The "New" Physician Enterprise – Leveraging technology to enable cash-on-the-clock medical practice

There is an increasing trend towards cash-based medical practices. Some are the high-end “Anti-Aging” or “Age Management” practices that view aging as a treatable condition that can be significantly slowed down through the application of hormone replacement, nutritional supplementation, and other non-conventional medical modalities. Other money practices are typical family practices that have become frustrated with the insurance model and have embarked on the new paradigm of money-based medicine. They all share the basic principle that they do not maintain contracts with insurance companies and instead require patients to pay cash for medical services rendered.

To be successful and profitable in the insurance model, practices must have very high daily patient volumes (35 – 40 for a single person household practice) to generate the revenue needed to earn just a “professional” level of income. Along with the high volume comes a lot of overhead, including a large office and multiple support staff to begin with. Due to volume combined with a number of logistical factors (patients arriving late, office inefficiency, etc.), patients typically have to wait 30 – 60 minutes or more from their scheduled appointment time, all to spend an average of 6 minutes. minutes with the doctor. The inefficiency of this model is at least partly responsible for the relatively low overall effectiveness of health care in the US compared to other industrialized countries.

The “new” doctor’s company

The “new” physician business is all about prevention, new revenue streams, operating in a “cash” model, maintaining a high-quality physician-patient relationship while still operating with business-like efficiency. Technology enables the new Physician Enterprise and the right technology must be quick to implement, easy to use, accessible to patients and staff 24×7 and highly cost effective.

In the new paradigm, physicians see only 7 to 10 patients a day, have a much smaller workforce, significantly lower overheads, and are able to truly participate in wellness by identifying the root causes of disease rather than just focusing on focus on symptoms and therefore positively influence outcomes. The patient pays the doctor in cash, bypassing the insurance model and all associated reimbursement rules that many believe hinder effective patient care and favorable outcomes.

But without effective technology to enable the practice, the money practice will still suffer from higher-than-necessary staffing and overhead costs, as will the insurance model practices, affecting the long-term viability of this model. The primary technology for cash practice can be broadly categorized as “self-service technology”. For example, instead of having a staff member schedule appointments for patients, the practice could implement a web-based self-service appointment scheduling system. There are several low-cost systems on the market today that offer a high degree of configurability to accommodate doctor schedules, multiple types of appointments, and virtually any scheduling complexity a human can manage. Further, since many of the practices operating in the new paradigm offer nutritional supplements for sale, an Internet shopping cart is the natural solution for this instead of having a member of staff take orders. Again, there are several commercially available tools that can meet this need. Broadly speaking, the needs of cash practices can be summarized by the following list of requirements:

  • Patient management database (profiles, demographics, questions)
  • Electronic medical records
  • Schedule appointments
  • Marketing and communication for potential patients and patients
  • Shopping cart
  • Accounting/financial management
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Continuing the approach outlined above, money practices could implement multiple commercially available tools to meet this unique set of needs, as the typical practice management systems offered today continue to focus on the practices that operate in the insurance model and typically do not include shopping carts, real self-service appointment scheduling, a marketing and communication engine or financial management. But using the approach of deploying multiple disparate systems creates yet another inefficiency, as patient demographics must be entered and maintained across multiple systems and, most importantly, there is no support for the ideal business process in this scenario .

Enabling technology for cash-on medical practices

But now there’s a new option for out-of-pocket medical practices facing these issues. Using XML, HL7 and current integration technologies, it is possible to integrate third-party applications into “the cloud”, allowing all systems to share a common database for demographics, but there is no need to host hardware or software. In this target environment, practices can use multiple self-service applications, integrate them using a modern integration approach, and add workflow to provide additional efficiencies. This approach has a low cost of entry and relatively low total cost of ownership, yet it delivers significant practical benefits.

No doubt the big software companies will eventually see this niche and deliver fully integrated applications to serve them, but for now cash practices have at least one viable option to use technology to enable doctors to practice medicine, patients get better care and practice to be profitable.

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