S1E19 How to Build a Membership Based Private Practice That Still Takes Insurance with Rene Hermes

S1E23 The Secret Fishing Hole: The 100-Year Legal Blueprint for Cash Medicine No One Told You About — with Jim Eischen, Esq.

Episode Description Most physicians building concierge or membership-based practices are operating without a map. They've been told to opt out of Medicare, keep their fees low, and pick a tribe — DPC, concierge, hybrid — without ever understanding that a compliant, tax-advantaged, bulletproof model for cash medicine has existed in federal law since 1913. No one told them about it. That changes today. In this episode, Dr. Adama Diarra sits down with James Eischen, Esq., founder of Eischen Law Office and one of the foremost legal authorities on concierge and membership-based medicine in the United States. With nearly four decades of legal experience and 17 years spent exclusively in this space, Jim breaks down what the major practice models — DPC, concierge, executive health, lifestyle and longevity — actually are under the law, why the names don't mean what you think they mean, and why the confusion in this space is not an accident. Jim explains the legal and historical framework that has protected annual and routine exam-based subscription medicine since 1965, why you almost certainly do not need to opt out of Medicare to run a cash practice, how to structure your patient agreement so that your patients can unlock FSA and HSA benefits from day one, and why pricing yourself too low may be quietly undermining your practice before it gets off the ground. This episode also covers the history most physicians have never heard — the corporate, political, and racial roots of why this model was kept hidden from most of the medical profession, and why the cost of that ignorance has been borne not just by physicians, but by the patients and communities they serve. If you have ever asked yourself whether you can charge a membership fee and still bill insurance, whether you need to opt out of Medicare, or what your patient agreement actually needs to say — this conversation is the one you have been waiting for. Dr Adama Diarra, DO, FACP, DipABOM

S1E22 Why Four Doctors Quit the Machine — And What It Actually Cost Them.

After months of conversations with physicians building independent practices — a concierge doctor who makes house calls, a DPC physician who traded a 2,000-patient panel for one capped at 300, an internal medicine doctor in Bend offering 60-minute first visits, and a cancer survivor running a holistic practice out of a converted space — Dr. Adama Diarra noticed the same four themes surfacing again and again. In this solo recap episode, Dr. Diarra pulls those threads together into one conversation: autonomy as a deliberate trade-off rather than an escape fantasy, AI as a tool to sharpen clinical judgment rather than replace it, the patient relationship as the actual product of medicine, and the constant temptation to let your brand outrun your care. Along the way: how an extra 45 minutes of autonomy helped one doctor catch a missed aortic aneurysm, why "physically ill" is how one physician described her old inbox, and why none of the doctors featured on this show built a following before they built trustworthy care. A practical, story-driven episode for any physician, NP, or PA weighing what independence actually costs — and what it's actually for.

S1E21 The New Healthcare-Your Brain on Hypnosis: Pain, Prediction, and the Science of State Change with James Harrison

The New Healthcare | In this episode, Dr. Adama Diarra sits down with James Harrison, certified clinical hypnotist and author of Mental Foraging, to explore what clinical hypnosis actually is — and what it isn't. James strips away the pop-culture myths and grounds the conversation in contemporary neuroscience: predictive processing, allostasis, mirror neurons, and the stability-plasticity problem. The two discuss how hypnosis works as a guided state change that can help patients access their own capacity for pain modulation, habit updating, and emotional reconsolidation. Practical territory covered includes chronic pain, IBS, fibromyalgia, smoking cessation, and sleep — along with clear guidance on which patients are good referral candidates and which aren't. James also shares simple, in-office techniques any clinician can use to begin shifting a patient's relationship to their pain signal — right in the exam room. For physicians looking to expand their integrative referral network, this episode offers both the neuroscience rationale and the clinical roadmap to do it thoughtfully.

S1E20 "I Don't Know" — The Three Words AI Can't Say (But Every Clinician Should)

"I Don't Know" — The Three Words AI Can't Say (But Every Clinician Should) In this solo episode, Dr. Adama Diarra makes the case that saying "I don't know" is one of the most underused and undervalued tools in clinical medicine. Using a real patient encounter from the week of recording — a gastroenteritis case in late spring where the standard viral default turned out to be the wrong seasonal answer — he walks through what happened when he paused, admitted uncertainty out loud, did the research, and came back with a better answer. The data showed a meaningful seasonal shift toward bacterial pathogens like Campylobacter and Salmonella in warmer months, which changed how he counseled the patient and shaped their shared decision to pursue supportive care with a clear plan to escalate if needed. From that clinical story, Dr. Diarra draws out three things "I don't know" actually accomplishes: it preserves a clinician's calibration and credibility, it models intellectual honesty for trainees, and most importantly, it protects patients by creating a disclosure loop that a confident wrong answer never would. The episode then pivots to a May 2026 New England Journal of Medicine perspective piece — Can AI Say "I Don't Know"? by Sikora, Celi, and Abdulnour — which argues that AI tools, as currently deployed, lack the reflex to disclose uncertainty. They generate fluent, confident responses regardless of whether the underlying evidence is solid or absent. Dr. Diarra illustrates the danger with a methotrexate dosing example and maps it back to his own gastroenteritis case: an AI would have given the annual default answer with full confidence, missing the seasonal nuance entirely. He closes with a practical framework: become AI-fluent, not AI-dependent. Use multiple sources the way clinicians always have — PubMed, Cochrane, colleagues, subspecialists. Don't outsource critical thinking. And until the tools learn to say "I don't know," that responsibility stays with the clinician.

S1E19 How to Build a Membership Based Private Practice That Still Takes Insurance with Rene Hermes

The New Healthcare by Adama Diarra, DO, FACP, DipABOM Guest: Rene Hermes Content Type: Interview Primary Goal: Educational Summary Most physicians enter independent practice with clinical confidence and financial blind spots. Rene Hermes entered with both — and built something different. In this episode, Rene shares how a background in corporate finance shaped her approach to running independent primary care practices, why she developed a hybrid insurance-plus-membership model, and what it actually takes to make concierge medicine accessible without sacrificing financial sustainability. Whether you're curious about leaving employed medicine or already making the leap, this conversation offers a grounded, practical roadmap. Key Topics * Why corporate finance principles change how you see practice economics * How a hybrid insurance + membership model works in real primary care * Making concierge medicine accessible — and still viable * The operational infrastructure independent practices often overlook * What physicians consistently underestimate about building independence Sound Bites * "Finance looks at the future, not just the past." * "One emergency visit can pay for the entire year." * "Living independently in medicine is achievable." Chapters * 00:00 — Introduction: Who Is Rene Hermes? * 03:48 — From Corporate Finance to Medical Management * 06:46 — Building a Family Practice from the Ground Up * 10:14 — What Finance Teaches You About Primary Care * 13:53 — The Hybrid Practice Model, Explained * 17:59 — Making Concierge Medicine Accessible * 28:26 — Rethinking Concierge: A New Framework * 32:33 — Operational Realities of Running a Private Practice * 41:36 — Building Your Concierge Model: What to Consider First * 47:56 — The Case for Independence in Medicine Resources * Hermes Health [https://hermeshealth.net] * American Academy of Professional Coders (AAPC) [https://www.aapc.com] * Certified Physician Practice Manager (CPPM) Certification [https://www.aapc.com/certifications/physician-practice-manager/] * Contact Rene: rene@hermeshealth.net [rene@hermeshealth.net]