he Access Healthcare model is based on a combination of new and vintage approaches to patient care that work together to provide reasonable solutions to some of the current problems in the healthcare system. The hypothesis of the Access Healthcare model is that if practices can decrease overhead and collect payments at the time of service (i.e., eliminating practicebased insurance billing), then they can reduce fees and increase revenue. I performed an evaluation of several existing North Carolina family medicine practices and then opened a practice based on a model that would address some of the problems that had been observed. This commentary describes the Access Healthcare model and discusses what has been learned from it. Background The Access Healthcare model began as an observational study of existing practice models in the piedmont and triad areas of North Carolina. This particular evaluation began five years ago (2000) and involved several different practices and more than 50 providers. Various types of offices were studied, including a large group practice, a small group practice, and a multi-specialty group practice. The main aspects observed were patient flow, time spent in the waiting room, billing, patient check-in and check-out, verification of insurance, and DNKAs (number of patients who did not keep their appointment). For 42 of the providers, the average charge was $93 per patient visit, the average collection was $39 per patient visit, and the total average overhead was $50 per patient visit. Even though this is an average, it represents an $11 loss per patient seen. Additional study over a 16-month period and review of other innovative approaches from articles in Family Practice Management, Family Practice News, American Medical Association News, local newspapers, and magazines, helped me conceptualize the Access Healthcare model. For three and a half years, the Access Healthcare practice (located in Apex, North Carolina) has provided continuity care for more than 2,000 patients. Practice overhead is consistent at 25%. Charges/collections average $65 per patient. The net practice profit is $48 per patient. The $65 average is made up of the $45 office visit added to the average lab and supply cost of about $20 per patient. This means that the supplies and labs are paying the overhad and the office visit charge is basically the net profit for each provider. This makes it possible to charge less, see fewer patients, and still net a higher reimbursement per encounter than most providers due to the reduced overhead and higher collections. Also, it only takes about three to four patients per day to break-even (and pay overhead costs) with this model.