Cash-Only Practice: What You Need to Do to Succeed

By Neil Chesanow

Jul 24, 2013

Is a Concierge Practice in Your Future?

As frustration and anger with healthcare intensify among physicians, more and more doctors believe that they are ready to quit the system and start practicing off the grid: They are considering a switch to a cash-only or concierge practice.

These doctors are receiving plenty of positive reinforcement. Most recently, a survey of 14,000 physicians found that 1 in 10 practice owners are planning to transition from traditional to concierge practices in the next 1-3 years.[1]

Today, “concierge medicine” is a rubric for a wide range of practice models that for the most part (but not entirely) shun Medicare and commercial insurance. Instead, patients either pay in cash for each service rendered or prepay a monthly or annual subscription fee that includes various levels of service.

Concierge medicine was initially marketed to affluent patients, who paid $10,000-$20,000 a year to have a personal physician on call 24/7. Cash-only practices emerged at around the same time — the late 1990s — as an affordable alternative for middle- and lower-income patients, generally with high-deductible or no insurance. What they received were basic primary care services at rates that most physicians would consider eminently fair. And they got instant access.

But these 2 broad, previously distinct patient panels are now routinely merged into a single practice model. Whether it’s called “concierge,” “boutique,” “retainer,” “retail,” “cash-only,” “direct-pay,” or “direct primary care medicine,” different levels of service at different rates are commonly offered to appeal to a variety of patients, who may now range from modest income to upper crust within the same concierge practice.

If you’re caught up in the excitement of potentially moving to a direct-pay model of care, that’s understandable. But do your due diligence before you decide. When doctors who are initially interested in concierge medicine take a closer look, they often have second thoughts. Consider these challenges:

Patient Recruitment Isn’t Easy

A move to concierge medicine presents 2 immediate challenges. One is holding onto as many patients as possible among those you already have as you switch to a direct-pay model of care; the other is attracting and keeping new patients.

“It’s common for doctors, particularly those with long-standing patients, to significantly underestimate ‘ramp-up time’ — how long it takes to get new people signed up,” says Helen Hadley, Founder and CEO of VantagePoint Healthcare Advisors in Hamden, Connecticut, which has concierge physicians as clients.



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