A strong sense of personal responsibility and taking care of staff has helped orthopedic surgeon David Bailie, MD, run a successful practice with a cash basis model.
A strong reputation is important to getting a cash basis model practice off the ground, Dr. Bailie, who owns Scottsdale-based Arizona Institute for Sports Knees and Shoulders, told Becker's. But there are other strategies that can keep it and other solo practice models thriving.
Note: This conversation was lightly edited for clarity.
Question: What are three pieces of advice you have for spine and orthopedic surgeons who want to transition to a cash basis model?
Dr. David Bailie: Number one, treat the patient like they are your fragile child all the time even in the most routine case. Then demand that same type of approach by everybody on your team. Do not delegate to anybody if you're going to go cash basis. You need to take responsibility from start to finish even if you trust your physician assistant. I trust the PA who has worked with me. She has been in the business for years and worked with me for years, but I close my wounds nearly all the time because I own that patient. Take personal responsibility, like your life depends on it, and this patient's life depends on it from start to finish, because it does.
Number two, be fair and transparent — don't price gouge. If you've been in practice long enough, you know what you're getting paid from insurance and you know what you think is fair. So for rotator tear costs, I have a small, medium, large and massive fee schedule. If I get into a medium-size tear and I already charged the patient and it's way worse, I don't change the [price]. That's my risk for not being able to figure that out ahead of time. I'm fair and transparent with everything. I turn a lot of people away from surgery who are willing to pay because I don't think they need it. … Over time, that reputation gets even stronger.
Third, you have to be lean in your overhead and remove all waste from how many staff you have to how you function as a clinic role and drain that you go to the office every day and or your staff is in the office every day. I pay my staff a salary. They don't clock in and clock out. They're paid 40 hours a week, 52 weeks a year on a salary. They can come and go as you please. When I'm out of town, they can do whatever if the work's getting done and I don't hear a patient complaint. I don't want to worry about staff clocking in, clocking out, padding hours or being slow so they can get more hours being inefficient. And frankly I've only had two after-hours calls in 10 years.