villa6 Posted November 17, 2011 Share Posted November 17, 2011 I recently heard on the radio of how a MD would not accept insurance (cash only). He said he did not feel he could provide top quality healthcare as long as the insurance and pharmaceuticle companies were tied into his practice. As an example he described how it does no good to come up with a treatment plan only to have it denied by the insurance carrier. This then requires coming up with a (second best at best) non-preferred treatment plan. Given the current shortage of providers, it seems that independent practices have this option. Since everyone will soon have mandatory health insurance, how do you feel about not accepting insurance? Is this a reasonable option for some practices? Link to comment Share on other sites More sharing options...
just_me Posted November 17, 2011 Share Posted November 17, 2011 I worked in a practice like that as an MA....I will say that he gave his patients a lot of time but then again if you pay 1400+ for a physical you better be able to spend as much time there as you want. I will say that as a courtesy they would bill to see if there were any out of network benefits and if so that was deducted from the total costs. He handled everything for these patients, he knew them all very well and could tell you anything about them without the chart....may had been with him for YEARS. He took walk-ins all the time, would come in on non-patient days (weekends included) to see someone and even would take calls on his cellphone. The least amount of time he spent with a patient during a visit was about 45 minutes but Ive seen him spend upwards of 2 hours with them as well. I think it goes beyond whats good for the patient though....there are benefits to the provider as well. When you can charge what you want and get 100% paid to you that means less patients you have to see, less time in the office and essentially "less work". The doc I worked for pretty much only worked 3 days a week and we usually only scheduled 6 or 7 patients a day. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 17, 2011 Moderator Share Posted November 17, 2011 I did a rotation with an older fp doc (DO) like that. guy still did housecalls for his elderly pts, nursing home rounds, etc not enough docs like that left. Link to comment Share on other sites More sharing options...
JasonD Posted November 17, 2011 Share Posted November 17, 2011 My daughter shadowed a PA at a cash-only office. It's located in an affluent area so there was no shortage of patients. The PA was able to spend a lot of time with his pts. Sounds like a good place to work. Link to comment Share on other sites More sharing options...
jmj11 Posted November 17, 2011 Share Posted November 17, 2011 I've been a little surprised. I do "cash only" only for Group Health patients, because Group Health has boycotted my practice. I had 500 patients whom I was following, and they seemed to be very happy with their care. Many were calling daily begging for us to push GH more. However, to date, only two have forked over the $295 to see me. Some of these people are very affluent too. There is this mental barrier that blocks them from paying out of pocket. I'm sure it works for some people. Link to comment Share on other sites More sharing options...
whimsygirl Posted November 17, 2011 Share Posted November 17, 2011 I don't think people want to pay cash only for a traditional health care model. It does seem like the concierge practices are doing quite well. Link to comment Share on other sites More sharing options...
villa6 Posted November 18, 2011 Author Share Posted November 18, 2011 Wow that sounds incredible. I don't know how many times I was told to spend less time on patients. It always bothered me. My brother-in-law is a DO and he complains about being required to spend to little time with patients. Link to comment Share on other sites More sharing options...
just_me Posted November 18, 2011 Share Posted November 18, 2011 funny thing is that some of them would complain that he spends too much time with them.....but they love the attention in your case it seems that time is money....the more patients you see the more you can bill for because youre only getting a contracted portion of what youre billing out for anyway. in my physicians case that point doesnt matter because now he can bill for an extended visit and still get 200+ dollars just in a visit fee alone not to mention how much he up-charges for labs (we draw and send out), CXR which he does in-house and all sorts of other things when people pay out of pocket they arent paying to be treated like a patient they are paying to be treated like they matter....at least the patients he sees and for him he doesnt have to fight to get paid what he feels his time and attention are worth Wow that sounds incredible. I don't know how many times I was told to spend less time on patients. It always bothered me. My brother-in-law is a DO and he complains about being required to spend to little time with patients. Link to comment Share on other sites More sharing options...
villa6 Posted November 18, 2011 Author Share Posted November 18, 2011 in your case it seems that time is money....the more patients you see the more you can bill Actually, this was in the military. They were still about pushing more patients even though there was no billing. Link to comment Share on other sites More sharing options...
just_me Posted November 18, 2011 Share Posted November 18, 2011 ah there you have time is time (even though they still do bill/submit claims from my understanding) lots of patients to see. I remember as a kid (and even taking my mom now) seems they pack schedules tight...especially in areas where bases have closed Actually, this was in the military. They were still about pushing more patients even though there was no billing. Link to comment Share on other sites More sharing options...
andersenpa Posted November 18, 2011 Share Posted November 18, 2011 This is an article that I posted previously http://news-line.net/onenews.lasso?-Search=Action&-Table=webinfo&-Database=press*&-KeyValue=1807&-token.profession=PA&type=f PA owned practice, she doesn't accept insurance to lower billing service/staff costs, and is able to charge patients less. I get the sense that not all these cash only practices are for concierge/affluent client base. Link to comment Share on other sites More sharing options...
Qkwan Posted November 20, 2011 Share Posted November 20, 2011 I signed up with a relatively new concierge doctor in town for my family and I about 6 months ago. He does not deal with insurance, which saves him the need for all the staff related to that. He spends as much time as needed with each person at each visit. I have his cell phone, email, and twitter and have communicated by all 3. As recently as 10pm tonight when I texted him a picture of a skin reaction my husband is having to a new medication. It's certainly not only for affluent patient's though. $120 monthly fee for my family of 4 for 24/7 access, anything he does in-office is included, and labs and meds are wholesale. He doesn't upcharge at all. CBC is $3. Prednisone $.02/pill. Just examples. Many patients spend less money than they were before because the savings on medications is so significant if they have several chronic meds. He limits the # of patients he will accept so he still has time for everyone, and it's still profitable. He has an insurance contact who can help patients get set up with major medical for things like surgery or hospitalization. Truly I'm still amazed by the whole thing. For myself and many others the service is worth the cost or actually saves money, so I don't think everyone having insurance will have any negative affect on his practice. Link to comment Share on other sites More sharing options...
jmj11 Posted November 20, 2011 Share Posted November 20, 2011 I signed up with a relatively new concierge doctor in town for my family and I about 6 months ago. He does not deal with insurance, which saves him the need for all the staff related to that. He spends as much time as needed with each person at each visit. I have his cell phone, email, and twitter and have communicated by all 3. As recently as 10pm tonight when I texted him a picture of a skin reaction my husband is having to a new medication. It's certainly not only for affluent patient's though. $120 monthly fee for my family of 4 for 24/7 access, anything he does in-office is included, and labs and meds are wholesale. He doesn't upcharge at all. CBC is $3. Prednisone $.02/pill. Just examples. Many patients spend less money than they were before because the savings on medications is so significant if they have several chronic meds. He limits the # of patients he will accept so he still has time for everyone, and it's still profitable. He has an insurance contact who can help patients get set up with major medical for things like surgery or hospitalization. Truly I'm still amazed by the whole thing. For myself and many others the service is worth the cost or actually saves money, so I don't think everyone having insurance will have any negative affect on his practice. You must have a secondary insurance for catastrophic events, hospitalizations and etc. ? In my office, if I only dealt with cash, it would lower my fees by about 50-60%. First of all, at best, I am paid 70% of my billings. Then I pay $490/month for our electronic billing service, $1,000 for my biller (part time), Then there is all the paper work, resubmits, etc. However, even at a 60% reduction, many patients still prefer to see someone for whom their insurance covers. Link to comment Share on other sites More sharing options...
Moderator ventana Posted November 20, 2011 Moderator Share Posted November 20, 2011 $120 monthly fee for my family of 4 for 24/7 access, anything he does in-office is included, and labs and meds are wholesale. He doesn't upcharge at all. CBC is $3. Prednisone $.02/pill. . humm $120/m for family of four $1440/yr income for family of 4 doc's need to make a min of $120,000/yr or $10,000/month NOT including office staff and all other expenses like malpractice insurance office expense likely another $120,000 total expense is $240,000 divide this by $1450 is about 666 familys of 4 for a year to get his office runing - or a panel of 2500 patients.... honestly this is a little tight to make sense - should make about $150,000, with total expenses in the $300,000 range means he would need to carry alot of patients.... he needs to raise his per person fee a little bit ($120/m for a family of four is honestly too cheap) but I love the idea and think it has merit - but it certainly does have a selection bias (no medicaid patients or that soscioeconimic tier) Link to comment Share on other sites More sharing options...
hum1doug Posted November 20, 2011 Share Posted November 20, 2011 We have a local cash only walk in clinic with a slightly different mission, target population. Visits are $50 and $40 for a follow up. Their target population is the many that are employed but don't have medical insurance which is a large group ... and they also said that they see those that have insurance with a high deductible and just want to pay $50 to get meds for a sinus infection. Some have come to use their clinic for mgmt of chronic conditions ... always come in out of meds and not managed well because they come when they can afford it .. clinic just does what they can (just like a volunteer free clinic that they don't qualify for because they have income). Clinics are staffed with PAs and NPs only so NO controlled substance prescribing (Florida law) and there are large signs posted on front door and waiting area stating so ...That is one cool exclusion. Those pts know where the local 'doc in the box' narc dispensary is. This is a cash only business idea on the the opposite side of the concierge deal ... Link to comment Share on other sites More sharing options...
Febrifuge Posted November 21, 2011 Share Posted November 21, 2011 I solo in an Urgent Care and honestly, a lot of the people I see are using me as this general sort of thing. Sure, there are those who can't wait until their primary's first available spot on the schedule, but there are at least as many who just don't feel like dealing with the hassle. I'm convenience care, to these patients. If they're members of the health plan I work for, the copay is the copay, and only like $10 more than the copay for an office visit, plus I'm open evenings and weekends. My personal feeling is that I'm a lousy substitute for an actual primary care provider, and I frequently "refer" people back to their primaries, but our members are basically showing us what kind of a model they would most like to be using. And if it's a UTI or sinusitis, I honestly can't blame 'em. Link to comment Share on other sites More sharing options...
DeniseT Posted March 13, 2012 Share Posted March 13, 2012 It seems like the older doctors who have been practicing for over 40 years got into the business because they love taking care of people. It was simpler back then and even before that when everyone paid out of pocket. Now, like someone mentioned above, you have to pay a whole staff to file paperwork and claims. I do see how it could save money to not accept insurance although the $120 a month for a family of four does seem a little low. I think this would be great for my family. We would still get a catastrophic health plan but not have to worry about getting a plan for regular doctor visits and medicine which make up about 95% of my family's medical costs. Link to comment Share on other sites More sharing options...
DeniseT Posted March 13, 2012 Share Posted March 13, 2012 It seems like the older doctors who have been practicing for over 40 years got into the business because they love taking care of people. It was simpler back then and even before that when everyone paid out of pocket. Now, like someone mentioned above, you have to pay a whole staff to file paperwork and claims. I do see how it could save money to not accept insurance although the $120 a month for a family of four does seem a little low. I think this would be great for my family. We would still get a catastrophic health plan but not have to worry about getting a plan for regular doctor visits and medicine which make up about 95% of my family's medical costs. Link to comment Share on other sites More sharing options...
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