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Business Observer Tuesday, Sep. 15, 2009 12 years ago

Sarasota doctor goes with flat fee

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For several decades, Sarasota internist Dr. Randy Silverstine ran his own solo medical practice, but that ended last November when he says rising costs convinced him to join a group-run practice.

For several decades, Sarasota internist Dr. Randy Silverstine ran his own solo medical practice, but that ended last November when he says rising costs convinced him to join a group-run practice. Less than a year later, Silverstine is gearing up to reopen his own practice with new a business plan designed to disentangle it from the cost and regulations of insurance and Medicare.

Like the growing concierge model, Silverstine's new practice will accept no insurance or Medicare payments, but unlike most plans patients only need to pay $600 a year. For $600, patients are being offered 24 free office-visits a year and easier access to the doctor through same-day appointments, 24-48 hour return phone calls and 24-hour, seven-day a week availability to the doctor.

“It has become more and more difficult to run a viable practice,” Silverstine says. “Before I left private practice, I was working close to 85 to 90 hours a week. My accountant said I was making close to $25 an hour. My overhead was close to 85%. I found out [in the group practice] that I had traded one whole set of problems for another set. The response so far has been extremely positive to this new practice.”

Silverstine was opposed to the more expensive concierge model so he devised a model that he felt was affordable to the majority of his patients.

“The number we came up with was $50 a month,” Silverstine says. “Most people spend that much money on bottled water or pet food. Plus doing this makes me Obama-proof. Don't get me wrong, I voted for him. (But) if Medicare reduces rates by 50% to 20% my practice is fine.”

The change will also cut down his practice from six employees to four. One area were Silverstine plans to spend money is on electronic medical records and a Web-based patient management system that will allow patients access to lab results, physician referrals, electronic prescriptions and more.

Silverstine says his goal is not necessarily to make more money with the new practice but to reduce his work load to a more manageable 40 to 60 hours a week.

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