[faangFar]

Side note on billing. My wife's practice is finally hitting it's celing. She needs to either charge more or hire more doctors + get a bigger space.

She is her brand, so we probably won't get more doctors. But we have slowly raised prices from 50$ to 75$ per hour.

Next we are going to stop accepting some government health insurance because they only pay $60/hr. Long term I can see 125$-200$/hr private pay only.

The alternative to her 1 on 1 care is a hospital/clinic where you get 37 minute visits shared with multiple other clients, and have a new doctor every few weeks due to high turnover.

Word of mouth is more powerful than ads.

[gen220]

This is kind of a deep question, and not meant to cast aspersions on what you're doing, because it's perfectly rational. The world of private doctors who don't accept patients paying with insurance (government or otherwise) is very interesting to me.

Do you think there's a major difference in expected outcome for the average patient, between your wife's practice and a hospital/clinic?

I can totally grok how a patient would find her services valuable enough to pay a much higher rate, out of pocket; but I'm trying to figure out if the payer's arbitrary cut-offs are rational.

Maybe 60/hr is close to the price-point of exponentially-diminishing returns, from the risk-carrier's perspective?

Obviously, institutional payers are way more conservative with risk than financially-well-off individuals, so maybe they're making mistakes on the margin.

Anyways, hope I'm making sense. It's a fascinating topic.

[thoraway1010]

No insurance hassles - I did medical billing for a bit. The insurance co's basically just run around doctors because they KNOW folks give up. You could absolutely force the $40 extra payment if dr + patient etc proved it out / appealed it - but often not worth it. Also govt billing into central county system for the poor - ugh - the bureaucracy / overhead was a nightmare (always having to recertify to financial need / paperwork this and that - 50% of time was on stuff I'd consider no value add).

For a while I had individual insurance (prior to obamacare). Because it had pretty high deductibles, I would just do a private pay / cash doctor for primary care etc.

Some big wins:

NO discussion about whether something was covered or not! You want to get service, just call.

No crazy surprise bills - yes - I once tried to go to urgent care for something at the main hospital, but NO ONE would tell me what I would be charged as a cash pay client. Yes, it can be expensive to do cash pay, but with a doctor billing by the time you can basically predict / know your cost.

Service - you are paying by the hour. I never felt pressured out the door (no surprise). The service is good to great.

Convenience - I got someone close who used his downstairs as his office. Have a problem, go in and get checked out. Because you don't need the huge billing infrastructure I think you can get away with smaller office sizes. To pay for a full time biller you need a few doctors, who then need a receptionist etc etc.

[faangFar]

There seems to be a lot to unpack, so sorry if this is jumping around but I tried to provide lots of details.

My wife has worked at those places and the difference in patient outcomes is night and day. Sure some people will get better regardless, but there's something special about people saying a 3 year old injury has 0/10 pain. At a big name company, they get people "good enough".

She's one of those people that would prefer to be a Physical Therapist rather than a business owner.

As a side note, many of her patients came from that 60$/hr insurance because most places don't accept it. It seems like it's a stepping stone. Knowing her, they will be grandfathered in.

Something I didn't mention is how often she does free work/eat the cost because insurance will deny payment for services that were approved but later deemed "not necessary". (Despite the person being unable to work) It's complicated because a phone call, or Physician, or patient can sometimes fix this.

[clairity]

if she's maxed out, why does she need to make more money? is the point not to help people?

[tootahe45]

no?

[faangFar]

You can only help 40 people per week without cutting down on the care. Another benefit for private pay is that you don't have to spend time on insurances or calling physicians for a prescription.

I talk a big game about raising prices but I know my wife has done free services for disabled children. She's a sucker, and we claim it's advertising/marketing.

Hospitals and big name clinics would never do this.