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Essential Tools for Building a Direct-Pay Practice


Patients come to a direct-pay practice for improved access to physicians. In order to deliver on that promise, a physician must have the right tools.

I have been operating my direct-pay practice (I accept no insurance; patients pay me a low monthly fee for care) now for over two years. Two years means several things. First, it means that I am out of the "start-up phase" of the business; it is no longer an experiment, or a concept I am trying to prove. I am successfully making a living using an entirely different business model than most doctors in this country.

Two years also means that people see me differently. I have experienced a recent surge in patients joining my practice; many of whom were initially nervous about joining, but now see that my practice is stable.

The last thing that two years means is that I've had a chance to figure out what really works in this type of practice and what is window dressing. Here are the tools I have found most useful in building a successful direct-pay practice.

Essential #1: A good office space

I am not in a typical medical office area, but instead intentionally found a homey-looking space in a commercial office complex. I designed it to feel different from most doctors' offices: comfortable and welcoming. From the outside it looks like a house, not a medical office, and I've filled it with comfortable furniture, pleasing decorations, and coffee for patients on request. Patients will make a point to come in just to chat; and we can because our schedule allows us the extra time to connect with our patients.

This was my biggest start-up expense, but I believe it was absolutely essential in building a new mindset in my patients.

Essential #2: A staff that believes

I now have two nurses (to handle 600 patients), both of whom came from my previous practice. Both of my nurses are zealous in their belief in the direct-care model. Part of their zeal comes from the fact that their lives are so much better in this new office setting, but also, much of it is because they truly like to help patients. My practice model is all about customer service and exceeding expectations. I am really fortunate to have staff to whom that focus comes naturally.

Essential #3: The right communication tools

The one thing my patients value the most in my practice is access to me and my staff. If they have questions, they can call the office or reach me via secure messaging. While it's technically OK to use e-mail for communications (as long as patients sign a HIPAA waiver), I found that most of my patients value security in communication over ease of use. Here are three ways I communicate with my patients:

1. A good phone system. I use Ring Central which is a VOIP Internet phone system, which allows me to cheaply have a complex phone system. Voicemails are e-mailed to me; faxes are also received and turned into e-mails. I can text with patients as well as hold a conference call. It has its flaws, but overall we get a lot for a low price.

2. Messaging system. I use Twistle, which is a HIPAA-compliant "chat" system. This might be the tool my patients value the most. It works like a secure chat, with apps available for Apple and Android phones. It also notifies me via e-mail when patients have tried to contact me, and my nurses can be copied on the messages as well. I can securely send lab reports (as PDF files) or handouts regarding conditions as attachments, and patients can send images (rashes, wounds, etc.) to me from their mobile app.

3. E-mail system. While I don't encourage e-mail communication, some patients prefer it. We use our own domain hosted on Google's Gmail website. It's very easy to use and extremely affordable.

Essential #4: Billing systems

I experimented with several billing systems. I initially used Intuit Quickbooks and their integrated billing features. For a while I used ADP's automatic billing system, which worked fairly well, but didn't integrate well. Most recently, a new start-up, Hint Health has built a very elegant and easy-to-use billing system specifically designed for direct-care practices. They are very easy to work with, and solve issues quickly and easily. They also integrate with several EHR systems, and are always open to further integrations.

Essential #5: Facebook

Hands-down, the best marketing tool I have is my Facebook page. Not only does it provide an easy communication tool for patients and those interested in my practice, but I can promote posts to the exact demographic I am interested in. I promote any specials I am running for new patients, but I also promote posts or articles that highlight how my practice is different. The money I've invested here has paid itself over manyfold.

There are other tools I use regularly, but these are what I consider essential, and without which I could not have created a successful direct-pay practice.

Robert Lamberts, MD, who is board-certified in internal medicine and pediatrics, practices in Augusta, Ga. In October 2012, he left his "traditional" primary-care practice and opened a cash-only "direct-care" practice.  His writings on this and other topics can be read on his popular blog, "Musings of a Distractible Mind" http://more-distractible.org.  Lamberts can be reached at rob.lamberts@gmail.com.

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