It has been 15 years since Brian Forrest, MD, a family medicine physician in Apex, North Carolina founded Access Healthcare, which is considered one of the earliest Direct Primary Care (DPC) practices in the U.S.
In this podcast, Forrest highlights the failures he has experienced over the years since starting a DPC practice, and explains how other physicians can learn from his mistakes.
Brian Forrest: I would say that one of the things that I’ve seen as that you have to figure out where your patients are and sometimes that takes a little adjusting, figuring out what patients want, what they desire in the medical practice. Also finding out what they can afford because part of our goal as a practice is to make healthcare affordable for everybody. You sort of have to experiment around with that and know different patient types to figure out what’s going to work for everybody.
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You also have to set up some policies in this model since you’re not billing insurance to make sure that you do get paid. You know our collections have been really, really high and that’s gotten a little better every year but it’s probably around 98% to 99% and the reason for that is we keep it very simple. We use an automated system, a type of software that you know originally the company that developed it used it for those Gold’s Gym memberships. They do a lot of the membership processing for Gold’s Gym. So, we just adapted that to work for our model and it makes the collections pretty seamless. Before we had that in place, I think one of the bigger mistakes was we used things like PayPal and other ways to do monthly billing and we just weren’t reliably getting collections.
Now in terms of mistakes that I’ve seen others make because you know over the years we’ve helped a lot of physicians, but we’ve also seen a lot of physicians sort of do this the wrong way. And unfortunately, sometimes a doctor might read one article, or they might go to a conference and feel like ‘okay I know how to do this’ and then set out on their own without any guidance or mentorship to try to do it and they tweak something this way or that way and it really doesn’t work for them. So, I’ve seen failures where physicians decided to charge too much. Maybe they charged twice the average level as direct primary care. I’ve seen physicians who set up in really, really affluent areas which is actually not good. If you set up in a direct primary care practice in an affluent area, what happens is none of those patients find you because they’re all really well insured, they go to look in their insurance manual and you’re not there.