Revenue & Service Lines

This model can realistically deliver on the order of 97% of care. The remaining ~3% — ICU-level critical care, major/complex surgery, NICU — is explicitly out of scope and would still route to a full referral hospital. It isn't impossible to expand into these areas later, though.

What Carries the Model Financially

• Monthly memberships paid by the community: the ultimate win if the community itself has enough members who want to contribute to get half price at the hospital — it could even feel like a GoFundMe-style challenge, a donation the community actively wants to make to keep the hospital afloat.
• Cash-pay surgery: the primary financial engine, priced competitively and marketed directly to employer benefits advisors and self-funded employer plans.
• Imaging center: a second reliable cash-pay revenue line, run on the same transparent-pricing logic.
• Cross-subsidy: surgery and imaging margin helps cover specialties that don't generate their own revenue easily on a cash basis (infectious disease, rheumatology/immunology, nephrology, etc.).
• Local DPC network: the independent DPC practices DHC helps grow in the region (see Relationship to DPC) provide a loyal referral pipeline and better continuity of care feeding into the hospital side, even though DHC doesn't run those practices itself.
• Hospital admission pricing: could work as a low monthly add-on fee, pure a-la-carte billing, or a hybrid — needs testing against real demand.

A Possible DPC Residency Program

Housing a DPC-focused residency at the facility would provide a supply of motivated, mission-aligned physician labor at lower cost, and build a pipeline of doctors trained from day one outside the standard insurance-driven system — directly advancing the goal of growing the number of independent DPC physicians in the region. Open question: residency accreditation typically flows through Medicare-linked channels, so a program opting out of Medicare would need an alternative accreditation path worked out in advance.

Reducing Referrals via In-House Diagnostic Tools

Primary care and DPC physicians should be equipped to refer out less often — by adopting point-of-care tools (dermatoscope, otoscope, stethoscope, ultrasound, AI-estimated ejection fraction) that let them resolve more of a workup in the same visit. Faster, better in-house care means fewer referrals, less fragmentation, and lower total cost per patient.

For physicians hesitant to add these tools to their own practice, dedicated support structures can lower the barrier: procedure how-to guides, training videos, standardized templates, and clear malpractice coverage for the added scope of practice.