09/30/2025 Steve Tager, DPM
Value-Based Healthcare is Coming...Please Be Ready (Robert Kornfeld, DPM
I tell this story with the sole purpose of helping
those in the profession who are fed up with
the current nonsense and mental gymnastics
required to sustain the traditional and
current model solo or group podiatry practice
today. And more so, the uncertainty on the
horizon.
For reference, starting solo practice in 1966
after a short stint in a terribly busy (60
patient/day) (40 to me and 20 to the owner) I
quickly learned a bit about private practice
and its management. So, without hesitation and
extremely limited business experience, in
the winter of 66 I opened my practice in a medical
building in Cranston, RI. After 16 years
experiencing ridiculously low reimbursement from
RI BCBS, a move to Northern CA made
sense for a variety of personal reasons.
Complaining as I did about terribly low
reimbursement from Rhode Island BCBS which covered
98 percent of RI population at the time, in
retrospect, my practice flourished and grew. I
aggressively pursued as much knowledge as possible
to enhance my post doctorate skills in private
practice both in techniques to improve patient
outcomes as well as practice management. With
parents living in the Bay Area of northern CA
where the weather, family presence and
reimbursement for podiatric services appeared far
more attractive, I convinced my family
to make the move.
With mid-life crisis looming, I started over.
Again, success as opposed to failure, the
objective, I did what was necessary to start
again. After another 20 years of accepting
insurance for services rendered, it became clear
that I, along with most of the medical profession,
were fighting an uphill financial battle and
losing. Inflation, not keeping up with
reimbursements for covered services necessitated
working smarter rather than harder was the
challenge of the day.
Selecting procedures and treatment options and
alternatives that paid the bills as opposed to
those realizing a monetary loss became the
challenge. Exhausting my talents to overcome the
challenging hurdles of the day (maybe just burnout
or fatigue) I sold my again successful practice
and moved to Monterey, CA (great air) Having an
opportunity to re-establish another podiatry
practice under the roof of a very successful
physical therapy practice, I did so. But this
time, fee for service only.
Taking NO INSURANCE was an eye-opening, and very
satisfying experience. Personally, I developed a
little skill in sports medicine and lower
extremity biomechanics and pediatric podiatry. I
can tell you without hesitation, the joy
experienced “getting paid” the same day for
services rendered was an exhilarating experience.
At least for me and clearly those advocating it in
this platform, direct pay for podiatric services
in podiatry does work. Drs, Roth, and Kornfeld are
clearly advocates as noted. Historically, comments
made in this area have been fiery, confrontational
and carry an undercurrent of clear frustration,
but also a conviction. The strength of these
emotions brings passion and authenticity, which is
likely shared by many currently in practice, as
well as those recently retired, reading the
comments posted in this format.
Personally, I continue to feel the current
negativity and share the emotion of uncertainty
experienced today. On the positive side,
historical perspectives from those direct pay
practices of the eighties and nineties cannot be
discounted as nonsense. The uncomfortable truth
is, it has been done and can flourish today with
the acquisition of the education and skills
required to accomplish a successful DP model or
hybrid podiatry practice.
SOLUTIONS: Let’s temper the rhetoric from those
experienced in “direct pay” (DP) engaged in the
conversation. It just makes sense: We have a clear
Dx. Next is a clear Tx plan.
PATHWAYS TO DIRECT PAY (DP):
1. DP Transition Blueprint: ? Start small and
carve out a portion of the practice as cash only.
This may be difficult for those currently
contracted but certainly possible.
? Tiered membership models: monthly plans for a
specific set of services like concierge medicine
could be tailored to podiatry. ? Bundling services
producing clear transparent itemized fees for
common procedures so patients know what they are
paying for up front.
2. Patient Education & Marketing: ? Position
DP as better value for patients: no surprise
bills, more time with the Dr. and tailored
personal care. ? Create educational materials that
compare insurance -dependent costs vs. DP costs.
3. Professional Collaboration: ? Forming a Direct-
Pay Podiatry Network (DPPN) where practices share
their best practices, pricing models, and
marketing strategies. ? The power of “community”
would make leaving the current system less
isolating.
4. Pilot Programs & Case Studies
? Instead of pushing everyone to leave the system
now, implement pilot programs within select
practices.
? Data collection on revenue stability, patient
satisfaction, reduced burnout can
demonstrate proof of concept.
5. Mindset Reframe:
? Shifting the narrative from “putting on your big
boy/girl pants” (scolding) to
“You already have the skills, training, and
patient relationships to thrive
outside the system. The system needs you more than
you think.”
DIRECT PAY CONCEPT FRAMEWORK (DPPN)
I propose a group of an entrepreneurial
podiatrists form a panel to look at the potential
of what I described above. This panel might
consider things like:
? Establishing core components consisting of a
knowledge hub showing case studies, sample fee
schedules, bundling pricing templates, membership
models. along with marketing tool kits,
educational handouts etc., legal/contracting
guidelines with state specific guidance
? Peer community face-to-face panels (what I call
“Twenty Clubs) or online forums
with podiatrists sharing challenges and successes.
? Regular Zoom round table to problem solve with
“experienced” panelists aiding the
discussions.
? Establishment of a mentorship program pairing
early adaptors with season DP practitioners.
The panel might consider inviting a pilot circle
of 5-10 practices to co-create the first
set of resources and refine the model.
Create an On-line hub, a private website or
community platform or possibly a private
LinkedIn group.
Publish a DP Starter Kit for Podiatrists) could be
free PDF download as a first
resource.
Visibility pushes sharing success stories.
Initially perhaps by those who have had DP
practices for a period. Blogs, podcasts Linked-In
posts to inspire and build momentum.
Phased in expansion adding membership dues
following established value. Use funds
to hire admin, organize events, and negotiate
group deals.
CREATING A LONG-TERM VISION might consist of
developing an Annual Direct Pay Podiatry Summit,
along with a National Education Campaign
possibly collaborating with DP MD and DO practices
or concierge medical groups to amplify reach.
If your reading, this dialog may be the motivation
needed by those who have the skill to put this, or
something similar together. Personally, I no
longer have the will, skills, interest, or the
time to commit to the organization of this
program. However, if asked by those with a longer-
term interest and/or possibly a for profit
organization, I am happy to participate on a
limited elective basis as a consultant. I view
this as a “giving back to the profession”
for what it has given me. I would like to see
those with continued passion and fire in their gut
to step up to the plate and go for it.
I am happy to take point in this endeavor and with
sufficient response to this post, collect names
and contact information. I urge you to share your
interest in establishing the Direct Pay Podiatry
Network. (DPPN) model and identify your area of
interest such as organization skills, speaking,
sitting on an “experienced panel,” or having high
tech skills needed to get this off the ground.
Respond to me personally or share your interest in
this format. All personal responses will be shared
with the collective or chosen leaders for
implementation.
Steve Tager, DPM (retired), Scottsdale, AZ
