Podiatry practices that do not deal with any insurance.

[mandrew]

Are there any private practice owners out there who do not accept any insurance plans, patient pays for all services? If so, how did you get there and are you pleased with your decision to not accept any insurance?
I know of only one on the East Coast and one on the West Coast, but was thinking there must be more pods doing this. Thanks for your input.

---

Members don't see this ad.

 

[Weirdy]

Knew a guy who had the same setup. Cash pay only with a menu of all items and their prices. Dude was very well off.

No idea how you would start one.
Think there was a user on here who did something similar, maybe @Creflo ?

 

[pod squad]

I think it is probably feasible if your overhead is very low and you practice in an area where people have disposable income. The tricky part is you have to opt-out of Medicare and that requires a 2 year minimum before you can opt back in, so it's a bit risky. Seems to me that most PP these days take insurance but also rely on non-covered cash pay services to boost their revenue. But ya, insurance sucks.

 

[Feli]

I don't think it's very viable for our specialty.
The only podiatrists I know who do cash pay offices do it as more of a hobby (family money or spouse is majority breadwinner), or they are in a very affluent place and had a very strong reputation or niche built awhile ago (house calls, certain procedure or machine, etc). It's typically both.

The cash pay ("direct care") thing is viable for primary care and some MD specialties that do few/no procedures (most IM specialists), and it works because they are in high demand. The nearby offices of same specialty/services are on substantial wait, they rush through visits, etc... so people will pay cash to get in sooner and a bit more f2f time for those types of docs.

Mainly, you need two things for cash pay:
1. The service is in demand and hard to get in with otherwise with normal insurance-based peer clinics
2. The office visits people are cash-paying are affordable (nobody obviously wants to cash pay facility fees for surgery or heart cath)
[ and maybe 3. The doc/skill is ridiculously better (perception) than others in the area. ]

However, cash pay is a huuuge risk for most ordinary DPMs who are trying to make a regular living, pay loans, support (or help support) a family on their earnings. It fails massively right on #1 above. The reason it's a risk in podiatry is the saturation. People want to use insurance if they have it... and RFC is a ton of the podiatry pie. They need to use their insurance for surgery, so that portion also goes bye if many nearby let them use it. If anyone can find a place where there aren't other DPMs where at least one of them can see a patients within a week or two (and let them use insurance), then wow... that's rare for podiatrists. Set up shop there if the payer mix is decent and just have a conventional insurance-based podiatry practice. You'd do well.

...It is the dream to remove insurance hassles, though.
I just don't see it in 99% of areas for podiatry. There are too many of us.
We're not derm or nephro or rheum with a rare + affordable skill... not even PCPs or psychiatry or endo where the service is reasonably rare.

 

[Creflo]

I know of about 6 pods who have done it successfully. I'm sure there are more. Most, but not all of the ones I know of have marketed their plan to some extent via books, podcasts, memberships, courses, etc. I have bought a couple of the books and found that much of the content covers why to opt out and general business principles. But the real question is how to get patients. My practice has been a hybrid (original Medicare and cash only) until recently when I decided to opt out of Medicare. I would say that the way to pull it off is to have a solid business (accounting, taxes, marketing, etc) education/foundation, avoid debt, live below your means (Dave Ramsey principles), keep overhead low, serve your patients, and slowly drop insurance plans. It doesn't happen overnight, it took me about 7 years to feel ready to take the plunge. From what I can see today, I think it's going to become easier to do and more popular as inflation rises and it will become more difficult to serve patients at the level of payment provided by insurance.

 

[Hybrocure]

The cash pay guys I see generally appear to be guys who built up their practices in the golden age of podiatry and shifted to cash pay after they already built their nest egg back when insurance paid well