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Starting a Cash-Based Medical Practice in 4 Steps

As a cash-based business, you become your own boss. No dealing with administrators or sharing profits with insurance businesses, you can spend time with patients as much as you want, no surprise insurance charge for them... What an exciting way to take your practice into your own hands! However, it can also be challenging.

To help you have everything defined and prepare for things to go as smooth as possible, here's an outline of steps you should keep in mind. 

Step 1: Types of Cash Based Practices 

What do you want to get from telemedicine? Being clear about this will allow you to build the structure of what later will be your shining Telemedicine practice. Take the following information as a checklist of steps you should take when starting out.

You can choose between Direct Fee or Membership models.

Direct Pay Fee per Service:

  • No memberships. Payments made by visit, as patients come and go.
  • Payments are dependent on the quantity of care, rather than quality.


Recurrent fixed payments. However, just because models are built around a membership fee, doesn't mean that they are the same. You can either go for Direct Primary Care (DPC) memberships or Concierge memberships.

a) Direct Primary Care (DPC):

  • Based on a monthly fee, and patients are able to drop out at any time.
  • Affordable, aimed for low to moderate income patients.
  • Generally covers unlimited patient visits

b) Concierge

  • Based on an annual fee, and the contract id for the entire year.
  • Higher priced, aimed for people with higher income.
  • Covers an in-depth comprehensive physicals and services that go beyond what a government program would offer.

In order to figure out which type is best for you, think about who do you want to serve, their spending capabilities, and which payments method is best for you. Direct Primary Care (DPC), Concierge, or Direct Fee?

Step 2: Inside the Pricing Models: Pure Cash vs. Hybrid

​If you are starting from scratch, most people would recommend a pure cash model. Of course, a pure cash model takes more work in the marketing aspect to build and ramp up. However, you won't have to deal with insurance policies and small letter.

Pure Cash Model:

No dealings with insurance companies. Memberships or one-time payments go directly to you.

Hybrid Models:

a) Hybrid Insurance and Membership Model:

For practitioners that started out with an insurance model and are transitioning to pure cash model (or memberships).

b) Hybrid Fee for Service and Membership Model:

Practitioners who have a membership (DPC or Concierge) for i.e. chronic disease patients; but also accept patients that come and pay for a one-time service as they come and go.

c) Hybrid Package Model and Membership Model:

Doctors manage memberships and packages set up for different conditions which involve several sessions/services

d) Hybrid Fee for Service and Package Model:

Doctors accept one-time payments as well as packages including selected services. / number of sessions.

Step 3: Choosing the Services you Want to Provide

In order to figure out which type is best for you, think about who do you want to serve, their spending capabilities, and which payments method is best for you. Direct Primary Care (DPC), Concierge, or Direct Fee?

by Dr. Maiysha

Always consider who do you want to work with, and who do you want to serve.

Before you choose, keep in mind the importance of honoring your expertise. Consider you physical space and your budget.

Direct Primary Care (DPC):

Consultative services, care coordination, chronic care, and comprehensive care management. Also known as conventional medicine.

The body is seen as a group of organ systems. This model has made huge advances over the past years treating emergencies, diseases, surgery, etc. However, this model isn't the only one that should be applied to the whole spectrum of healthcare.


"Alternative" and complementary treatments, such as acupuncture and hypnosis.

Treatments are focused on body, mind, and spirit. The goal is to bring them all into coherence. It's a beautiful concept, and a very broad one.


Supporting learners/client in achieving specific personal or professional goals through training.


Lifestyle modification, including diet and physical activity. For example, nutrition.


Providing physical or virtual products. It's important to take in consideration certifications and legal aspects.

If you are thinking about multiple services, that's great! Going over different models can help you provide patients with a more integral experience with your services. However, keep in mind that you don't have to start with everything! One step at a time.

What is the most workable or the most reachable for you? START WITH THAT.

Expand as you get more clients, more space... Expand as you feel more comfortable.

Step 4: Getting Your Own Space: Healthcare Premises 

If you've ever purchased a home, you'll know that it's all about location, location, and location. The same applies when it comes to choosing a space for your medical practice. But before making the final decision think about your needs as a practitioner, and most importantly, the needs of your patients. Use the following points as a guide:

Keep in Mind the Equipment You'll Need:

Think about what is it that you need to start. DPC, integrative, coaching or wellness may only need 1000 sq ft. Other specialties like fertility or anesthesiology do need bigger spaces.

Start as Small as Possible:

Start workable so that you don't put yourself into an enormous amount of debt. You'll be able to redirect that money into what it's really needed, such as marketing.

Consider Sharing the Space:

With the purpose of saving money, you can sublease a space from another physician. Also, it's possible to co-sign with another health practitioner.

Make it Yours:

You can choose something that's boutique, cute, nice, savvy, modern... anything that speaks your style. It just doesn't have to be huge.

Take your time and do your research before settling for one place. What do you consider non-negotiable? What are things that you don't necessarily need? Keep those things in mind while going through your options!

​If you want help starting your telemedicine, integrative medicine, coaching, consulting or cash based practice, let's get on a call. Schedule your FREE strategy session:

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Tuesday, 27 February 2024