There is an increasing trend toward cash-based medical practices. Some are the high end “Anti-Aging” or “Age Management” practices that regard aging as a treatment condition that can be significantly delayed by the use of hormone replacement, nutritional supplements and other non-conventional medical conditions. Other cash practices are typically family practices that have become frustrated with the insurance model and have begun the new paradigm of cash-based medicine. Everyone shares the basic principle that they do not have contracts with insurance companies and instead require patients to pay cash for medical services provided.
In order to be successful and profitable in the insurance model, practitioners must have very high daily patient volumes (35 – 40 for a single practicing family practice) to generate the income needed to earn a “professional” income level. Along with the high volume comes a lot of costs including a large office and several support staff just for starters. Due to the amount combined with a number of logistical factors (patients arriving late, office inefficiency, etc.), patients typically have to wait 30 – 60 minutes or more from their scheduled appointment time, all this just to spend an average of 6 minutes with the doctor. The inefficiency of this model is at least partially responsible for the relatively low overall effective health care in the United States compared to other industrialized countries.
The “new” medical profession
The “new” medical profession is about prevention, new revenue streams operating in a “cash” model, maintaining a quality / doctor / patient relationship, yet operating with company-like efficiency. Technology is enabler for the new medical profession, and the right technology must be quick to implement, easy to use, accessible 24×7 for patients and staff and be very cost-effective.
In the new paradigm, doctors see as few as 7 – 10 patients per day. Today, have a much smaller staff, significantly lower overhead and have the ability to truly participate in wellness, identify root causes of illnesses rather than just focus on symptoms and therefore positively affect outcomes. The patient pays the doctor cash by circumventing the insurance model and all the accompanying reimbursement rules that many believe disrupt effective patient care and favorable outcomes.
However, without effective technology to make this possible, cash practices will still have a greater than required staffing and expense costs, much like the insurance model’s practices, which affect this model’s longevity. The primary enabling technology for cash practices can be broadly categorized as “self service” technology. For example, rather than having an employee scheduling appointments for patients, practices can implement a web-based scheduling system for self-service appointments. There are several low cost systems on the market today that offer a high level of configurability to accommodate medical plans, multiple appointment types, and virtually any scheduling complexity a human can manage. Since many of the practices operating in the new paradigm offer supplements for sale, an Internet shopping cart is the natural solution to this rather than having an employee ordering it. Again, there are several commercially available tools that can meet this need. Overall, the needs for cash practices can be summarized with the following list of requirements:
- Patient Management Database (profiles, demographics, surveys)
- Electronic medical records
- appointment Scheduling
- Marketing and communication for prospective patients and patients
- Shopping cart
- Accounting / Financial Management
Continuing with the approach described above, cash practices could implement multiple commercially available tools to meet this unique set of needs as the typical practice management systems offered today continue to target the practices that operate in the insurance model and typically do not include shopping carts, true self-service contract planning. , a marketing and communications engine or financial management. However, using the approach to implementing multiple systems creates yet another inefficiency as patient demographics need to be entered and maintained across multiple systems, and it is important that there is no support for the ideal business process in this scenario.
Activation of technology for cash medical practice
But now there is a new opportunity for cash medical practice to face these problems. Using XML, HL7, and today’s integration technologies, it is possible to integrate third-party applications into the “cloud,” allowing all systems to share a common demographic database, while still excluding practices from hosting hardware or software. In this target environment, practices can use multiple self-service applications, integrate them using a modern integration method, and add workflow to provide additional efficiencies. This approach has low cost of entry, relatively low overall cost of ownership, but nevertheless delivers significant benefits for practice.
Undoubtedly, the major software companies will eventually see this niche and provide fully integrated applications to service them, but currently monetary practices have at least one viable opportunity to leverage technology to allow doctors to practice medicine, patients get better care and practice to be profitable.
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