In any given year, the overwhelming majority of American’s either won’t need to see a doctor at all, or will only need to visit a primary care provider for basic or relatively routine medical issues. Self-pay patients are no different in this regard, which is why being able to find an affordable and accessible primary care provider should be near the top of the list of things to do for people who will be paying directly for their own care.
Two of the best options are telemedicine and retail health clinics, both of which offer relatively low-cost access to quality care. Both have their drawbacks, however – some things just can’t be handled over the phone and require an in-person visit, and likewise the highly-trained nurse practitioners staffing retail health clinics aren’t doctors and some things are simply beyond their knowledge and skill.
For these reasons, finding a doctor who caters to self-pay patients is important. That’s why I’m so pleased to see that cash-friendly practices continue to spread, providing more options for self-pay patients.
I recently read about Express Family Care, a cash-friendly practice opening in Roanoke, Virginia:
Sunday, January 26, 2014
…Express Family Care, a Roanoke County physician’s office that opened last month… is posting the prices of a visit for its cash-paying patients to see, right there in the waiting room before they are treated.
The goal is to provide transparency in a world of high — and some would say hidden — costs, said Dr. David Alligood, one of three physicians at the practice.
“There is an opacity to the price structure in modern medicine, and it’s difficult to get a straight answer,” said Alligood, who began seeing patients at the Bonsack office in late December along with Dr. Scott Crosby and Dr. Scott Hayes.
“It’s difficult and frustrating for the patients when there are different price structures.”
Direct payment systems like the one at Express Family Care are unusual for Southwest Virginia and across the state, several health care experts said in recent interviews.
If this was a fast food restaurant, the prices would be for small, medium and large.
A simple doctor’s visit costs $109, as patients can see from a price list as soon as they walk into Express Family Care… An intermediate visit, which might include X-rays or lab work, is $149. And a complex visit, described as involving minor surgery such as stitches or splinting, costs $199…
One of the interesting things about Express Family Care is that they appear to be blending the concepts of primary care and urgent care:
While it’s modeled after urgent care centers that have been popping up in the Roanoke Valley in recent years, the practice will also offer primary care on a continuing basis.
Alligood, Crosby and Hayes have a combined 45 years of experience in emergency room care, and all three are board-certified in family medicine.
Their hope is to offer primary care to repeat patients while maintaining enough flexibility to take the unexpected walk-ins that are the staple of urgent care: cuts that need stitching, broken bones, bad colds and the like.
The article notes something that I’ve addressed in the past, that for people with high-deductible plans it often makes sense not even trying to use their insurance and instead just pay directly:
In some cases, insured people with high-deductible plans may find it simpler and less expensive to forego their insurance plans and just pay cash at Express Family Care.
And I was happy to see referenced in the article another doctor in the Roanoke area, Dr. Janine Talty, that has abandoned insurance payment:
Another Roanoke-area physician, Dr. Janine Talty, has found a way to distance herself from the insurance filing process while also posting her prices in a way that is similar to Express Family Care.
Talty takes direct payment from her patients, then turns those who have insurance over to an independent biller who processes their claims and has the insurance company send reimbursements to the policy-holders.
“I just got tired of running to the mailbox every day, wondering if I was going to be able to run my business,” Talty said in explaining why she decided to stop dealing directly with insurance companies.…
I referred to Express Family Care as ‘cash-friendly’ as opposed to ‘cash-only’ because they do in fact take insurance. Dr. Talty’s practice is a blend as well, in that she only takes direct payment but does facilitate the insurance billing process so patients can be reimbursed.
Another cash-friendly practice that is opening up is the Sora Lily Medical Clinic in Plano, Texas. They don’t accept any commercial insurance, but they do accept Medicare payment. Here’s how their site describes their pricing policy:
Our pricing is a bit different than most other clinics. In the insurance world, insurance pays per visit, for either one medical problem or two medical problems. This is a bit unrealistic in a couple of ways. It is not really fair for someone with a basic stuffy nose to have to pay as much as a complex problem like diabetes. So, we charge less for basic problems.
Secondly, we charge per medical problem, not per visit (and NOT per symptom). It is only fair that a patient with one medical problem should pay less than a person with two medical problems. We have a fixed price for each medical problem. So, a patient with knee pain would pay for a basic visit, or $45. A patient due for his diabetes follow-up would pay for a complex visit, or $75. If a patient is due for his diabetes visit AND he wants his knee checked out, he pays for both problems, or $45 (basic problem) + $75 (complex problem) = $120.
They also explain why, in their view, it’s better not to use insurance:
Why it is better NOT to use your insurance:
1. Your doctor pays fees and hires extra staff to cover the overhead of accepting insurance. The doctor increases his prices to cover these costs.
2. The insurance corporations make a very, very long contract with the doctor, with lots of complicated rules about YOUR healthcare.
3. You, or your employer, pay a lot of money for an insurance policy with a deductible.
After paying all of this money upfront, you finally need to see the doctor. The doctor will charge you the posted (inflated) office visit price and maybe run some labs. One of the following will likely happen when you use your insurance for the office visit:
– If you have not met your deductible, you will still pay cash for the cost of the visit, even after paying all of that money for insurance.
– If your visit includes medical problems or labs that are not covered by the insurance company, you will still pay cash for the cost of the visit, even after paying all of that money for insurance.
– If you have met your deductible and have met all the insurance companies rules and regulations, then the insurance company will pay for some of your visit. For your portion, you will still pay cash.
That sums it up pretty well.
More primary care practices are embracing cash-friendly medicine, and for many I suspect it’s an easier transition than going to a cash-only practice. I was speaking with a doctor at an event last week where the focus was direct-pay medicine, and he explained that even though much of his clientele is fairly wealthy, many of them are locked into the mindset that insurance should pay for all of their healthcare. This meant, he told me, that if he went cash-only or even to a concierge practice he’d lost most of his patients.
The doctor may be misjudging his patients, of course, but that’s the way he feels and obviously it’s a huge barrier to being able to transition to a conventional insurance-accepting practice to cash-only. Hopefully the cash-friendly model, which doesn’t require completely opting out of commercial insurance or government programs like Medicare, will be seen as a comfortable middle ground. If that happens, self-pay patients can expect to see many more options for primary care in the coming years.