cash-only primary care

[openeyes]

This is an article on a local primary care doctor that found a decade ago that he could have more time for his patients, save his patients money, AND make more money by operating on a simple cash-only basis and keeping overhead low. If/when I have a practice of my own (currently aiming for family nurse practitioner/midwife, but still have to get into nursing school) I'd see this as a promising model to follow if we don't have a single payer system by then, and perhaps even if we do. I don't want to ever have to deal with filing with dozens of different insurance companies.

How to run a cash-only practice and thrive - How this family physician runs a cash-only practice sees 16 patients a day, goes home at 5, and takes home more than $250,000 a year - ModernMedicine

For national healthcare to really cut costs I think we need to look seriously at cutting out the insurance middleman.

[Sfumato]

yes if you don't mind ignoring the poverty stricken masses. His practice is in Apex outside of Raleigh, a fairly upper middle to upper class region almost as wealthy as the "research triangle park" folks are.

Figure like this, if every patient sees him once a year and he brings home 270K at a min. Then he has to charge 108 dollars per single visit, just to pay for his salary, never mind the nurses, secretary and his part time physician, building, consumables, insurance etc etc.

Now i grant you many of these people will go see him more than once a year, but the above figure only accounts for his salary, the other visits the patients may make (since that number is variable and unknown) will equal out for the rest of the overhead.

Did you notice they did not publish how much an office visit costs?

This model will work, so long as you don't mind withholding medical attention from the majority of the poor, poverty and sub-poverty (subsistence) level people.

Eugenics anyone??

[openeyes]

Originally Posted by Sfumato

Did you notice they did not publish how much an office visit costs?

Actually they did, under the bold all-caps subheading "POSTING PRICES"

"Inside Access Healthcare's long, rectangular, windowed waiting room, just left of the check-in window, is a feature uncommon in most primary care physician offices: a price list.

"Nearly every service, supply, and test is printed on paper behind a glass-covered stand. Office visits: $45; sports physicals: $25; ECG: $75; wrist splint: $40; lipid panel: $25. If those prices appear low, keep in mind that these gross charges aren't reduced by health plan contracts or reimbursement errors, and Forrest's collection rate is 99.8 percent."

I see on their website prices have gone up about $4. http://acchealth.com/

Part of the point of the article was that he could charge close to what many people with insurance have as a co-pay, allowing him to serve the uninsured "majority of the poor, poverty and sub-poverty (subsistence) level people" you mention.

"You don't need to charge more to make more," Forrest says. "You need to cut waste to make more."

[SatvikBeri]

By the way-as a general rule, if you offer to pay doctors cash up front in exchange for a lower rate they will often accept. Collections and going through insurance is ENORMOUSLY expensive for doctors, so it makes sense that a cash-only doctor can charge lower prices.

[Clover]

Where I live in Britain, we have no paid insurance. Healthcare is free at point of contact. However, it often takes up to ten days to get an appointment to see my doctor, and there's nothing to be done about this but suck it up and wait. Private health insurance is a 'luxury' here, and prohibitively expensive for most.

I'd absolutely pay for primary care to bypass this waiting system. Last year I had an excruciatingly painful ear infection and by the time I could get anti-biotics I had no hearing in one ear, couldn't walk without help because my balance was shot and had a dangerously high fever (apparently). Could have been easily avoided.

I'd pay because I can, and I'm lucky, but I'd resent that I was paying my taxes then paying again for basic care.

[LostMyMap]

This all seems well and good for the general practice stuff. But serious injury or illness, and you better have insurance. That's what it's for.

[James81]

Originally Posted by LostMyMap

This all seems well and good for the general practice stuff. But serious injury or illness, and you better have insurance. That's what it's for.

We actually need to go back to that model actually, because health insurance today is *not* just for major illness anymore. They've added so much into the policies (figuring out how to jack their premiums up while making it seem like the perceived value is better) that it's anything but a major illness. Insurance companies, in fact, BANK on the fact that you never have to use it for major illness because that's how they make their money.

In order for the current health insurance model to work, they have to convince more people to pay for something they do not need than people who might have to use it. And they have restrictions on pre-existing conditions and everything else.

So, no, insurance isn't for that anymore. And THAT is the problem with healthcare in this country.

Honestly, if we went to a catastrophic illness model of insurance and used out of pocket expenses for everything else, healthcare in general would be way more affordable. Mainly because it would drive costs down (lower overhead costs) and would take away the need for beefing up the cost of healthcare to cover the taxes surrounding using healthcare providers.

For example, if you go to a wellness checkup, and pay cash, you would be charged, say, $50. However, if you have health insurance, your charge would be whatever your copay is ($15 or $25 roughly usually) and your insurance company would be billed somewhere around $80. So, the same procedure has got to be beefed up because the taxes on the provider forces them to raise the price, which drives up the cost of premiums, which creates our current system as it is today.

As someone said above, if you cut out the insurance middleman, prices would stabilize and be more reasonable.

I would be in favor of a law forcing people to payroll deduct a small percentage of their income to a healthcare savings account (non-taxed of course ) and to carry health insurance geared entirely toward the possibility of a major illness or operation (say, any healthcare cost that goes above whatever they put in their healthcare savings account that year).

What would happen there is that your healthcare savings account would grow and become huge at the beginning of your life (when you're less likely to need it), your insurance premium for major stuff would be lower (because fewer claims would be made, thus fewer people need to handle claims, thus lower overhead cost for insurance company), and not a dime of healthcare would ever go unpaid by the recipient of the healthcare (i.e. our government would not be forced to pay for those who bankrupt their medical bills).

That would so have a major positive impact on our economy it wouldn't even be funny how far-reaching those effects would be. It would be utterly amazing and good and right and holy.

[LostMyMap]

Originally Posted by James81

I would be in favor of a law forcing people to payroll deduct a small percentage of their income to a healthcare savings account (non-taxed of course ) and to carry health insurance geared entirely toward the possibility of a major illness or operation (say, any healthcare cost that goes above whatever they put in their healthcare savings account that year).

What would happen there is that your healthcare savings account would grow and become huge at the beginning of your life (when you're less likely to need it), your insurance premium for major stuff would be lower (because fewer claims would be made, thus fewer people need to handle claims, thus lower overhead cost for insurance company), and not a dime of healthcare would ever go unpaid by the recipient of the healthcare (i.e. our government would not be forced to pay for those who bankrupt their medical bills).

That would so have a major positive impact on our economy it wouldn't even be funny how far-reaching those effects would be. It would be utterly amazing and good and right and holy.

I don't even technically have 'insurance', I have a health plan, so yeah I see what you are saying.

So, something like a 'health IRA'? Pretax money you save throughout your life. Wow, that's a really interesting idea. How would it work for spreading costs? Right now HSA's are only for you, right? So let's say, you are 30, you get injured, and the costs run way past what have saved. How would that be paid?

[openeyes]

Originally Posted by LostMyMap

This all seems well and good for the general practice stuff. But serious injury or illness, and you better have insurance. That's what it's for.

Very true. That's why I'd like to see a single payer system where there's no insurance middleman adding to costs, just a system where the doctor gets paid and the patient gets treated, with minimal expense incurred to make sure the doctor (or hospital and ambulance) gets paid.

Cash-only doctors could still have their place within that network, but it should be possible to have a single payer system without huge wait times, or even a system with insurance that is more streamlined for lower overhead. Right now many doctor offices spend six figures on staff with the primary job of filing claims.

The best compromise available in the US at the moment seems to be having high deductible insurance for emergencies and seeing a cash-only doctor for low cost, low wait, and plenty of attention. This is far from a perfect system since many people can't afford a high deductible, but they also can't afford high premiums, and not everyone has a full time job with benefits.

Of course, if catastrophic insurance were just used for catastrophes and not regular primary care visits, the deductible may not need to be so high.

[LostMyMap]

So on most dental plans I've been on, preventative care is 100% covered (cleaning, Xrays). Because they know that prevention really works. Seems like we could have something like that on the medical side. You could get a basic physical, with whatever that might entail based on your age and sex, every year for free. Better for the patient and the system to catch things early on, or prevent them altogether.

[James81]

Originally Posted by LostMyMap

I don't even technically have 'insurance', I have a health plan, so yeah I see what you are saying.

So, something like a 'health IRA'? Pretax money you save throughout your life. Wow, that's a really interesting idea. How would it work for spreading costs? Right now HSA's are only for you, right? So let's say, you are 30, you get injured, and the costs run way past what have saved. How would that be paid?

Essentially MyPlan(TM) () would involve a dual approach:

1. An overarching insurance plan through a health insurance provider that covers any and all major expenses above what is not currently in your health savings account. Anything beyond, say, $5000 in a given fiscal year (that's a number I pulled out of my ass...it could be adjusted either way with further analysis).

2. A required (by-law) payroll contribution to a health savings account (like an health IRA). In fact, these types of accounts already exist, and they are already pretax. And it could be based on percentage of income in the same way other things are (like social security and that jazz). And essentially, that account is only used for medical expenses for yourself and any dependent that lives in your house. And the percentage that gets deducted can be adjusted based on the number of dependents. More for more dependents, less for less dependents.

With those two facets, you start building your own healthcare account (money that is YOURS, that never goes away unless you use it for medical expenses, rather than funneling hundreds of dollars to an insurance company that you'll never see again).

And with that plan, what will happen is that your medical savings account gets billed (rather than your insurance provider). If you don't have money in the account in the beginning, your account drops to a negative and gets replenished over time. OR, if it's a more major medical thing, your insurance company picks up the tab.

For the majority of people, what will happen is that their medical savings accounts will grow over time (I hardly ever use my insurance for myself right now, for example). And you may even set it up that that money goes to investments so that it can grow even more with interest (and can make an even DEEPER positive impact on the economy ).

Basically, you take control of your own healthcare costs by payroll deducting a certain percentage of it towards medical bills and only relegating health insurance to bigger picture health costs.

[openeyes]

My employer pays $500 per month per employee for health insurance, adding my fiancee when we get married would be another $550, making it $1050 for both of us to have regular insurance (we could get it cheaper on our own at our age), while a high deductible HSA would cover both of us for $140 total per month.

Getting the high deductible plan and saving the difference in premiums would cover the deductible in less than a year. Even if we were in our early 60s it'd only cost ~$350 monthly for both of us.

Since my employer doesn't charge me anything to have insurance, and wouldn't provide me with anything if I opted out of it, my fiancee has a high deductible plan of her own, with enough savings to readily cover it, while I keep the insurance that lets me be wasteful if I choose to, since there's no incentive not to. I'd love to convince them to get me an HSA and put even half the savings into my account if I could take it with me when I leave.

[LostMyMap]

James81 For Congress 2012

[LostMyMap]

Originally Posted by James81

Essentially MyPlan(TM) () would involve a dual approach:

1. An overarching insurance plan through a health insurance provider that covers any and all major expenses above what is not currently in your health savings account. Anything beyond, say, $5000 in a given fiscal year (that's a number I pulled out of my ass...it could be adjusted either way with further analysis).

Question, where do the premiums for this come from? Me or the company? Or ?

[James81]

Originally Posted by LostMyMap

Question, where do the premiums for this come from? Me or the company? Or ?

That could be a detail that's hashed out.

I think the current way it's setup in a lot of cases is that the company pays a portion and the employee pays a portion. They could do it the same way, except the amount each of you would have to pay would be significantly less.

In fact, they could take the money that is saved through this and have your company also contribute to your own health savings account as well (and you keep it whether you work there or not) and your company would not pay anymore than it already has to (and could potentially pay less).

Remember me this November when you go to the voting both.

[Sfumato]

Originally Posted by openeyes

Actually they did, under the bold all-caps subheading "POSTING PRICES"

"Inside Access Healthcare's long, rectangular, windowed waiting room, just left of the check-in window, is a feature uncommon in most primary care physician offices: a price list.

"Nearly every service, supply, and test is printed on paper behind a glass-covered stand. Office visits: $45; sports physicals: $25; ECG: $75; wrist splint: $40; lipid panel: $25. If those prices appear low, keep in mind that these gross charges aren't reduced by health plan contracts or reimbursement errors, and Forrest's collection rate is 99.8 percent."

I see on their website prices have gone up about $4. http://acchealth.com/

Part of the point of the article was that he could charge close to what many people with insurance have as a co-pay, allowing him to serve the uninsured "majority of the poor, poverty and sub-poverty (subsistence) level people" you mention.

"You don't need to charge more to make more," Forrest says. "You need to cut waste to make more."

I am a dummy, i did not notice it went on for two more pages

Now that I have read rest of the article I am warming to the idea. Sorry for the hasty post.