Functional medicine offers a revolutionary approach to health: addressing root causes rather than just managing symptoms. But creating a compliant, sustainable practice model has been challenging for many practitioners due to insurance limitations and regulatory uncertainties. Our approach allows you to practice authentic functional medicine, including BHRT and peptides therapy, with full regulatory compliance, economic sustainability, and expanded patient accessibility.
Many functional medicine services, including hormone optimization and BHRT, fall outside traditional insurance models, creating uncertainty about Medicare compliance when serving older patients. This is particularly concerning given that older patients often benefit most from functional approaches but are also most likely to have Medicare coverage.
Program patient fees are designed to be qualified medical expenses to enable employer/self-employed/HSA/HRA/FSA/MSA funding.
Create a practice structure that allows for the extended time, thorough testing, and comprehensive approach that functional medicine requires, all within a compliant framework that clearly distinguishes routine services from medically necessary interventions.
Maintain the ability to bill insurance for specific covered services when appropriate while collecting cash for routine exam components. Bill plans never, some, or more. You choose.
Whether you’re adding a cash component to an existing practice or creating a hybrid model, our approach provides the framework for specialty-specific success with full compliance confidence.
The routine exam model creates a structure that supports all essential components of functional medicine practice
All these components can be structured within the routine exam model while maintaining clear Medicare compliance and qualifying for employer/self-employed/HSA/HRA/FSA/MSA funding.
| Feature | Insurance-Based Model | Typical Direct Payment Model | Routine Exam Model |
|---|---|---|---|
| Medicare Compliance | Limited by coverage constraints | Often requires opt-out | Medicare compliant without opt-out |
| Visit Duration | Typically 15-20 minutes | Variable, often limited by price constraints | Comprehensive, typically 60-90 minutes |
| Testing Options | Limited to covered tests | Unlimited but accessibility issues | Unlimited with HSA/FSA funding options |
| HSA/FSA Eligibility | Yes, for covered services | Generally disqualified | Fully eligible when properly structured |
| Functional Approach | Limited by time and coverage | Possible but accessibility limited | Fully supported with accessible funding |
| Patient Affordability | Covered services accessible, others not | Often limited to wealthy patients | Expanded accessibility through tax advantages |
| Long-term Economics | Challenging with declining reimbursements | Variable, often unsustainable | Predictable, sustainable subscription model |
| Documentation Burden | Extreme, focused on billing requirements | Minimal but compliance risks | Appropriate, focused on service delivery |
| Therapeutic Freedom | Severely constrained | Unlimited but often financially limited | Unlimited with expanded financial accessibility |
We provide a structured transition framework that emphasizes the enhanced value of comprehensive care in the routine exam model. The most engaged patients readily understand the benefits of the new model.
The routine exam model provides an ideal framework for integrating functional medicine with conventional approaches
Functional medicine represents the future of healthcare: addressing root causes rather than just managing symptoms. Now, the routine exam model offers the perfect framework to practice authentic functional medicine with full compliance confidence and economic sustainability.
Discover how to transform your functional medicine vision into a compliant, profitable reality that serves patients at the highest level while creating the practice you’ve always wanted.
“I was extensively trained in functional medicine but struggled to implement it within the constraints of insurance-based practice. Jim’s routine exam model gave me the framework to practice authentic functional medicine with full compliance confidence. I now have the time, resources, and structure to address root causes rather than symptoms, creating transformative results for my patients. The economic model is sustainable for me and accessible for patients through HSA/FSA funding. Most importantly, I’m finally practicing the way I always envisioned—truly helping patients achieve optimal health through comprehensive, personalized care.”
Contact Information:
Jim Eischen
Eischen DPSC LLC
2323 Locust Street
San Diego, CA 92106
619-919-5395
jim@eischendpsc.com
