A High End-Low Volume Clinic Will Make You RICH… Part Time!

High end and low volume? What does that even mean? It means that when you charge a premium for a niche service, then you do not need to see large amounts of patients, like in primary care, to generate profits. But is this something that can be done full time? Doubtful, that is why it is the PERFECT part time practice for a nurse practitioner.

When you work primary care or urgent care for example, you must play the insurance game. This game involves seeing large amounts of patients for mediocre returns. The only way to make money playing the insurance game is by seeing 20-30 patients a day at a minimum. That is a difficult number to achieve for a new practice. It is another reason why so many primary care practices struggle to turn over a profit.

Let’s run some simple numbers. Let’s say that you decide to start a primary care practice as a nurse practitioner where you will accept Medicaid, Medicare and private insurance. Most of the visits will be coded as either a new level 3 or 4 or established 3 or 4. What does the reimbursement for this look like? According to the Centers for Medicare and Medicaid Services (CMS), new reimbursement amounts going into effect in 2021 will be:

                A new level 3 or 4 visit will generate $130

                An established level 3 or level 4 visit will generate $90.

These are the new reimbursement amounts if you take patients with Medicare and Medicaid, which will be a large portion of your patient population. Private payers typically follow suit of what CMS does, but their reimbursement will be SLIGHTLY higher. That is why taking private insurance generally is more profit generating.

A new patient takes 30-45 minutes typically and will generate $130-$150. Established visits take anywhere from 10-20 minutes and will generate $90 in revenue. Realistically you can see anywhere from 20-30 patients in an 8-hour shift in primary care. This will generate approximately $3,000 in revenue for the day.

WOW! $3,000 a day! I am going to be rich!

Hold your horses. Running a higher volume primary care practice carries along with it some significant expenses. You will have at least 2 employees, a fancy EMR as required by CMS, supplies, lease/rent, utilities, etc… Plus this assumes you are seeing 20-30 patients a day. It takes a long time to build a high-volume primary care practice with those kinds of numbers. We are talking about YEARS to build up this type of practice.

Now let’s look at a cash practice that charges more than what insurance reimburses but has less patient volume. When you have a concierge practice that provides niche services it affords you to mark up for the services and products you sell.

Your target market are individuals who have disposable income and are in the upper middle class or higher socioeconomic sector. You can charge rates as high as $200-$250 a month for a niche service. For my concierge men’s health practice for example, most men spend between $125-$200 a month for the services and products I provide. They have no issue spending this kind of money to optimize their health and to feel better.

Some of you are probably saying:

“But there aren’t enough people in my area that have disposable income!”

“Everyone has Medicare and Medicaid!”

“The patient population in my area are very poor!”

Well you know what I say to that? Bullshit. It is nothing more than an excuse not to take action. You would be surprised how many people in a poor area have a disposable income. Who owns the businesses? Your target market! I live in one of the poorest counties in the country. Guess what? This practice model is generating significant profits.

All you need to have is around 50-100 patients as well to generate a significant part time income. This is EASILY doable compared to the THOUSANDS of patients you need for an insurance accepting primary care practice. If you have 50 patients averaging $150 a month, that will generate $7,500 a month. If you have 100 patients that is $15,000 a month!

If there are 100,000 or more people within a 2 hour drive of your location, then there are 100 potential patients. I guarantee it!

These numbers might not look impressive but remember, THIS IS A PART TIME SIDE BUSINESS. This is a foundational principle for the Elite Nurse Practitioner Model of having a part time job, multiple part time side business, low personal and business expenses and being debt free. It is also crucial that this side business has very low expenses. If you need an employee then keep it at just one. The more expenses you have, the less money you will make.

The goal with this business is to only practice 6-8 hours a week at a maximum. This is how my side businesses are set up. I spend 8-20 hours a week on them and easily bring in a healthy 5 figure income per month PART TIME. You can do it too!

With the above example, you could potentially generate anywhere from $5,000-$10,000 a month working 1 day a week for yourself. Who couldn’t use a spare 10 grand a month?

So instead of focusing on high volume medical practices that take insurance and require significant expense and overhead, focus on a higher cost niche practice that has a low patient volume that can be done on a part time basis.  

17 Responses

        1. Not that I know of. I will be releasing a course on how to start a medical cannabis clinic in the upcoming months though. Stay tuned.

    1. I’m FNP and I’m a co-owner of a wellness practice in Bowie, MD, which we provide health and wellness services and medical cannabis recommendations.
      This post is an accurate depiction of how I set my rates and income. Great info! Thanks for sharing!

  1. What is the best way to learn NP home and office visit coding? Any suggestions for online classes? Im starting to practice but could use a good baseline course.

      1. Thank you. As a start up I am also covering home care visits for a local practice part time. Fully want to transition to what you are promoting.

        1. Having multiple part time businesses is the best structure for a nurse practitioner. Keep doing the home care visits part time and start a little cash practice on the side and see what happens. Worse case scenario? You are out $5,000. Could be a lot worse.

    1. Men’s health is 90% TRT. The trick is opening a men’s health specific clinic. A general BHRT clinic is just that, it is general. You need to NICHE it!

      1. I do TRT already & I’m actually doing more men than women at this time, can’t I just create the niche within my current practice?? Also, what’s the best way to market? I’ve used FB ads which have gotten me ZERO returns…

        1. Sure you can create that niche within your practice, but a true niched practice is just that. I only treat men in my men’s health clinic. We do not offer other services. It helps maintain the practices niche atmosphere. I will be releasing an article about marketing soon and there will be info about it in my book. FB can be good as can google ads if done right. Good old fashion physical advertisements throughout your region work well too. Way to much to post in a comment. Message me if you need a consultation.

  2. Do you have information or suggestions if we want to do Direct Primary Care, cash based as a “side business”? Not full time.

  3. Does this model work well for a PMNP? Do people feel like you should be at their beck and call with a concierge service?

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