He Does It His Way

After 30 years at the Texas Medical Center in Houston, R. Anders Rosendahl, MD, left behind 22,000 patient charts and moved to Lakeway, a small town outside of Austin where he had no patients and knew no referring physicians.

An inauspicious start to a story about medical practice success, Rosendahl readily admits. On his Practice of the Year application, he added the title, "2005 Practice of the Year? Not likely!"

But Rosendahl had the guts to make significant changes to the way he runs his practice, and has, in fact, found a formula of success he says he'd "wish on all his colleagues."

His first decision was to focus solely on thyroid surgery: "I had performed thousands over the years, and this would give me a niche to capitalize on," he says. His second was to ditch the insurance companies. Rosendahl chafed at the idea of reapplying to all the plans he'd contracted with for years, then "begging for acceptance from the insurance industry to be paid 15 to 20 cents on the dollar of a truly usual and customary fee."

Besides, it was becoming clear to him that the related overhead costs were prohibitive. Today, the practice's expenses add up to just $4,000 a month. Rosendahl leases his second exam room to a general surgeon.

Not only does the practice's no-insurance policy eliminate costs and a mountain of paperwork, but because patients pay for their procedures in advance, there is no billing, virtually no postage, and no requests for authorization. Office visits - including post-op visits - are free.

Rosendahl has a schedule that many physicians can only dream of: a four-day week and just two to three patients a day (he spends as much as one to two hours on each patient visit). "People are willing to pay a little bit more to get quality because they're not getting it anywhere else," he explains. "Since virtually all patients that come to us need a thyroidectomy or thyroid-related procedure, we do quite nicely by charging a modest surgical fee and nothing else." And since most insurance companies will pay a portion of out-of-network physician charges, patients may be reimbursed anywhere from 40 percent to 80 percent of his fees.

Old-fashioned Touches

When he was new in town, Rosendahl laid the groundwork for physician referrals the old-fashioned way. "I went around to all the family practices, OB/GYNs, and endocrinologists in town and introduced myself," he says. He also sends out a newsletter featuring patient cases and photos, and maintains a comprehensive Web site. His efforts have paid off: 85 percent of patients are referred to the practice by local physicians or through the Web site.

Aside from the Web site, however, the practice is decidedly low-tech - the only things in the office that plug in are the computer and the combination printer/fax/ copier, says Rosendahl. "I don't believe in electronic medical records. When electronic things go haywire, they really go haywire ... ." His office manager still types records from dictation, and Rosendahl says he likes to think that "clear and organized records are one of the main reasons we have a virtually perfect [malpractice] record after a lifetime of performing nothing but dangerous operations."

Reactions from colleagues have been mixed. "Some of them thought I was crazy," says Rosendahl, " ... and some came to ask for advice." As for his patients, "My younger patients tell me this is the way healthcare ought to be, and my older patients tell me this is the way healthcare used to be."

His revenues are not yet what they were when he saw 20 patients a day, but says, "If the practice continues to grow at its current rate, I'll be as busy as I want to be in a year." Besides, there are some benefits that can't be measured in dollars. " [On] the first day of school, my wife and I walked our kids to the bus stop. I could have never done that
in Houston." 

- Abigail Green

This article originally appeared in the November/December 2005 issue of Physicians Practice.