Why Forrest Direct Pay?

When I started a cash-only, Direct Pay practice nine years ago, my reasons were simple: spend more time with my patients, provide better care, and live a better life.  

I was uncomfortable signing insurance contracts that limited my ability to care for my patients. I was unwilling to sign an employment contract that required me to see a patient every 7.5 minutes, or lose a productivity bonus.

Nine years later, my practice Access Health Care in Apex, North Carolina is living proof that primary care physicians can provide better care to more patients more economically while making significantly more income if we start answering to our patients instead of answering to insurance companies or government bureaucrats.

Our model attracts a lot of interest:

  • Interested in low cost? How about a patient reducing her expenses managing her diabetes from $5,000 per year to less than $500?
  • Interested in improved outcomes? How about 91% of patients achieving their target blood pressure within 6 months? How about being named one of only four Cardiovascular Centers of Excellence in our state?
  • Interested in quality of life? How about only scheduling eight patients per day, leaving ample time for walk-ins and same day appointments, and never seeing more than 16 patients per day?
  • Interested in reducing professional liability? How about your malpractice premium being cut in half, and having zero risk of Medicare recovery audits?

As word about my practice began to spread, I began answering questions from other physicians looking to start or transition their own practices following our Direct Pay model. Over the past five years, those questions evolved into a consulting practice helping over 75 physicians across the country, in specialties ranging from family medicine to ophthalmology.

Initially, it was just a few lunch meetings, phone conferences, and informal advice. However, physicians began requesting in person consulting with on-site visits to my practice. I blocked out half days on Friday and would spend that time explaining some of the details that make my practice work. Physicians have flown in from California, Arizona, Illinois, Pennsylvania, Ohio, and Texas just to name a few.

I felt I had to charge physicians for this time since it cut down on my time to spend with patients. Initially I charged $2,000 for a half day, but so many physicians wanted to participate that I increased that to $3,500 to focus on people who were really committed. There have been days I have received 200 emails from physicians wanting help. Needless to say, I was getting overwhelmed by the numbers of requests and could not meet them all.

Thanks to Forrest Direct Pay, we've improved the consulting process by making the information I provide available as an online curriculum, plus additional resources to help physicians make a "turnkey transition".I can have my Fridays back to see patients, physicians do not have to fly across the country, and we can help more physicians take back health care.

Of course, anyone is free to do cash practice if they like -- the more the merrier. Practicing without taking insurance is not a new idea. However, some of the things we've learned over nine years of refining Direct Pay are unique innovations, formulas, and methods that allow physicians to really thrive in this type of practice.

It's also important to understand where Forrest Direct Pay fits relative to other companies offering practice consulting and transformation services. Some examples:

  • MDVIP charges the doctor $500 per patient per year to transition into concierge medicine. That means that 2 patients pay for a year of our service at the Basic level and 7 patients pay for our service at the Full Access level.
  • SignatureMD charges up to $100,000 per practice to convert it to a concierge model.
  • TRANSFORMED is a consulting firm that grew out of a subsidiary of the AAFP. It charges around $3,000-$5,000 for the initial consultation and up to $100,000 to help you transform to an NCQA-accredited Patient Centered Medical Home.

To compare and contrast these offerings, consider that concierge practices are good for doctors and the patients who can afford them. However, they decrease access for patients who cannot afford the extra fees that typically exceed $1,000 per year. Also, concierge practices worsen the provider shortage by making patient panels much smaller. Finally, most concierge models (such as MDVIP) still bill insurance and government payers in addition to upfront concierge fees, so those practices still carry the risk of Medicare audits and accompanying criminal liability.

In PCMH, the assumption is that payers will eventually pay more money for practices that are certified in this more efficient and coordinated patient care model. In some states insurers have paid these practices a little more. However, this model is still dependent on the whims of insurance companies and government payers.

PCMH and our Direct Pay model are not mutually exclusive, however -- we will be getting PCMH certified ourselves this year and look forward to helping other Direct Pay practices do so as well. We will be certified in providing PCMH care even though we will not be getting paid more -- it does increase overall practice efficiency by about 15% even without increased reimbursement.

So that's the long story of how ForrestDirectPay.com got started, and why it exists. It's entirely due to physician demand. I have never advertised or marketed my consulting services before now. It's just that when physicians can cut their patient volume each day in half and make 2-4 times their old salary -- they get excited about it.

Joining Forrest Direct Pay does not make you an employee of Forrest Direct Pay, or limit your options within your practice. In fact, just the opposite. It allows you to operate as independently as you like but just gives you access to resources to help make you successful.

I hope that helps you understand the concept, and I look forward to welcoming you to Forrest Direct Pay!

Brian Forrest, MD