Makes me wonder if I just did a flat rate and pull it off.
Just my two cents. My practice is set up for families who are uninsured or underinsured and I don't deal with insurance companies at all. Flat rate appointment or flat rate membership and I pass on the cost of everything over $1 (so I buy my suture for $2 a piece, sterile gloves for $1.50, sterile water for $1...cleaning and stitching a simple wound costs $4.50) An appointment is $60 no matter how much or how little I do. A membership is $30 a month for each of the first two members of a household and $15 a month for each household member after that. I have no staff (other than my husband, who I don't have to pay and doesn't do much) and have really worked to keep my overhead low. I broke even in 2 months. I can "squeak by" support my family on about 200 members (most people prefer the membership option) or we live like kings on 500 members (we aren't there yet). Squeaking by, I'm only seeing a few patients a day (2-3 on average...I live 3 blocks from my office so if no one is scheduled, I go home). I'm assuming at the living-like-kings level, I'll be working half-days. I'm on call 24-7 but it barely affects my life and my patients have never abused it. I have another solo practitioner to trade call so I can still go on vacation.
Some people would say that I'm depriving the world of a full time doctor by doing this, but between my small children and a VAD/stroke, I wouldn't be practicing medicine at all if I couldn't do it at my current pace. And my patients LOVE it. I have several families who have one or more family members on medicaid or medicare who see me for almost everything and have those for back up. They appreciate the time I spend just listening and straightening things out medically. It can take a couple hours to sort out a medicare patient who has been getting disjointed care from a disjointed conglomeration of family and home health and rushed PCPs and rushed specialists and in the end is time well spent...even though medicare wouldn't pay for it. I don't deal with auditors or insurance rules...I just provide the medical care people need.
I spend my time doing what I love.
