A solo practice that bucks conventions

Key Points

The sign reads: "YOUR DOCTOR HAS DECIDED NOT TO CARRY MALPRACTICE INSURANCE!"

A few other lines above and below that statement explain how doctors who don't carry insurance-also called "going bare"-must demonstrate financial responsibility to cover potential claims, but it's the part in the middle that grabs your attention.

Aventura Family Health Center is a cash-only practice. Wollschlaeger doesn't accept Medicare or Medicaid, and 90% of his patients have no insurance. It's a practice that has almost all same-day or next-day appointments, a large portion booked online. Aventura has had an electronic health record (EHR) system since its launch in 1998, and Wollschlaeger has been an e-prescriber since 2003.

"Twelve years ago, I noticed a steady increase of people with no insurance," Wollschlaeger says. "I hate to say I was right, because it's not good, but it then exploded to where 30% of the population here in Miami-Dade County has no insurance. I saw this as a niche market I could get into."

INDEPENDENT SPIRIT

Wollschlaeger has always sought a unique path in life. He was born in 1958 in Germany, the son of a former Nazi tank commander who proudly displayed his military medals and ribbons but never discussed the horrors of the Holocaust with his children. As a result, Bernd researched the Holocaust on his own; this effort led to the study of Judaism and visits to Israel. His experiences moved him to convert to Judaism and immigrate to Israel when he was 28. He studied medicine in Germany and served in the Israeli military as a medical officer in battle and at a Tel Aviv military hospital.

In 1991, with the first Gulf War interrupting his Israeli residency, Wollschlaeger immigrated to Miami and served his American residency at Jackson Memorial Hospital through the University of Miami's Miller School of Medicine. While he earned his American medical license in 1996, he worked as a medical director for a homeless shelter in downtown Miami. Wollschlaeger says he witnessed how a lack of insurance forced men and women to forgo care due to cost and lack of physician access. "That opened my eyes to world of the uninsured," he says.

After earning his license, Wollschlaeger and another physician opened an office in 1997, partnering with a for-profit practice management company. The unrealistic revenue demands of the firm forced Wollschlaeger and his partner to shut their doors, he says, but the closure created a new opportunity.

A short distance away, located in a five-unit shopping center in North Miami Beach, Wollschlaeger opened his solo practice with a mission to treat the community's uninsured, focusing on chronic disease management.

LARGE DEMAND, SMALL SUPPLY

Wollschlaeger had established few patients from his first office, not enough to sustain his solo practice. He tried a modest amount of print advertising, which had little effect, but word about this unique cash-only medical office that offers same-day appointments quickly spread in the Aventura neighborhood, he says. Within a few months, Wollschlaeger began to see patient volume increase to its current levels, 15 to 25 patients a day.

Wollschlaeger charges $95 for his initial visit. Once the patient is established, visits are $65. He says that he is not anti-insurance. (Wollschlaeger is considering accepting Medicare next year due to the new value-based compensation methods for primary care described in the healthcare reform legislation passed last year.) He's opposed to the system in which, he says, physicians are forced to boost their volume to increase-or even maintain-their income, which he believes is at the expense of providing quality care for chronic conditions.

"I've noticed the more cost-effective you make it for [patients], the more often they come to you because they feel that it's not too expensive and that I offer them same-day appointments," Wollschlaeger says. "I see a higher retention of my patients, they come back more frequently, and it's better care because I see them more frequently."