Can a Direct Primary Care model be feasible for psychologists?

[texanpsychdoc]

I was curious to see if others knew about Direct Primary Care (DPC) as a new model that circumvents insurance payers completely. Essentially, the DPC model allows for primary care services to be delivered at lowered costs and therefore, not require astronomical fees to be billed which gets passed to the patient in the form a subscription fee. Essentially the patient will pay a fee, and from the DPC providers I've seen they tend to have a tiered structure of subscription levels. Either way, the costs are often lower than what people may pay for their monthly premiums either out of pocket or out of their paychecks with their employers. I've listed a link to one of the practices I have followed for years. I really love his style and I try to rack my brain around how we can get this model applied to psychologists.

Direct Primary Care — Plum Health Direct Primary Care

www.plumhealthdpc.com

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[WisNeuro]

I can't see how you'd make more money then charging cash pay directly, unless you are hoping that a good number sign up and just keep their subscription going without using it. It's why it works for primary care, people don't use it that often, but when they do want it, it's available quickly. I don't think this works as well in services in which one sees a provider weekly or biweekly.

 

[summerbabe]

Never heard of this but the site looks interesting enough…but wouldn’t a mental health model basically be BetterHelp? Am I missing something major?

The major problems that I see for applying this to mental health are service usage demands and how long it takes to provide that service.

A person might have 1 UTI every 3 years and it’ll take like 10 mins to diagnose it and send in an antibiotic. And you’re making money on all the months when they don’t have UTIs or other PC needs.

But somebody can have an interpersonal stressor every day of their life and want to talk about each one and even if we are trying to have 30 min apts, that’s a lot of apts. I imagine this is why BetterHelp doesn’t pay much.

And if they don’t have an active need for a therapist, how many people would pay a monthly peace of mind retainer? Or if they want to see a therapist once a month for an hour, does this model still make sense?

 

[PsyDr]

God no. That’s a great way to have a practice full of patients that want to see you for 5hrs a day, and call you up at 3 AM.


That’s how the Beach Boys’ psychologist Eugene Landy got himself in trouble. And there was that psychiatrist on that podcast series that did the same.

 

[Therapist4Chnge]

DPC seems to align w a Concierge medicine approach, which I think is a great response to a failing PC model. I have a concierge med PCP and they are well worth the money, though there can be some variance in offerings and the devil is very much in the details. Can it translate to a psych model somehow? I’m not sure. Maybe.

If l were to try this approach, I’d likely offer a pre-paid annual package equal to x-number of cash-pay sessions plus an annual subscription/access fee. These could be “check-in” sessions where small things can caressed before they become bigger issues. I have some other ideas unique to this setup I’d offer, but I’m keeping those ideas for myself.

I could see this pitched to niche groups w disposable income, think middle management and up, with diff packages and offerings, depending on areas of practice. I’ve worked w C-level and professional athletes over the years, both groups tend to pop back up a couple/few times per year. Just like pro athlete might see their ortho or pain management doc for off-season injections, I’d see them pre and/or post their season and re-eval for ongoing issues. Curiously, trades & free agency have ended a few cases, but I can see the appeal for the right kind of setup. I’d love a customized EAP for high-networth patients, which could cover the initial subscription cost (paid annually per employee) and tailored to the needs of the employee group(s).

This approach isn’t without pitfalls, whether they be acuity-based, expectation based, or just attracting too many high-need pts. I can still see an upside, but this model def should only be considered w. a well-seasoned clinician who knows how to handle the highly demanding type.

 

[texanpsychdoc]

DPC seems to align w a Concierge medicine approach, which I think is a great response to a failing PC model. I have a concierge med PCP and they are well worth the money, though there can be some variance in offerings and the devil is very much in the details. Can it translate to a psych model somehow? I’m not sure. Maybe.

If l were to try this approach, I’d likely offer a pre-paid annual package equal to x-number of cash-pay sessions plus an annual subscription/access fee. These could be “check-in” sessions where small things can caressed before they become bigger issues. I have some other ideas unique to this setup I’d offer, but I’m keeping those ideas for myself.

I could see this pitched to niche groups w disposable income, think middle management and up, with diff packages and offerings, depending on areas of practice. I’ve worked w C-level and professional athletes over the years, both groups tend to pop back up a couple/few times per year. Just like pro athlete might see their ortho or pain management doc for off-season injections, I’d see them pre and/or post their season and re-eval for ongoing issues. Curiously, trades & free agency have ended a few cases, but I can see the appeal for the right kind of setup. I’d love a customized EAP for high-networth patients, which could cover the initial subscription cost (paid annually per employee) and tailored to the needs of the employee group(s).

This approach isn’t without pitfalls, whether they be acuity-based, expectation based, or just attracting too many high-need pts. I can still see an upside, but this model def should only be considered w. a well-seasoned clinician who knows how to handle the highly demanding type.

Ah...well, since I am the "Costco" of psychologists, I would not be well-seasoned.

 

[medium rare]

This model hasn’t and doesn’t really work in psychiatry/psychology. I know several psychiatrists and a few psychologists who have considered this and all have decided against it for the reasons stated above as well as others. It just works better in mental health to do self-pay as you go.

 

[Sanman]

Ah...well, since I am the "Costco" of psychologists, I would not be well-seasoned.

Will you be offering a $4.99 roast chicken with a psychotherapy subscription?

 

[Sanman]

The thing about a concierge model in primary care is that the subscription fee is usually for capping panel size. Unless there is a giant access problem for rich folks with MH problems, I don't see how that would work. Then comes the part about avoiding a practice full of borderlines.

 

[MCParent]

Become the preferred assessment/behavioral health referral source for the concierge medical boutiques. That’s what I did.

 

[Sanman]

Become the preferred assessment/behavioral health referral source for the concierge medical boutiques. That’s what I did.

 

[ThatPsyGuy]

Become the preferred assessment/behavioral health referral source for the concierge medical boutiques. That’s what I did.

 

[ClinicalABA]

... I've listed a link to one of the practices I have followed for years. I really love his style and I try to rack my brain around how we can get this model applied to psychologists.

Direct Primary Care — Plum Health Direct Primary Care

www.plumhealthdpc.com

May or may not be a good practice. Our of curiosity, I followed the "is this for me?" link on the website, and there is no series of different answers that doesn't lead to a "this is perfect for you!" page. I find that a bit misleading, giving the appearance of guiding you to the practice type based on assessing your individual situation, when in fact all individual situations have the same results.

We have a local practice that adopted the same model. Similar talk of "restoring doctor patient relatinship" with lower overall caseload and "no waiting for services." Only way that works is to lower the number of patients who can access the provider and have the patient pay for non-realized or more potential vs. actual services, which is really just another type of insurance, though managed by the actual care provider. Theoretically works better for provider, as they have a predictable schedule and income, with subscriptions allowing for open slots that generate the same income whether filled or not. Balancing the number of patients and fees with how many openings are needed to assure quick access seems to be the meat of the business model. Whatever the formula, only works by limiting access to services. It's clearly a clinicians prerogative to do so, but ultimately results access to care issues for those with the least ability to pay.

I'm not sure how quick the access would need to be to be make it better. Through my run of the mill employer based group HMO, PCP access isn't that difficult- generally same day access to a provider or same week or two access to my specific doctor if needed. With a DPC model, you'd still want at least a high deductible plan for catastrophic costs, if not for just those more regular high priced things that come about rather regularly (MRIs, overnight inpatient stay) as you age or lifestyle (e.g. child playing sports) dictates. I just personally don't see what problem the 200 bucks extra per month would solve for  me. Maybe if it where just me singly, 75 bucks per month extra might be worth it, but years worth of $75/per month would be eaten up with hust one high deductible procedure. Now, if on behalf of every citizen in this country put 75 bucks into one big pool, from which all our healthcare needs would be covered (such as is done in pretty much every other developed country in the world) from which my Healthcare costs would be paid- even if it meant I had to wait a week longer to have that wart checked out- I'd get behind that model!

 

[BuckeyeLove]

God no. That’s a great way to have a practice full of patients that want to see you for 5hrs a day, and call you up at 3 AM.


That’s how the Beach Boys’ psychologist Eugene Landy got himself in trouble. And there was that psychiatrist on that podcast series that did the same.

Oh my god just went down this rabbit hole. "In 1982, Landy was re-employed as Wilson's therapist, subsequently becoming his executive producer, business manager, co-songwriter, and business adviser."

HOW WAS THIS REAL LIFE?!

(Also...this Landy dude was managing guitarists in the 60s and then just happens to go to Oklahoma and get a doctorate, why couldn't cool stuff happen for me like that).

 

[borne_before]

Here's my million dolla idea: you know how there is Klarna/layaway style financing options. We set up one for psych evals, especially as more insurances are moving away from ADHD/LD reimbursement and more testing psychs are moving to cash pay models. As a plus, it would remove conflict of interest and less liability from the psychologist.

 

[AcronymAllergy]

Here's my million dolla idea: you know how there is Klarna/layaway style financing options. We set up one for psych evals, especially as more insurances are moving away from ADHD/LD reimbursement and more testing psychs are moving to cash pay models. As a plus, it would remove conflict of interest and less liability from the psychologist.

I've heard of some practices that do actually allow payment plans, but my understanding is it can get a bit sticky. The tricky part is ensuring you actually get fully paid after the eval is done, especially if you provide feedback and the report before you've gotten fully paid.

Edit: Ahh, you were talking about a third-party service, not the office itself providing the payment plan.

 

[WisNeuro]

Here's my million dolla idea: you know how there is Klarna/layaway style financing options. We set up one for psych evals, especially as more insurances are moving away from ADHD/LD reimbursement and more testing psychs are moving to cash pay models. As a plus, it would remove conflict of interest and less liability from the psychologist.

How does this reduce liability?

 

[borne_before]

How does this reduce liability?

Psychologist gets paid upfront, funding by 3rd party.

 

[WisNeuro]

Psychologist gets paid upfront, funding by 3rd party.

Ah, I thought you referring to medical/legal/ethical liability, which did not make sense.

 

[PsyDr]

Psychologist gets paid upfront, funding by 3rd party.

That's a credit card. We call that "using a credit card".

 

[PsyDr]

Oh my god just went down this rabbit hole. "In 1982, Landy was re-employed as Wilson's therapist, subsequently becoming his executive producer, business manager, co-songwriter, and business adviser."

HOW WAS THIS REAL LIFE?!

(Also...this Landy dude was managing guitarists in the 60s and then just happens to go to Oklahoma and get a doctorate, why couldn't cool stuff happen for me like that).

You might like the podcast, "The Shrink Next Door". It's a docu-series about a psychiatrist who basically started advising his patient in how to conduct his company. Eventually took over the guy's beach house and business or something.

The True Story Behind The Shrink Next Door

Paul Rudd and Will Ferrell star in the new Apple TV+ series adapted from a podcast

time.com

 

[summerbabe]

That's a credit card. We call that "using a credit card".

CareCredit does this with things like major pet surgeries with no or very low interest if you pay it off within a few months or whatever your term is.

There are also seems like elective surgery businesses that are within their network and offer this option.

 

[ClinicalABA]

This thread prompted me to look into the local practice that is offering Concierge PCP services. It was a big deal when they started it, with newspaper articles and radio interviews (we're a pretty small town, so local stories get some relatively big press). The service is an optional part of the practice (existing insurance patients can remain so with no apparent change to level of care), with a new-to-the-practice PCP providing the Concierge service.

Apparently, they got some blowback from the community regarding the new model. We're a very progressive area, and the practice touted itself as being accessible to a variety of demographics, particularly addressing the needs of marginalized populations. The new PCP comes to the practice with a history of providing care to LGBT clients, with an emphasis on transgender care. Thing is, they are charging a $3500 concierge fee. This will be on top of typical insurance coverage, which they clearly state you would still need, as the Concierge service does not cover emergencies. The website indicates that it is against state (Mass.) law to enroll medicare patients in concierge services, so there's that to consider. Turns out that if you want to make some enemies and be labeled a hypocrite, doing something that is only accessible to a privileged few while maintaining your "everyone deserves good healthcare regardless of (fill in the blank)" is a good way of doing it. One stated goal of the Concierge service is to reduce non-direct admin work for the whole practice by cutting the number of insurance cases.- The "have nots" are pissed off that there is now a "higher" tier of services for the "haves", while the "haves" are starting to catch on that, in such a mixed-model practice- their Concierge fees are, to some extent, subsidizing lower caseloads of the "have nots." Who'd have thunk that would happen?

 

[SomeGreatNotion]

It's a different model but is there any appetite here for bundled rate/reimbursement? There have been efforts to facilitate this for coordinated speciality care programs for first-episode psychosis. I'm not sure if it has been adopted anywhere. One bundled rate that allows for multiple services/providers given a particular diagnosis. Not subscriber-based, and still reliant on third-party payers.

 

[eeor1006]

Who is going to be your target population?

Usually people who can afford such concierge subscription can afford to pay out of pocket for psychology services. When you are cash pay, you will have no problem getting someone to take you in next day at ungodly hour like 6:30pm. Why would they pay extra for quick access then?

 

[Sanman]

It's a different model but is there any appetite here for bundled rate/reimbursement? There have been efforts to facilitate this for coordinated speciality care programs for first-episode psychosis. I'm not sure if it has been adopted anywhere. One bundled rate that allows for multiple services/providers given a particular diagnosis. Not subscriber-based, and still reliant on third-party payers.

This is essentially the value based care model. The big problem that comes with this model is deciding workload credit or reimbursement. We run into these issues even at the VA where only one service can claim credit for team based work. How will it work when it comes to deciding bonuses in the private sector?

 

[WisNeuro]

This is essentially the value based care model. The big problem that comes with this model is deciding workload credit or reimbursement. We run into these issues even at the VA where only one service can claim credit for tram based work. How will it work when it comes to deciding bonuses in the private sector?

This is why you don't see many neuropsychologists scrambling to create multidisciplinary memory disorder clinics. Tough logistics and difficult not to be holding the short end of the stick reimbursement/productivity-wise.

 

[Therapist4Chnge]

“Bundling” is almost never good for ANY specialist bc being able to charge separately is viewed as revenue generating, while a bundled service doesn’t really allow for “credit” to be seen by the number crunchers. In-pt physical rehab is a great example of this, as the hospital gets paid one amount for 1 treat day and stay in-pt, and why a rehab or neuropsych should only bill independently or risk being seen as a cost and not revenue generating.

 

[texanpsychdoc]

My big thing is, when I view practice's websites that claim to be inclusive and really care for the marginalized, and knowing that a large percentage of folks struggling with MH concerns make up a disproportionate amount of folks that are marginalized is perplexing when they set their fees at $200+ an hour, then they try to mask it as "it's for your best interest that you pay me my cash pay rate because we can get the middle man out of the equation, and I don't have to see as many patients."

As a psychologist who makes really good money and has insurance, I will 100% of time rely on my insurance benefits before I ever went to someone charging $200+ an hour for therapy. If the assumption is, those who are private pay see less people and niche down and only see "left-winged South African flies" as their scope of practice, and therefore represent the highest caliber clinician in their speciality to validate their pricing, then no....I am totally okay with seeing a mediocre provider who accepts my insurance. I was curious to see others' sentiments about this on some Facebook groups I'm on and they as well (for the most part) echoed that they would just as soon use their insurance benefits rather than pay cash.

It's mind boggling "well, if you don't pay my cash rate, you just aren't ready for change then." That's the subliminal message. They are being hypocrites and it's BS.

 

[WisNeuro]

Meh, depends on what you need. If I need a power tool, I can go to Harbor Fright and pick up some cheap knockoff pretty cheap pretty easily. It'll probably get the immediate job done, but probably break in a couple years. Or, I could get a high quality tool that'll last at least a decade. Sometimes it's worth getting quality. Not to say some high priced stuff isn't complete junk, just like in healthcare. If people are willing to pay cash to certain providers when they have access to other providers via their insurance, that's their choice.

 

[PsyDr]

It's mind boggling "well, if you don't pay my cash rate, you just aren't ready for change then." That's the subliminal message. They are being hypocrites and it's BS.

1) I learned to refer marginalized people to CMHCs, a long time ago. When I tried to treat the underserved, I wound up getting in over my head. You're depressed? Okay. You're hungry and need housing? Uhhhh, I'm not exactly sure how to fix that. Your kid has legal issues? Uhhhh... call legal aide maybe? You have no ride and you've been in my parking lot for 4 hrs, and it's getting cold and dark? There is a reason CMHCs have social workers with those resources.

2) That is a strange interpretation. I don't walk into Ferrari and think, "if I don't buy here, I'm not ready to drive a car". I think, "this is not the place for me to buy a car, I need to walk down to Toyota".

3) The way I have handled this: I focus on making money, and give things away when I want to. It is easier to give when you already have.

 

[summerbabe]

My big thing is, when I view practice's websites that claim to be inclusive and really care for the marginalized, and knowing that a large percentage of folks struggling with MH concerns make up a disproportionate amount of folks that are marginalized is perplexing when they set their fees at $200+ an hour, then they try to mask it as "it's for your best interest that you pay me my cash pay rate because we can get the middle man out of the equation, and I don't have to see as many patients."

As a psychologist who makes really good money and has insurance, I will 100% of time rely on my insurance benefits before I ever went to someone charging $200+ an hour for therapy. If the assumption is, those who are private pay see less people and niche down and only see "left-winged South African flies" as their scope of practice, and therefore represent the highest caliber clinician in their speciality to validate their pricing, then no....I am totally okay with seeing a mediocre provider who accepts my insurance. I was curious to see others' sentiments about this on some Facebook groups I'm on and they as well (for the most part) echoed that they would just as soon use their insurance benefits rather than pay cash.

It's mind boggling "well, if you don't pay my cash rate, you just aren't ready for change then." That's the subliminal message. They are being hypocrites and it's BS.

If we take our car to a mechanic, some will charge extremely fair rates and never perform any services except what’s necessary, some are mostly fair but might be more prone to throwing in some extra diagnostics that helps their business’ bottom line or vary charges based on how much they think we know about auto repair and some are straight up grifting every opportunity they have.

I imagine our profession would fall under the same distribution patterns but with different marketing/business tactics and perhaps self-justifications.

But hey what do I know? I just click on my VA VVC links every day and happily collect my standard biweekly direct deposit lol.

 

[texanpsychdoc]

If we take our car to a mechanic, some will charge extremely fair rates and never perform any services except what’s necessary, some are mostly fair but might be more prone to throwing in some extra diagnostics that helps their business’ bottom line or vary charges based on how much they think we know about auto repair and some are straight up grifting every opportunity they have.

I imagine our profession would fall under the same distribution patterns but with different marketing/business tactics and perhaps self-justifications.

But hey what do I know? I just click on my VA VVC links every day and happily collect my standard biweekly direct deposit lol.

I'm doing perfectly fine earning $13-14K a month being an insurance based practice and expect the double that monthly income by the end of the year. I keep things affordable for the broad audience and I also get over 3 times per hour than what I would have earned continuing to work at the VA. There's also many other benefits outside of the salary you get being in private practice vs. working for others. My point being, is you can still provide good quality services, earn a killing and balance those without price gouging the very people we purport to want to help.

 

[borne_before]

My big thing is, when I view practice's websites that claim to be inclusive and really care for the marginalized, and knowing that a large percentage of folks struggling with MH concerns make up a disproportionate amount of folks that are marginalized is perplexing when they set their fees at $200+ an hour, then they try to mask it as "it's for your best interest that you pay me my cash pay rate because we can get the middle man out of the equation, and I don't have to see as many patients."

As a psychologist who makes really good money and has insurance, I will 100% of time rely on my insurance benefits before I ever went to someone charging $200+ an hour for therapy. If the assumption is, those who are private pay see less people and niche down and only see "left-winged South African flies" as their scope of practice, and therefore represent the highest caliber clinician in their speciality to validate their pricing, then no....I am totally okay with seeing a mediocre provider who accepts my insurance. I was curious to see others' sentiments about this on some Facebook groups I'm on and they as well (for the most part) echoed that they would just as soon use their insurance benefits rather than pay cash.

It's mind boggling "well, if you don't pay my cash rate, you just aren't ready for change then." That's the subliminal message. They are being hypocrites and

My big thing is, when I view practice's websites that claim to be inclusive and really care for the marginalized, and knowing that a large percentage of folks struggling with MH concerns make up a disproportionate amount of folks that are marginalized is perplexing when they set their fees at $200+ an hour, then they try to mask it as "it's for your best interest that you pay me my cash pay rate because we can get the middle man out of the equation, and I don't have to see as many patients."

As a psychologist who makes really good money and has insurance, I will 100% of time rely on my insurance benefits before I ever went to someone charging $200+ an hour for therapy. If the assumption is, those who are private pay see less people and niche down and only see "left-winged South African flies" as their scope of practice, and therefore represent the highest caliber clinician in their speciality to validate their pricing, then no....I am totally okay with seeing a mediocre provider who accepts my insurance. I was curious to see others' sentiments about this on some Facebook groups I'm on and they as well (for the most part) echoed that they would just as soon use their insurance benefits rather than pay cash.

It's mind boggling "well, if you don't pay my cash rate, you just aren't ready for change then." That's the subliminal message. They are being hypocrites and it's BS.

Hard agree bro. If I ever went out on my own, I do a lot of learning disability testing/ADHD testing good luck trying to get insurance to pay for that stuff though.

But also, I’d rather have a cash pay business because, and this will be a huge shocker, have a limited mental bandwidth. I’d rather focus on patient care than submitting stuff to insurances, etc. that increased administrating burden is one reason I haven’t set up a practice yet.

I just have limited bandwidth.

But, I also find it interesting that the same people who virtue signal about equity and bill 200+ really hypocritical. But hey, student loans don’t pay themselves, and if your parents are still alive, the family trust probably won’t go into effect for a while.

But honestly, I’d rather pass those savings onto the consumer and more patient hours, you know doing Psychology.

Let’s 200 is the bench mark. I’d much rather see four patients at 150hr than three at 200hr because I like doing psychology.

 

[Sanman]

If we take our car to a mechanic, some will charge extremely fair rates and never perform any services except what’s necessary, some are mostly fair but might be more prone to throwing in some extra diagnostics that helps their business’ bottom line or vary charges based on how much they think we know about auto repair and some are straight up grifting every opportunity they have.

I imagine our profession would fall under the same distribution patterns but with different marketing/business tactics and perhaps self-justifications.

But hey what do I know? I just click on my VA VVC links every day and happily collect my standard biweekly direct deposit lol.

The mechanic analogy is apt. However, I look at it from the mechanic's point of view. Do you want the kind of customer that can only afford the bare minimum (just change the oil and brake pads) and then calls you a bad mechanic when something fails because all they could afford the bare minimum. Or, do you want the kind of customer that does preventive maintenance and changes all the fluids so that the car runs 300k miles. At the end of the day, you need resources to be the second kind of customer.

Same thing with marginalized people. Working with a lot of these people over my career, it is hard to make progress when they can't manage the basics like rent, food, may be doing drugs or drinking to excess, or simply lack a support system to help them. Hard to engage them in interventions when change is impossible in some cases. You need a certain level of resources for what we do to be effective in private practice, imo.

 

[eeor1006]

It's mind boggling "well, if you don't pay my cash rate, you just aren't ready for change then." That's the subliminal message. They are being hypocrites and it's BS.

Funny I have the opposite of the experience. I have worked with marginalized groups throughout my graduate training. I often find the folks who pay next to nothing to see me are not ready to change, for many good reasons. It is hard not to be depressed when you are homeless, have no money, and are stuck in an abusive relationship while caring for four kids. When they come see me, I often find them need something I can't provide. What I can provide, they are too overwhelmed or tired to put them into use or they try them, make some progress, and their reality immediately pulls them back to where they started. I was demoralized a lot.

I now run a cash-only private practice. I charge over $200 a hour, and I enjoy therapy a lot more than I did in graduate school. Remember Yalom's description of the ideal patient, YAVIS or something like that? Many of my patients fit that description and it is just so easy to work with them. They are a lot more ready to change than my community mental health patients. I can actually do what I was trained to do, people actually do homework! I can honestly say I feel I am helping people making tangible and persistent progress.

I still care about marginalized groups, among many other things. I just make annual donations to organizations who are equipped to help them from a broader and systematic level.

 

[WisNeuro]

If someone wants to open a sliding scale clinic, or volunteer time, they can do that, it's their choice. If someone wants to maximize their earnings and charge a high fee and get people to pay that? Good on them. Go for it. I have no problem charging high fees for my services, especially legal. If people want more availability for affordable healthcare services they can vote in representatives that coincide with their healthcare beliefs. If they want someone to blame for their current healthcare predicament, they can look at their fellow voting-eligible citizens, and not providers.

 

[texanpsychdoc]

Hard agree bro. If I ever went out on my own, I do a lot of learning disability testing/ADHD testing good luck trying to get insurance to pay for that stuff though.

But also, I’d rather have a cash pay business because, and this will be a huge shocker, have a limited mental bandwidth. I’d rather focus on patient care than submitting stuff to insurances, etc. that increased administrating burden is one reason I haven’t set up a practice yet.

I just have limited bandwidth.

But, I also find it interesting that the same people who virtue signal about equity and bill 200+ really hypocritical. But hey, student loans don’t pay themselves, and if your parents are still alive, the family trust probably won’t go into effect for a while.

But honestly, I’d rather pass those savings onto the consumer and more patient hours, you know doing Psychology.

Let’s 200 is the bench mark. I’d much rather see four patients at 150hr than three at 200hr because I like doing psychology.

Exactly I think we can strike a balance where folks can have their cake and eat it do. Doesn't have to be either or.

 

[texanpsychdoc]

I fear this topic might derail into a cash pay vs. insurance pay thing, so to reiterate I am curious to see if in some weird alternate reality where a DPC approach could help facilitate increased access to care, especially for those marginzaled but also allows for more earnings and capital gains for private practitioners. Like...let's really think outside of the box and outside of convention.

 

[WisNeuro]

I fear this topic might derail into a cash pay vs. insurance pay thing, so to reiterate I am curious to see if in some weird alternate reality where a DPC approach could help facilitate increased access to care, especially for those marginzaled but also allows for more earnings and capital gains for private practitioners. Like...let's really think outside of the box and outside of convention.

If the goal is to have more access and more earnings/capital gains/dividends income than general insurance/Medicare/Medicaid, it doesn't really matter until you answer the first big question. Who is going to pay for this?

 

[Therapist4Chnge]

3) The way I have handled this: I focus on making money, and give things away when I want to. It is easier to give when you already have.

This has been my approach too. I offer pro-bono services bc it is more efficient than trying to jump through hoops for Medicaid to collect a wholly insufficient reimbursement.

 

[smalltownpsych]

I offer a bundled service for young people with severe/chronic mental health issues that is cash pay. It’s about two thirds of my business and the other third is cash pay outpatient. A concierge service would apply more to my standard outpatient type people and it just doesn’t seem to make much sense. They don’t need extra access, the sicker patients do and we charge accordingly. Truth is since I am cash pay, my patients do get more access to me, it’s just that they don’t typically need it. I will also use interns and other staff to provide additional support and some pro bono/sliding scale stuff too because although I am running a business and want to make lots and lots of money, I still want to be able to help people that we come across that need help and can’t pay. We did about 10k in pro bono last year. We would do more but we can’t always find very many to work with.

 

[SomeGreatNotion]

I offer a bundled service for young people with severe/chronic mental health issues that is cash pay. It’s about two thirds of my business and the other third is cash pay outpatient. A concierge service would apply more to my standard outpatient type people and it just doesn’t seem to make much sense. They don’t need extra access, the sicker patients do and we charge accordingly. Truth is since I am cash pay, my patients do get more access to me, it’s just that they don’t typically need it. I will also use interns and other staff to provide additional support and some pro bono/sliding scale stuff too because although I am running a business and want to make lots and lots of money, I still want to be able to help people that we come across that need help and can’t pay. We did about 10k in pro bono last year. We would do more but we can’t always find very many to work with.

Very interesting! May I ask how you structure the bundled service?

 

[smalltownpsych]

Very interesting! May I ask how you structure the bundled service?

3200 per month each week includes two hours of psychotherapy, 30 minute family education/update call, 2 hours of mentoring/case management with a masters level therapist in training, one hour of group therapy. Also, I work with a company that provides additional mentoring or support or crisis intervention as needed and I meet weekly with the owner of that company to coordinate and advise. We also help with coordinating psychiatric care. One thing that we do that is a plus is having people with masters degrees or are interns in a Masters program who are training to be therapists provide community support and coordination. A lot of what we do is try to replicate the amount of support that is available in a residential setting without the structure and rules thereby allowing patients to develop autonomy. All of our young adults are working and some are going to school, but are not capable of being fully self-supporting at this time. Each individual and their family work together with therapist to negotiate the amount of fiscal support and pathway to independence. Family and patient tend to jump to an all or none way of viewing it which is a setup for regression and getting stuck so we help keep people on a reasonable pace of progress.

 

[WisNeuro]

Kudos, man, getting people to spend almost $600/hour for clinical and case management services is a pretty sweet gig. That's around good forensic numbers.

 

[smalltownpsych]

Kudos, man, getting people to spend almost $600/hour for clinical and case management services is a pretty sweet gig. That's around good forensic numbers.

The good part is we have no real competition because all the other therapists in the area just do the standard once a week insurance based practice. A couple of agencies provide some community mental health with case management based on Medicaid funding that was routed through Optum. It’s pretty weak. I get my patients from residential programs where they were paying up to 20k a month so they are willing to pay quite a bit for what we provide.

 

[SikeThatsTheWrongNumber]

2024 Medicare rates for those services in my GPCI location come out to $396 per week (or $726 if the 2 mentorship hours were to be billed as 90837 instead of t1016).

So approx. $1584 (or $2904 as above) per month.

Nice work! And I imagine much needed and appreciated services, too.

 

[smalltownpsych]

Kudos, man, getting people to spend almost $600/hour for clinical and case management services is a pretty sweet gig. That's around good forensic numbers.

On second glance. The amount per hour is much less. Since I’m primary therapist for most of them, I spend two and a half hours minimum with each per week so about ten hours per month so 320 per hour not even counting that I have to hire people to do the other support. Still able to make a bit of profit and also building things with a goal of not being always providing the direct services myself and still making some money.

 

[FutureCycologist]

Become the preferred assessment/behavioral health referral source for the concierge medical boutiques. That’s what I did.