The Direct Care Model’s Win-Win For Patients And Physicians


                                             By Grace Torres-Hodges, DPM, MBA

As I approach 25 years of practicing medicine in the same community where my parents dedicated 50 years to their medical careers, I’ve been privileged to develop lasting relationships with individuals who have entrusted me with their health care. The continuity of care and community connection is exactly how many of us envisioned our medical journeys, and for that, I am so thankful!

I recognize the importance of legacy. The profound impact my parents have had is a reminder of the significance of leaving something for the generations to follow. This journey isn’t just about the care I provide today; it’s about ensuring a foundation of excellence, community commitment, and health care sustainability for those who will continue the legacy of healing in the years to come. I feel incredibly fortunate to be part of this continuum of care and community service, leaving a legacy that extends beyond my own practice.

When asked about what’s different about my direct care/direct pay practice, I always start off with, “I didn’t change how I practice medicine; I just changed how I interacted with the system.”

However, one of the questions that always seems to be brought up anytime that I have the opportunity to address physicians about considering transitioning to a direct care/direct pay private practice is: “What about the patients who can’t afford you?”

First off, understand that you can’t treat everyone! It’s not realistic to think that you can. There are only so many hours in a day. Secondly, your ability to treat low-income or medically indigent patients is not contingent on the business model you use to run your business! Eliminating third-party payor requirements and oversight allows you more freedom and flexibility. You can be more intentional with your time. You can continue treating low-income or medically indigent patients if you so wish – either in an outside community clinic or within your own office. In my experience, it’s much more rewarding to treat my financially at-risk patients without a large bureaucracy looking over my shoulder. I am able to use my skill, training, and experience to help a high-risk individual – without interference. It’s just the patient and me.

As physicians, our commitment to providing compassionate care to all patients is at the core of our professional ethos. It is part of WHY most of us went into medicine! And more often than not, there always seems to be a skepticism that arises when contemplating a shift that may seem to limit a patient’s access to us. The concerns about potentially reneging on our ethics and excluding patients based on financial means are valid. However, I have found that by eliminating third-party payor contracts, I can spend MORE time with my medically indigent patients AND have a more profitable business! It’s not an “either/or” situation; it’s a “both/and” situation.

Transparent pricing is actually a path to inclusivity.

Transparent pricing not only fosters openness about the cost of health care services but also creates a unique opportunity for physicians to engage in meaningful discussions about alternative payment plans. By laying out clear and understandable costs, patients are empowered with information that allows for informed decision-making. With the opportunity to have built the doctor-patient relationship on communication, this transparency can open doors to discussions about alternative pricing.

This can include anything from tiered pricing and sliding scale fee structures to bundled pricing (for most of us in surgery, this allows us to work up prices for patients that are inclusive – the physician fee, facility, and anesthesia are priced together) and payment plans (which are negotiated predetermined amounts and due dates). In this context, the physician and patient can collaboratively explore options that align with the patient’s financial situation, fostering a sense of mutual respect and accountability. I have found this more respectful of the patient’s dignity as opposed to allowing the insurance company to make all relevant financial decisions. The latter disempowered my patient and left us in a situation where we both had to “take it or leave it.” The patient had the negative incentive of postponing or canceling the treatment or procedure, and I was often left with the choice of not providing the service or treating them at a financial loss to my practice.

A physician should never be faced with the decision to postpone or cancel treatment, and you don’t want to send people to collections. I don’t mind providing reduced cost or free care to those who need it; however, as a partner in my patient’s health care, it should be the patient and the physician to make these decisions, not an insurance company.

Eliminating administrative overhead: Passing on the savings.

Transitioning to a direct care/direct pay model not only streamlines our administrative processes in delivering health care, but it positions us as small business owners, attuned to the principles of sound financial management. Understand that as a private practice owner, you are a small business – you have been one whether you have realized it or not.

By eliminating the cumbersome overhead associated with insurance billing such as prior authorization, referrals, and delays in reimbursement from things such as payment denials and coding corrections, we gain the flexibility to navigate our revenue cycle independently. As small business owners, we recognize the importance of balancing income and expenses, responding dynamically to market pressures, and having control over the financial trajectory of our practices. This autonomy allows us to pass on the resulting cost savings directly to our patients, fostering a health care experience that is not only more affordable but also reflective of our commitment to delivering high-quality, patient-centric care.

As we look ahead, the longevity and sustainability of private practices adopting this model can be instrumental in affording doctors with independence – thus ensuring physician autonomy both clinically and financially as well as contributing to the overall sustainability of health care. It’s critical that the business side of our practice aligns seamlessly with our commitment to delivering excellent care, but at the same time, it is important that we are always forward-thinking to lay down a foundation for a health care landscape that remains robust and patient-focused in the years to come.

Emphasizing preventative care creates a long-term investment.

Promoting the direct care/direct pay private practice model represents a multifaceted, long-term investment in the well-being of both patients and physicians. Delivery of care in this model tends to be more proactive than reactive and this fosters more emphasis on prevention. The emphasis on preventive care reflects our ethical dedication to averting major health issues and lessening the strain on the health care system over time. Consider what thinking this way does if more physicians adopt the practice. This strategic approach aligns with a broader vision for a healthier society by addressing health concerns proactively. Additionally, the incorporation of additional services, such as wellness programs (that promote exercise and nutrition) and alternative therapies, fosters a more holistic health care environment.

Simultaneously, the shift toward a direct care/direct pay model allows us to prioritize patient-centered care by reclaiming time that was once burdened by administrative tasks. This dedication to personalized attention not only aligns with our ethical commitment but also builds a mutually respectful ecosystem, valuing both the individual patient and the physician. In the long run, this holistic and patient-centered approach fosters a sustainable health care environment, contributing to better health outcomes, increased patient satisfaction, and the overall well-being of our health care system.

A win-win benefits all of us.

In contemplating a move towards a direct care/direct pay private practice model, skepticism may abound, rooted in concerns about ethics and inclusivity. However, a closer examination reveals that this model not only aligns with our commitment to patient care but also brings forth a host of benefits for both physicians and patients.

For physicians, the transition allows a return to the core principles of our profession. It restores the doctor-patient relationship by providing the time and attention needed for comprehensive, individualized care. The elimination of administrative hassles not only reduces burnout but also allows us to practice medicine in a manner that aligns with our ethical obligations.

Patients benefit as well by gaining access to a health care experience marked by transparency, affordability, and enhanced services. Tiered pricing and payment plans cater to diverse financial situations, ensuring that quality care remains within reach for a broad spectrum of individuals. The emphasis on preventive care, coupled with additional services, contributes to an overall improvement in health outcomes.

This independent private practice model nurtures a health care ecosystem where both physicians and patients feel empowered. It breaks away from the limitations imposed by the traditional insurance-driven paradigm, offering a more sustainable and patient-centric alternative.

The skepticism surrounding the adoption of a direct care/direct pay private practice model may stem from a fear of departing from established norms but that can be alleviated by education. As physicians, our commitment to ethical, compassionate care remains unwavering. Embracing this model is not a reneging on our ethics but rather, it can become a reaffirmation of our dedication to the well-being of our patients. It is a step towards a health care landscape and a legacy where both physicians and patients thrive — a true win-win scenario for the entire health care ecosystem.

Grace Torres-Hodges is a podiatrist.


Articles in this issue:

Journal of Medicine Sign Up

Get the Journal of Medicine delivered to your inbox.

Thank you for subscribing.

No membership required*


    • Editor-in Chief:
    • Theodore Massey
    • Editor:
    • Robert Sokonow
    • Editorial Staff:
    • Musaba Dekau
      Lin Takahashi
      Thomas Levine
      Cynthia Casteneda Avina
      Ronald Harvinger
      Lisa Andonis

Leave a Comment

Please keep in mind that all comments are moderated. Please do not use a spam keyword or a domain as your name, or else it will be deleted. Let's have a personal and meaningful conversation instead. Thanks for your comments!

*This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.