Derm Dispatch: Cutting Costs, Not Care with Jacki Kment, PA-C, MPAS, DFAAPA

In a recent Derm Dispatch interview, Renata Block, DMSc, MMS, PA-C, spoke with Jacki Kment, PA-C, MPAS, DFAAPA, about her decision to launch a direct pay dermatology practice in Lincoln, Nebraska, Integrity Dermatology. With 30 years of experience as a physician assistant—27 in dermatology—Kment made a bold move in 2018 to leave traditional insurance-based care and create a patient-centered model rooted in accessibility, time, and transparency.

The shift stemmed from frustrations in her previous practice. “I was in a large dermatology practice going on 20 years, and I was challenged by the limited amount of time to spend with patients,” Kment explained. The pressure to see more patients in less time to compensate for reduced reimbursement rates had become unsustainable. She also identified a need in the community for more affordable care, especially for uninsured individuals.

That need led her to explore a lesser-known option: direct pay. “So I looked into what's called a direct pay dermatology practice model,” she said. “And by doing this, I could create an opportunity to invest in education of my patients, something that is very challenging in a traditional medical practice due to the limited amount of time that we are able to have with our patients.”

In her direct pay model, Kment does not accept insurance or government programs like Medicare or Medicaid. Instead, patients pay a transparent, flat fee at the time of service. “We decided not to participate with any insurance companies or even governmental programs, and by doing so, you can actually significantly reduce your overhead costs and then pass those savings onto your patients,” she said.

This approach allows Kment to spend more time with each patient—appointments are typically booked every 20 to 30 minutes. “We don’t have patients every 5 to 10 minutes, like in typical dermatology practices,” she emphasized.

While the benefits are clear—lower fees, more personalized care, and fewer administrative headaches—Kment acknowledged that educating patients and providers about this new model has been the biggest challenge. “I think the greatest risk is that it's a completely new… it's a new practice model, and many people don't understand it,” she said. Patients often ask why they shouldn't use their insurance, and many are unaware of the potential cost savings.

Still, the impact has been profound. Patients with severe chronic conditions, like psoriasis, who previously avoided care due to cost, are now able to access treatment. “We have some patients that have 70 to 80% of their body surface area covered in psoriasis, and they haven't gone in, and they are recluse because they didn't have the money,” Kment shared.

Her practice not only provides vital care but also offers dignity, time, and trust—qualities often missing in high-volume, insurance-based settings. Kment continues to consult with other providers interested in replicating her model, proving that rethinking the business of dermatology can lead to both clinical success and meaningful patient impact.