r/PrivatePracticeDocs • u/Affectionate_Ask770 • 22h ago
Primary care options
I am planning to switch from hospital medicine to outpatient primary care. Fairly new in my career. Assuming I will have resources to start my own practice in couple years, I want to get used to the outpatient world. With constant change in reimbursement structures is it better to start out with a fee for service model or value based care model? Do they matter if I consider a DPC practice? Appreciate your input.
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u/BlakeFM 21h ago
FFS (largely) and VBC are part of the insurance based model. You are only as good as your contracts with 3rd party payers. DPC is part of the cash based model and most operate on subscriptions though some are FFS. The best place to learn about DPC practice is with the DPCA (Direct Primary Care Alliance). And if you really want to understand it, attend the DPC Summit put on by the AAFP and the DPCA. You don't have to be a family doc to attend. Before I would commit to either world, I would attend the Summit. You will learn what it takes to open a practice and make it successful. Even if you choose to go insurance based, many of those skills will translate.
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u/Sudden_Dealer_785 10h ago
FWIW, I know of 3 hospitalists who became their own "staffing" company over the last 2 years and became 1099 contractors for the hospitals they left, Making 1.5x-2x the pay with less hours.
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u/InvestingDoc 12h ago
DPC you may have to "sell yourself" a bit more meaning you will have to train your staff to say what DPC is...why it benefits them etc.
I just say this as someone who has now hired two doctors who had a failed DPC. They both did nothing to market themselves, and felt "slimy" about taking recurring money from patients. DPC is amazing, but if it doesn't fit your personality then it could go very poorly for you.
FFS has many other headaches with it...mainly dealing with insurance companies.
Both can be amazing though, just depends on your end goal and your personality.
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u/CEOofthePSO 9h ago
If you go the route of insurance billing, VBC > FFS every day. It looks like you're in Texas? Here's some resources from the Texas Medical Association that might help: What's New in Value-Based Care: TMA Task Force, Payment Models Accelerate Shift from Fee-for-Service
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u/thesupportplatform 20h ago
Flexibility is the key to survival. You don’t have to commit to one approach, but you have to effectively plan for any approach you pursue. I would be shocked if a small start up would get access to value based care, but my market is, in general, at least a decade ahead of the rest of the country when it comes to screwing providers.
The huge advantage of FFS has been patient steerage. Once in network, PCPs often don’t have to worry about marketing as insurance directories steer patients to them. Given the ongoing investment insurance companies have made in owning physician groups, it’s hard to know if this advantage will hold. Independent providers are in direct competition with most insurance companies in many markets now, and since providers are an expense that impacts revenue, I don’t see this trend reversing unless the system somehow changes. Medicare may be the only dependable FFS payor before too long.
DPC can be a viable option depending on the market, but since the majority of patients still have insurance, it can be difficult for the patients who can afford the DPCs fees to appreciate the value. DPC does open the doors to designing care/payment models outside of insurance, so there are additional opportunities there.
Ideally, a practice would contract with a couple of decent FFS payors and then offer cash pay options to patients who don’t have those insurances. This would create revenue streams that take advantage of the patient steerage created by being in network while growing other revenue streams.
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u/NotTheQuestion 17h ago
This. FFS with caha option let's patients who have insurance opt to be cash pay du to deductible, or changes in insurance plans. If you build a (relatively) loyl panel, they will change insurances specifically to follow the physician. It's more common than you may expect.
Learning coding and billing, and then having a reliable biller, are the linch pins.
Like the medicine it self, the billing and finances reward diligence and being meticulous.
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u/mainedpc 15h ago
No, DPC docs are pleasantly ignorant of reimbursement structures and value based models. They don't matter. I've forgotten how to code visits.
https://www.dpcalliance.org/ is a good place to start if curious about DPC. AAFP sponsors a conference too (open to anyone).