Price vs Value: What Direct Care Specialists Get Wrong About What They Charge

Direct specialty care pricing should be set on the value of the outcome to the patient, not on the time the visit takes or what it costs to deliver. That one shift is the difference between a practice that quietly starves and one that finally pays you what your judgment is worth. That one shift is the difference between a practice that quietly starves and one that finally pays you what your judgment is worth.

Here is the strange part. You already know this instinctively, and you were trained out of it. For years you worked inside the most extreme hourly-billing system ever built, and it taught you to value your work by the unit, not by the outcome. Direct care is your chance to unlearn it. The man who spent a career teaching professionals how is an accountant named Ron Baker, and what he found applies to medicine more cleanly than to almost any field.

Key Takeaways

• Value is set by the patient, in their mind, not by your cost or your clock.
• Insurance was the timesheet of medicine. The RVU is the almighty hour with a lab coat on.
• You do not sell a 45-minute visit. You sell an answer after months of fear. Price that.
• Set the price on purpose, before the work, through a value conversation that is really a diagnosis.
• Offer three options and you change the patient’s question from “should I work with you” to “how.”

You already survived the worst hourly system ever built

When Ron Baker tells professionals to kill the timesheet, accountants and lawyers flinch. Physicians should laugh, because you lived the most punishing version of it. The RVU is the almighty hour wearing a lab coat. Reimbursement was tied not to whether the patient got better, but to how many billable units you generated. See more, code more, earn more. It rewarded volume and punished the exact thing that makes you good: time, thought, and restraint.

Think about what that trained into you. It taught you that a fifteen-minute visit is worth less than a forty-five-minute one, regardless of what happened inside it. It taught you to undervalue the diagnosis you reached in ninety seconds because you had seen it a thousand times, which is the very thing the patient is paying you for. Baker calls hourly billing “a form of self-imposed rationing of your own knowledge.” Insurance did the rationing for you.

Direct care removes the meter. And the moment it is gone, most physicians make a quiet mistake: they rebuild it themselves.

The mistake: pricing your time instead of your outcome

Dr. M left a large rheumatology group and opened a direct practice. Free at last, she set her prices the only way she had ever seen it done. She estimated how long a consult took, guessed at an hourly figure that felt reasonable for a specialist, and multiplied. Her initial consult came out to a number that covered her time and not much else. She was proud of it. It felt fair.

It was the RVU again, just with her holding the calculator. She had swapped the insurer’s timesheet for her own, and she was still selling minutes.

Baker’s central claim, borrowed from a century of economics, is that this is backwards. Cost and time tell you the floor you cannot go below without losing money. They tell you nothing about the ceiling. Price is not a function of your cost. Price is a function of value, and value lives in one place only: the mind of the person receiving it.

Value is subjective, and the patient sets it

There is an old puzzle economists call the diamond-water paradox. Water keeps you alive and costs almost nothing. Diamonds do nothing useful and cost a fortune. If price came from cost or from usefulness, this would make no sense. It makes perfect sense once you understand that value is subjective and marginal. A glass of water is worth little when you have a tap. It is worth everything in a desert.

Your patient is often in the desert. They have waited nine months in pain. They have been dismissed, rushed, and handed a bill no one could explain. They do not walk into your practice shopping for forty-five minutes of a rheumatologist’s time. They are buying the end of uncertainty. They are buying an answer, a plan, and the specific relief of finally being believed. That is worth a great deal, and none of it is measured by your clock.

This is why two visits of identical length can carry wildly different value. One patient needs reassurance and leaves with it. Another has been misdiagnosed for two years and leaves with the thing that changes their life. Same minutes. Not remotely the same worth. Only the patient can tell you which is which, and the only way to find out is to ask.

Stop selling time. Sell the transformation.

Baker’s line for this is blunt: “We don’t sell time. We sell transformations.” For a physician the translation is almost too neat. Nobody wants a consultation. They want what the consultation gives them.

So change the words. Do not say “I spend an hour with each patient.” That describes your labor, and labor is a cost. Say “you will leave knowing exactly what is wrong and what we are going to do about it.” That describes their transformation, and transformation is value. Same visit. Completely different thing being sold. (This is the same muscle as communicating the benefits of direct care to your patients — you name what changes for them, not how the model works.)

Go one step further than the fix. Solving a problem returns a patient to where they were before it started. The specialists who communicate the most value point past the fix to a better future state: not just normal labs, but the plan that gets their life back. Patients pay more, and pay it more gladly, for a future they want than for a problem merely removed.

Set the price on purpose, before the work

Here is where physicians resist hardest, because medicine trained you to do the work first and let billing sort itself out later. Baker insists the opposite: price is set on purpose, before the work begins, through a conversation about value.

You already own this skill. We say in medicine that prescription without diagnosis is malpractice. The value conversation is a diagnosis. Before you talk about cost, ask what the patient is trying to accomplish. What has the waiting cost them? What are they afraid of? What would relief actually change in their life? Listen the way you listen to a history. Only then do you describe your value, in their words, and set a price that reflects it.

That conversation does two things. It lets you price the actual value in front of you instead of a generic hourly guess. And it makes the number feel earned to the patient, because by the time you say it, they have told you themselves why it matters.

Want the full framework, the scripts, and the pricing structures worked out for direct practices? It lives in the founding member library. Join the founding round and it is yours.

Give them three options, not one

When you hand a patient a single price, you force a yes-or-no decision about you. When you hand them three, you change the question entirely, from “should I work with this doctor” to “which way do I want to.” Baker, drawing on decades of pricing psychology, is emphatic about the power of three: a basic, a standard, and a premium option, anchored with your best offering first.

In practice this is a focused consult, a management package, and a membership. Most patients land in the middle and feel they chose rather than were charged. The options are not a sales trick. They are a way to let a patient match your care to what they actually need and can carry, which is its own kind of respect.

Consumer surplus: why fair value pricing earns loyalty

There is a fear lurking under all of this: that pricing on value means squeezing the patient. It means the opposite. Baker talks about consumer surplus, the gap between the value a customer receives and the price they pay. The patient keeps that gap, and it is the source of loyalty and referrals.

Dr. Steven Borene’s first patient at his direct practice is the cleanest example I know. She arrived with a surgery quote from a large health system. He looked closer, brought in his surgeon, ordered more imaging, and concluded she did not need the operation. She avoided it, saved tens of thousands of dollars, and got better. His practice earned nothing from that visit. The consumer surplus she walked away with was enormous, and it is exactly why a practice built on honest value does not lack for patients. People do not forget the doctor who saved them from a surgery they were about to buy.

There is no such thing as a commodity

The last objection is the quiet one: “specialists in my field all charge about the same, so I have to match them.” Baker’s answer, hammered across every book he wrote, is that there is no such thing as a commodity. Anything can be differentiated, and the belief that you cannot is the only thing making it true.

Your availability is a differentiator. Your honesty is a differentiator. The fact that you answer to the patient and not to a payer is a differentiator patients have never been offered before. Specialize, narrow your focus, be known for one thing, and your perceived value rises on its own. Patients will travel across state lines for a specialist who is unmistakably the right one, and they will pay for the certainty.

The bottom line

You escaped the timesheet the day you left insurance. Do not rebuild it. Price the value of the outcome, not the length of the visit. Have the value conversation before the work. Offer three ways in, not one door. Let the patient keep a real surplus, and they will bring you the next ten patients themselves.

Ron Baker spent a career proving this to skeptical professionals. Medicine gave you a head start he never had: you were trained to diagnose, and pricing on value is just diagnosis pointed at worth instead of disease.

If you are building a practice that finally lets you charge for your judgment instead of your minutes, join the founding round before it closes December 31. Your first year is free.

Frequently asked questions

How should a direct specialty care physician set prices? On the value of the outcome to the patient, not on the time the visit takes or the cost to deliver it. Use a value conversation before the work to understand what the patient is trying to achieve, then price against that.

What is value pricing for physicians? Setting price based on the worth of the result to the patient rather than on hourly rates or unit-based billing. It is the opposite of the RVU model most specialists trained under.

Isn’t pricing on value just charging patients more? No. Value pricing often leaves the patient with a large consumer surplus, the gap between what they received and what they paid, which is what builds loyalty and referrals. Honest value pricing and fairness are the same thing.

Should I offer one price or several? Offer three: a basic, standard, and premium option. It changes the patient’s decision from whether to work with you to how, and most patients choose the middle and feel they chose it.

What is the DSC Alliance, and how do I join? The DSC Alliance is a physician-led community, co-founded by Dr. Diana Girnita, that gives specialists the education, contracts, financial frameworks, and peer network to build independent direct-care practices. You can create a free founding account and join the movement here.

Learn more

• What direct specialty care is, and why specialists are leaving insurance — the model behind value-based pricing.
• How to communicate the benefits of direct care to your patients — turning value into words patients feel.
• Ten steps to start your direct specialty care practice — the practical build.
• External: Ron Baker and the VeraSage Institute on value pricing.

About the author — Dr. Diana Girnita, MD, PhD, FACR Dr. Diana Girnita is a double board-certified physician in rheumatology and internal medicine, and the founder of Rheumatologist OnCall, the first direct specialty care rheumatology practice, caring for patients across multiple U.S. states through telemedicine and in person in California. She is a co-founder of the Direct Specialty Care Alliance (DSC Alliance), a physician-led organization that educates, mentors, and advocates for specialists building independent, transparent, patient-first practices. A national speaker and educator, Dr. Girnita helped define and popularize the direct specialty care model and is a leading voice for transparent, accessible specialist care. Learn more or join the movement at dscalliance.org/membership.