some specialty practices. Despite looking clean and simple clinically, it looks legally complicated though. It seems the issue is that you are either all in or not in at all. In other words, if you take don't want to take Medicare, then you have to opt out. However, that means you can't work a second or third job where you treat Medicare patients. 

 

I am wondering if anyone here has experience working in a direct pay model where patients either pay a monthly fee or are billed for the time of the appointment. Can a direct pay provider opt-in to Medicare in order to moonlight but then simply limit the number of Medicare patients in his practice to only one patient. Does the Federal Government dictate how many Medicare patients a practice must accept? I'm wondering if you could opt in (to moonlight) but make it obvious to Medicare patients that you will drop them when you no longer need a moonlighting job which could be six months or a year away. 

 

Obviously, PAs can't run their own direct pay model without a SP. So that raises the question. Does the SP need to opt out if he only signs charts but doesn't see the patient? 

[jmj11]

I had a hybrid practice and would have gone cash only, however, my SP was not interested in cash only.

 

You can double check me, but in the situation you are talking about I see no reason that you can't work with a cash-only practice and moonlight in a regular -insurance based, contracted practice. The contracts are based on Tax ID of the practice not on the ID of the provider.

 

The ONLY draw-back to a cash only practice is finding enough paying patients to sustain it. A huge amount of overhead and work is avoided if you have no relationship with insurance companies.  When a normal primary care practice converts to cash-only, they only keep about 25% of their patients. So you have to have ways (or demand) that will replace the 75% who leave.

[overthehorizen]

Watched you videos just now on youtube. That was some of the best education on PA ownership of a practice I have ever had. Thank you for creating and sharing them. You are right on so many points. I want to underscore "The name matters."