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Add new revenue streams to combine quality and quantity


Primary care physicians want to deliver excellent patient care, but often find they are forced to focus on volume instead of quality to keep up with their insurance contracts.

Key Points

Primary care physicians want to deliver excellent patient care, but often find they are forced to focus on volume instead of quality to keep up with their insurance contracts. While some physicians have chosen concierge medicine as a way to offer better patient care, others are taking a "hybrid" approach by finding ways of adding revenue that allow them to shift from quantity to quality without entirely forsaking insurance dollars.

These additional earnings can come in many forms, such as charging patients an annual fee for enhanced access to their physician, or offering noncovered, cash-only services, such as personal training and medical spa therapies.

"The old model of healthcare is broken and physicians are forced to look at new ways to treat their patients," says Gregory A. Oliver, DO, a primary care practitioner in Indianapolis. "The profession is trying to find more cost-effective ways to manage their patients better."

Oliver's main practice is a traditional insurance-based model, but he has created a second practice, The Midwest Center for Healthy Living, that offers services such as smoking cessation and weight loss, for which patients are willing to pay out-of-pocket.

"We are growing like crazy and it's mostly been from word-of-mouth," he says.

For example, while most insurers would just cover an office visit and basic medications for a patient seeking help to stop smoking, The Midwest Center delivers a much more comprehensive approach. This includes an EKG, pulmonary function testing, medical examination, behavior modification assistance, and, when appropriate, injection of atropine and scopolamine, all for $399.

"Basically, we do whatever it takes to help patients stop smoking," Oliver says. "Too often, physicians only focus on treating disease entities, but if we can help patients actually stop smoking, or lose weight, we have really improved their lives. Unfortunately, we often don't get paid for that type of work," he adds.


Another practice that has recognized that additional revenue streams can allow physicians the time to practice more rewarding medicine is Rittenhouse Women's Wellness Center in Philadelphia. The practice was founded about two-and-a-half years ago by Leslie Saltzman, DO, who is medical director, and her husband, Robert Saltzman, who had experience marketing medical devices.

Leslie Saltzman's mother was a primary care physician who even made house calls, and the family lived above her practice. Upon finishing medical school, Saltzman was determined to deliver this type of personalized care as well. After extensively studying the marketplace, she and her husband founded the practice with the commitment to accept insurance while still delivering excellent care, such as wait times of 10 minutes or less, hourlong first appointments, same-day visits for sick patients, and staying open 2 nights a week and Saturdays.

Communication is a priority in the practice. Patients can email their physician and expect a response within 24 hours. After-hours emergency calls are answered by a physician. Their electronic health record system features electronic prescribing and tracking systems that alert the doctor if a patient isn't completing necessary tests.

"We offer a level of service that is above what you get at many primary care practices," Robert says. "We call it an 'enhanced level of primary care.' Our doctors are not pushed to see as many patients as possible. Instead, they are pushed to offer quality."

Delivering the desired level of care requires keeping physicians' patient volumes low, and the practice earns the additional revenue needed to do that by offering extra services that are attractive to its clientele. Some are covered by insurance, such as nutritional and psychological services, while others are not, such as a fitness facility with personal trainers, a medical spa that provides skin treatments, laser hair removal, spider vein removal, and injectable cosmetic medications. The practice captures additional revenue by offering billable services such as spirometry and an onsite lab.

"Patients want what a concierge practice offers, but do not want to pay any additional fee. We deliver that, providing enhanced service for standard insurance reimbursement," Robert says. "We adhere to patient-centered medical home standards.

"There is more to healthcare than just accurately diagnosing and treating ailments," he adds. Women want a doctor who listens to them. "My wife spends 1 hour with every new patient and the shortest appointment time is 15 minutes. Many times she finds the patients just want to talk. She even gives them her cell phone number to call or text her."

The practice has about 3,000 patients and continues to grow rapidly. It added a third physician recently, and Robert predicts more will be hired soon.

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