Questions about a more independent practice?

We work with physicians and practice owners who are thinking about how their practice is paid. That includes physicians considering Medicare opt-out, physicians weighing a move away from commercial insurance, and physicians who simply want to understand the landscape before deciding anything.

Practice administrators are welcome to reach out on behalf of a physician or practice.

No. Orthopedic surgery is a founding area of focus and shapes how we think about surgical practices, but the questions involved in practice payment change are shared across many specialties.

Where a question depends on specialty-specific billing, referral patterns, or facility relationships, we will say so rather than assume your situation matches another practice.

No. They are two separate decisions with separate requirements.

Medicare opt-out is a specific regulatory subject governed by federal rules and administered through Medicare Administrative Contractors. Ending or changing commercial payer participation is a contractual matter governed by the agreements you signed with each payer.

A practice can pursue one without the other. Many practices evaluate them on different timelines.

Direct-pay describes a payment arrangement in which the patient pays the practice directly rather than the practice billing an insurer for that service.

It is a description of how money moves, not a description of practice structure. Two practices can both be direct-pay and look nothing alike in how they schedule, price, staff, and communicate.

Not automatically. Concierge and membership describe practice structures, most often a recurring fee for defined access or services. Some practices that use these structures still participate with insurers for covered services, and some do not.

The structure you choose does not by itself settle your Medicare participation status or your obligations under existing payer contracts. Those need to be reviewed on their own terms.

Yes. Exploring is a normal and useful place to start, and the consultation request form includes a still exploring option for exactly that reason.

Submitting an inquiry does not commit you to changing anything about your practice.

No. Any practice change carries uncertainty, and patient response, local market conditions, referral relationships, and your own pricing decisions all affect the result.

What we can do is help you think through the assumptions behind a plan so you understand what has to be true for it to work, and where the risks sit.

Patients need clear, unhurried information about what is changing, what it will cost them, how the practice will work day to day, and what choices they have.

That usually means planning the message before the change, preparing your front desk and clinical team to answer questions consistently, and giving patients enough notice to make their own decisions.

It varies, and we will not quote you a timeline before understanding your practice. Timing depends on your existing payer agreements and their notice provisions, your patient mix, your financial runway, staffing, and how much preparation your practice needs before the change is visible to patients.

Some practices move deliberately over many months. Others determine that now is not the right moment, which is also a legitimate outcome.

The first conversation is about your practice as it exists today: how you are paid now, what is prompting you to look at this, what you would want to be different, and what constraints you are working within.

From there we can talk about which education and guidance would actually be useful to you. To begin, send a consultation request with a short note about what you are considering.