The Economics of a Mobile Direct Care Practice

Daniel Paull, MD writes that seeing 50+ people a day in an insurance based model is cranking up the hamster wheel to full speed, while a direct care mobile practice breaks the hamster wheel.

A point got brought up the other day that the bottom line of a mobile direct care practice must be paltry. These statements are usually brought up by those that have exactly zero experience in the field of direct care, but I think they express a common sentiment which boils down to the following:


“How are you making any money only seeing a handful of people a day?”


They base their experience on their practice where they are seeing sometimes 50+ people a day, and in the case of orthopedics, operating a lot.

But what are the resources that they consume? What kind of staffing and office space do you need to see 50 people a day? The average is 5 full time employees per physician, but with numbers of 50+ that number can double.

I have seen as high a ratio of 21/1, meaning that 21 people were employed to support one very high volume physician. Many of these people are coders and billers, or medical assistants whose main job is to pre-populate the chart so the doctor can get his or her billing levels. Most of the staff is insurance billing related in one way or another.

The real problem about seeing 50+ people a day in the insurance model, is that you can’t set your prices.

If Medicare decides tomorrow that you only deserve 50% of what you got last year, well, that’s what you are going to get. Say goodbye to your business. This sort of model cranks up the hamster wheel to full speed, and at the day what do you have?


If Medicare decides tomorrow that you only deserve 50% of what you got last year, well, that's what you are going to get. Say goodbye to your #business. Click To Tweet


It’s not about how much money you make, it’s about how much you keep.

The direct care model allows setting your own prices to market rates so you can be profitable.

The mobile aspect cuts the overhead down to almost nothing. There is no hamster wheel. That is how being mobile and only seeing a handful of people a day can be more profitable than the standard hamster wheel practice.


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