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Like many physicians, Dr. Michael Reinhorn was frustrated by the direction the practice of medicine has taken over the past 15 years. He founded Boston Hernia in 2015 and, along with his partner Dr. Nora Fullington, specialize in advanced hernia repair techniques and general surgery. Despite many highly satisfied patients with a growing number seeking their care, higher overhead and administrative burden was pushing Boston Hernia, and many other independent practices, out of business. Despite inflation of approximately 20% since 2020, Medicare has cut physician payments by over 10% since then, including an additional 2.8% cut planned in 2025.
Instead of closing shop and going to work for a hospital system, which increases costs to patients and employers, Boston Hernia decided to change their business model to Direct Specialty Care (DSC). This model allows specialists to take the path of their primary care colleagues, forgo insurance payments, and offer simple to understand bundled transparent pricing to their patients. Patients and their employers can access high quality care for a reasonable fee and know their costs in advance with no surprise bills. They pay the practice directly thus eliminating the burden of billing and collecting from insurance companies which can cost up to 30% of every dollar collected.
Sounds simple, but as Dr. Reinhorn notes, it was anything but easy to transition to the DSC model: “We cut the cord with Medicare in 2023. We had to bundle and price our services, figure out our costs and margins, and that took a lot of work. We then learned it was a lot harder to collect from patients, who needed more ways to pay and financing options. Employers and TPAs still wanted their traditional electronic claims forms. It was daunting, and we set about finding the right partner to streamline the process.” That search ended when they discovered HealthMe – a physician founded digital platform that connects doctors, patients, and employers to transparently priced healthcare.
HealthMe helps specialty practices bundle, price, and retail their services to direct payers. For the self-pay community there are easy to understand healthcare bundles from office visits to imaging, physical therapy, and surgery. A patient-friendly digital interface allows patients to receive SMS communications that allow them to pay with credit card, “one-click” Google/Apple pay, or finance their care. The self-insured employer ecosystem can discover Boston Hernia’s bundles, communicate directly with the practice to schedule patients, and receive EDI claims and pay the practice directly through the platform via ACH. HealthMe distributes the bundled payments to each provider in the bundle automatically and efficiently.
“Many physicians miss the direct-pay market, and don’t understand its size. Even the few who recognize the opportunity, really don’t know where to start, or how to do it. Dr. Reinhorn was the exception – he understood the market and how to do it, but he didn’t have the tools to scale and streamline the process” says Dr. Michael Havig, Founder and CEO at HealthMe.
Boston Hernia onboarded HealthMe to grow their direct-pay business in January 2024. In the first 9 months on HealthMe they saw over a 1000% increase in direct pay patient care, and 71 surgeries generating $267K in direct pay revenue. Most of this business was from new patients to the practice who would have had difficulty accessing high quality care prior to the genesis of their direct-pay program, and the business continues to accelerate as the self-insured ecosystem discovers the program. In addition to self-insured employers, patients from sharing ministries, out-of-network patients, medical tourists, and those with high deductible HSA plans see significant value from DSC. HealthMe’s direct-pay platform makes it easy to serve these patients, and easier for patients and employers to find Boston Hernia’s services and pay for their care.
“Getting paid is easy - with a couple clicks, the funds are deposited that day to our account,” states Dr. Reinhorn. “The transparent pricing of all the services makes the process more streamlined and ensures discussing pricing, and collecting payment is painless for both patients and staff.” With no uncertainty around pricing, patients can be assured of getting the care they need at a price they can afford. Furthermore, the HealthMe platform provides customer support, assisting patients with any questions or issues related to their purchase or treatment.
The initial success with direct-pay has led Boston Hernia to proactively build relationships with self-insured employers and aggregators, increasing their market share. This also revealed an opportunity to bridge the gap in access to high quality, transparently priced hernia care for direct-pay patients across the country. To meet this demand, they launched Hernia Connect. “Like most patients and employers, we feel that local care is better care. We have patients travel in from all over the country, but our goal is for them to get high quality care closer to home." notes Dr. Reinhorn.
Boston Hernia’s transition to Direct Specialty Care exemplifies how innovation and adaptability can overcome the challenges faced by independent medical practices in today’s healthcare landscape. By embracing a model that prioritizes transparency, affordability, and patient-centered care, Dr. Reinhorn and his team have not only secured the financial future of their practice but also expanded access to high-quality care for patients across the country. With HealthMe as a trusted partner, Boston Hernia has seen remarkable growth and has stayed true to its mission of providing the best possible care.
