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Specialty Referrals: The Basics
As a DPC physician, you have already shown the patient that transparent, fair pricing is possible within your walls; however, doing so outside your clinic can prove challenging. When referring a patient to another physician, here are the considerations and options:
DIRECT-PAY OPTIONS: Increasingly, specialists and other types of medical professionals are offering an upfront, direct-pay option for patients who wish to avoid the hassles of insurance. However, the number of specialty direct-pay options will be heavily dependent on your community and region. It is largely up to you (and your local DPC colleagues!) to forge relationships with specialists to create your cash-pay referral network. Share resources and direct pay specialists with your local DPC community. Consider a shared online folder with pricing lists for specialists who have shown interest in giving your patients direct service.
PATIENTS WITH INSURANCE: If a patient has an insurance plan with an “open” network* (most PPOs and Medicare), you can refer to a physician in their network as usual. The billing and patient costs may not be transparent. Advise the patient of this and encourage them to seek out cost estimates prior to service where possible. Small independent practices and facilities will generally have lower costs to insured patients compared to hospitals or large health systems. Also, it is worth noting that patients using insurance may end up with more out-of-pocket costs than they would have if using direct-pay options!
* If a patient has an HMO, these plans often require an in-network PCP, who is often assigned to the patient, to be the gatekeeper for all other care/coverage. This requirement is less than ideal for the patient and you. (See DPC and Insurance for more details)
Networking to find local direct-pay resources
There are a few ways to help you find existing direct-pay (also called cash-pay or self-pay) specialty and ancillary resources in your area.
- Local DPC physicians: Many have compiled a group of resources and are happy to share. Repay the favor by sharing future resources.
- Regional DPC groups: There are regional DPC clubs or organizations in some areas of the country that share resources, including direct-pay options. (Disclaimer: These have no official affiliation with DPC Alliance.)
- Charitable medical clinics/organizations: Some charitable clinics geared towards uninsured patients will have a list of providers in a community who have “cash” or self-pay rates. Reaching out to their doctors or practice managers may be helpful.
- City or county medical society. If you have an active local medical society, you should reach out to them to discuss any existing options. If none exists, you can use the organization to network with specialists who may be willing to see direct-pay referrals.
- Local physician-only social media groups: post on these groups describing the DPC model and what you are looking for in an independent specialist practice.
- Set up your own local social media group for independent physicians: Many physicians are too busy to attend networking events. Consider setting up a local DPC or independent physician social media group to get to know one another and encourage professional connection. You can use this to educate specialists in direct care and provide resources for them which many are unaware of.
- Hold your direct pay specialists to high standards of care: When you send a patient to a specialist, you have given that patient your recommendation. Cash pricing alone does not dictate the level of care. Do not settle. If you/your patient are dissatisfied with the care that was provided, it reflects poorly on your DPC reputation. Call and ask to discuss what happened. If the specialist is defensive/angry/uncommunicative/unwilling to be reasonable, move on. Find another practice who will work with you directly on your patients’ needs. DPC physicians have high expectations of specialists:
- Direct communication between physicians
- Timely appointments for patients
- Follow up information from a physician after the visit
- Price transparency and working towards bundled pricing
- A positive patient experience
Direct Specialty Care
In 2021 Direct Specialty Care Alliance was founded, in response to the increasing interest of medical specialists in the Direct Care Model. DSC Alliance is physician founded, physician led, physicians helping physicians to offer direct care services.
As more specialists transition to Direct Care practices and transparent, cash, pricing, you can often find a specialist with the same values and a similar model to your DPC Practice. A directory of DSC Practices can be found on their website, www.dscalliance.org.
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Specialty Referrals: The Basics
As a DPC physician, you have already shown the patient that transparent, fair pricing is possible within your walls; however, doing so outside your clinic can prove challenging. When referring a patient to another physician, here are the considerations and options:
DIRECT-PAY OPTIONS: Increasingly, specialists and other types of medical professionals are offering an upfront, direct-pay option for patients who wish to avoid the hassles of insurance. However, the number of specialty direct-pay options will be heavily dependent on your community and region. It is largely up to you (and your local DPC colleagues!) to forge relationships with specialists to create your cash-pay referral network. Share resources and direct pay specialists with your local DPC community. Consider a shared online folder with pricing lists for specialists who have shown interest in giving your patients direct service.
PATIENTS WITH INSURANCE: If a patient has an insurance plan with an “open” network* (most PPOs and Medicare), you can refer to a physician in their network as usual. The billing and patient costs may not be transparent. Advise the patient of this and encourage them to seek out cost estimates prior to service where possible. Small independent practices and facilities will generally have lower costs to insured patients compared to hospitals or large health systems. Also, it is worth noting that patients using insurance may end up with more out-of-pocket costs than they would have if using direct-pay options!
* If a patient has an HMO, these plans often require an in-network PCP, who is often assigned to the patient, to be the gatekeeper for all other care/coverage. This requirement is less than ideal for the patient and you. (See DPC and Insurance for more details)
Networking to find local direct-pay resources
There are a few ways to help you find existing direct-pay (also called cash-pay or self-pay) specialty and ancillary resources in your area.
- Local DPC physicians: Many have compiled a group of resources and are happy to share. Repay the favor by sharing future resources.
- Regional DPC groups: There are regional DPC clubs or organizations in some areas of the country that share resources, including direct-pay options. (Disclaimer: These have no official affiliation with DPC Alliance.)
- Charitable medical clinics/organizations: Some charitable clinics geared towards uninsured patients will have a list of providers in a community who have “cash” or self-pay rates. Reaching out to their doctors or practice managers may be helpful.
- City or county medical society. If you have an active local medical society, you should reach out to them to discuss any existing options. If none exists, you can use the organization to network with specialists who may be willing to see direct-pay referrals.
- Local physician-only social media groups: post on these groups describing the DPC model and what you are looking for in an independent specialist practice.
- Set up your own local social media group for independent physicians: Many physicians are too busy to attend networking events. Consider setting up a local DPC or independent physician social media group to get to know one another and encourage professional connection. You can use this to educate specialists in direct care and provide resources for them which many are unaware of.
- Hold your direct pay specialists to high standards of care: When you send a patient to a specialist, you have given that patient your recommendation. Cash pricing alone does not dictate the level of care. Do not settle. If you/your patient are dissatisfied with the care that was provided, it reflects poorly on your DPC reputation. Call and ask to discuss what happened. If the specialist is defensive/angry/uncommunicative/unwilling to be reasonable, move on. Find another practice who will work with you directly on your patients’ needs. DPC physicians have high expectations of specialists:
- Direct communication between physicians
- Timely appointments for patients
- Follow up information from a physician after the visit
- Price transparency and working towards bundled pricing
- A positive patient experience
Direct Specialty Care
In 2021 Direct Specialty Care Alliance was founded, in response to the increasing interest of medical specialists in the Direct Care Model. DSC Alliance is physician founded, physician led, physicians helping physicians to offer direct care services.
As more specialists transition to Direct Care practices and transparent, cash, pricing, you can often find a specialist with the same values and a similar model to your DPC Practice. A directory of DSC Practices can be found on their website, www.dscalliance.org.