Re: Cash Only -- another in a trend?

December 27, 2008

I have quite a few cash paying patients. Some of them I do not par with their insurance, but they come anyway. Some have no insurance. And the Urgent Care 4 hour wait is not worth it, since they have to pay there anyway. They love the half-hour they get for their $125. And then there's the HSAs. But, their visits can go well beyond my fee - labs, Xrays, mammograms, etc. I try to do without all the tests in all my patients anyway, but the self-payers certainly resist much more than the "can I have every tests done? My insurance will cover it if you say it is necessary?".

I am slowly making my way toward dropping insurances. Today I had 2 self pay patients, $265 combined. Ah, I can finally pay the phone bill!

To: Locke Sent: Friday, December 26, 2008 6:08:00 PMSubject: Cash Only -- another in a trend?

Story on a cash only practice.

The responders again miss the point -- they point out that nobody can afford healthcare visits of a $100 when they forget they are paying $200-500/month to the insurance company.

Why not pay the doctor directly?

Anyway, interesting info.

Locke, MD

============ ========= ========= ========= ======

Radio Gift: Dr. Boots Tries A No-Insurance Model

by Rose

Listen Now [5 min 1 sec] add to playlist

Rose/NPR

Some of Dr. Crowley's patients call her Boots because she wears Doc s to work.

Day to Day, December 23, 2008 · We only have radio to give you this holiday season. With that in mind, Kathleen Tacelosky asked us to produce a story on her sister-in-law — a doctor in New Jersey who doesn't accept health insurance from her clients.

http://www.npr. org/blogs/ daydreaming/ 2008/12/radio_ gift_dr_boots. html

Radio Gift: Dr. Boots

Rose

--Steve Proffitt

This season we asked listeners what they wanted to hear for the holidays, and we responded to their requests with a few "radio gifts."

This one goes out to listener Kathleen Tacelosky.

She wrote us this letter:

Crowley, M.D. is a family practice/primary care physician in New Jersey who is intensely dedicated to her craft and her patients. But healthcare has become an industry in our country, and it is out of whack. She was spending an insane amount of time negotiating with the insurance companies trying to get approvals and trying to get paid.

Instead of letting her frustration get her down, she has come up with a gutsy, creative solution: As of October 1, she dropped all insurance and Medicare and went all cash. She had a meeting with her patients about it. She's lost some patients, of course, and she's gained new ones. She's keeping a blog about it where she shares what led up to this, her fears, her occasional feelings of guilt, what others are saying to her etc.

She's been writing about her experiences on a blog.

Note that her blog name is "bootscrowley. " Some of her patients call her Boots because she wears Doc s to work. She's unconventional, determined and has a lot of pluck! I think she'll inspire your listeners as she has me and others who know her.

We sent reporter Rose to visit Dr. Boots, and his story is today's radio gift. Happy holidays to all who wrote us, and thanks for letting us give you a little radio.

Avruskin (nevadaPT) wrote:

As a physical therapist, I know several practitioners who have gone this cash-based-business route. I had a very small cash-based practice myself for a short while, when I lived in a very rural area. And some of the medical professionals I choose for my own healthcare do not take insurance. So I can see the situation from both the receiver and giver viewpoints.One of the first dilemmas that arise in a no-insurance office is patient "sticker shock" versus covering overhead expenses and being paid for your time and expertise. In my current practice, many patients regard even a $25 copay as prohibitively expensive, so asking $100, like Dr. Crowley does...may indeed cause customer loss.Hopefully, a solution may be found in the middle. Charging less than $100, or offering shorter visit times for a reduced fee, may allow greater accessibility. I would have been very interested to hear how Dr. Crowley decided on her

visit fee amount, what the considerations were and how it was calculated. And, although a doctor can determine the fee he/she will accept for their services, lab tests and diagnostic procedures can be enormously costly; I am interested as to how these could be handled in a no-insurance situation.

Wednesday, December 24, 2008 3:53:54 PM

Recommend (0)

Report abuse

(themarycarter) wrote:

Dr. Crowley joins many other doctors who have decided to go it without the insurance companies. The tone of this program was very upbeat and positive, but the ultimate result of patients' having to pay for services out of pocket is that only people with money will be able to afford medical care. Is this right? Is this okay? Is this fair? What about those of us who cannot afford to pay out of pocket for our medical care? Are we just supposed to go away and be sick without any medical care?

Tuesday, December 23, 2008 9:13:50 PM

http://www.njafp. org/njafp_ custom/practice. aspPractice: Crowley Name: Crowley Email: bootscrowley@ yahoo.com Job Title: Physician Address: 307 Stone Harbor Boulevard

Cape May Courthouse, NJ 08210 County: Cape May Business Phone: Business Fax: Home Phone:

December 28, 2008

, are you doing any "outbound" marketing for your practice--the self-pay part I mean?

To: Sent: Friday, December 26, 2008 10:08:12 PMSubject: Re: Cash Only -- another in a trend?

I have quite a few cash paying patients. Some of them I do not par with their insurance, but they come anyway. Some have no insurance. And the Urgent Care 4 hour wait is not worth it, since they have to pay there anyway. They love the half-hour they get for their $125. And then there's the HSAs. But, their visits can go well beyond my fee - labs, Xrays, mammograms, etc. I try to do without all the tests in all my patients anyway, but the self-payers certainly resist much more than the "can I have every tests done? My insurance will cover it if you say it is necessary?".

I am slowly making my way toward dropping insurances. Today I had 2 self pay patients, $265 combined. Ah, I can finally pay the phone bill!

To: Locke Sent: Friday, December 26, 2008 6:08:00 PMSubject: Cash Only -- another in a trend?

Story on a cash only practice.

The responders again miss the point -- they point out that nobody can afford healthcare visits of a $100 when they forget they are paying $200-500/month to the insurance company.

Why not pay the doctor directly?

Anyway, interesting info.

Locke, MD

============ ========= ========= ========= ======

Radio Gift: Dr. Boots Tries A No-Insurance Model

by Rose

Listen Now [5 min 1 sec] add to playlist

Rose/NPR

Some of Dr. Crowley's patients call her Boots because she wears Doc s to work.

Day to Day, December 23, 2008 · We only have radio to give you this holiday season. With that in mind, Kathleen Tacelosky asked us to produce a story on her sister-in-law — a doctor in New Jersey who doesn't accept health insurance from her clients.

http://www.npr. org/blogs/ daydreaming/ 2008/12/radio_ gift_dr_boots. html

Radio Gift: Dr. Boots

Rose

--Steve Proffitt

This season we asked listeners what they wanted to hear for the holidays, and we responded to their requests with a few "radio gifts."

This one goes out to listener Kathleen Tacelosky.

She wrote us this letter:

Crowley, M.D. is a family practice/primary care physician in New Jersey who is intensely dedicated to her craft and her patients. But healthcare has become an industry in our country, and it is out of whack. She was spending an insane amount of time negotiating with the insurance companies trying to get approvals and trying to get paid.

Instead of letting her frustration get her down, she has come up with a gutsy, creative solution: As of October 1, she dropped all insurance and Medicare and went all cash. She had a meeting with her patients about it. She's lost some patients, of course, and she's gained new ones. She's keeping a blog about it where she shares what led up to this, her fears, her occasional feelings of guilt, what others are saying to her etc.

She's been writing about her experiences on a blog.

Note that her blog name is "bootscrowley. " Some of her patients call her Boots because she wears Doc s to work. She's unconventional, determined and has a lot of pluck! I think she'll inspire your listeners as she has me and others who know her.

We sent reporter Rose to visit Dr. Boots, and his story is today's radio gift. Happy holidays to all who wrote us, and thanks for letting us give you a little radio.

Avruskin (nevadaPT) wrote:

As a physical therapist, I know several practitioners who have gone this cash-based-business route. I had a very small cash-based practice myself for a short while, when I lived in a very rural area. And some of the medical professionals I choose for my own healthcare do not take insurance. So I can see the situation from both the receiver and giver viewpoints.One of the first dilemmas that arise in a no-insurance office is patient "sticker shock" versus covering overhead expenses and being paid for your time and expertise. In my current practice, many patients regard even a $25 copay as prohibitively expensive, so asking $100, like Dr. Crowley does...may indeed cause customer loss.Hopefully, a solution may be found in the middle. Charging less than $100, or offering shorter visit times for a reduced fee, may allow greater accessibility. I would have been very interested to hear how Dr. Crowley decided on her

visit fee amount, what the considerations were and how it was calculated. And, although a doctor can determine the fee he/she will accept for their services, lab tests and diagnostic procedures can be enormously costly; I am interested as to how these could be handled in a no-insurance situation.

Wednesday, December 24, 2008 3:53:54 PM

Recommend (0)

Report abuse

(themarycarter) wrote:

Dr. Crowley joins many other doctors who have decided to go it without the insurance companies. The tone of this program was very upbeat and positive, but the ultimate result of patients' having to pay for services out of pocket is that only people with money will be able to afford medical care. Is this right? Is this okay? Is this fair? What about those of us who cannot afford to pay out of pocket for our medical care? Are we just supposed to go away and be sick without any medical care?

Tuesday, December 23, 2008 9:13:50 PM

http://www.njafp. org/njafp_ custom/practice. aspPractice: Crowley Name: Crowley Email: bootscrowley@ yahoo.com Job Title: Physician Address: 307 Stone Harbor Boulevard

Cape May Courthouse, NJ 08210 County: Cape May Business Phone: Business Fax: Home Phone:

December 28, 2008

Not blatantly. I do a spot on our local NBC every Wednesday Noon News. I pick a topic and the anchor and I discuss for 2-3 minutes. I get some calls from that. Word of mouth, usually. But, I will ask for anyone's creative input in marketing this...

To: Sent: Sunday, December 28, 2008 11:10:31 AMSubject: Re: Cash Only -- another in a trend?

, are you doing any "outbound" marketing for your practice--the self-pay part I mean?

From: nancy blake <nancycblake@ yahoo.com>To: Practiceimprovement 1yahoogroups (DOT) comSent: Friday, December 26, 2008 10:08:12 PMSubject: Re: [Practiceimprovemen t1] Cash Only -- another in a trend?

I have quite a few cash paying patients. Some of them I do not par with their insurance, but they come anyway. Some have no insurance. And the Urgent Care 4 hour wait is not worth it, since they have to pay there anyway. They love the half-hour they get for their $125. And then there's the HSAs. But, their visits can go well beyond my fee - labs, Xrays, mammograms, etc. I try to do without all the tests in all my patients anyway, but the self-payers certainly resist much more than the "can I have every tests done? My insurance will cover it if you say it is necessary?".

I am slowly making my way toward dropping insurances. Today I had 2 self pay patients, $265 combined. Ah, I can finally pay the phone bill!

From: Locke <lockecolorado@ gmail.com>To: Locke <lockecolorado@ gmail.com>Sent: Friday, December 26, 2008 6:08:00 PMSubject: [Practiceimprovemen t1] Cash Only -- another in a trend?

Story on a cash only practice.

The responders again miss the point -- they point out that nobody can afford healthcare visits of a $100 when they forget they are paying $200-500/month to the insurance company.

Why not pay the doctor directly?

Anyway, interesting info.

Locke, MD

============ ========= ========= ========= ======

Radio Gift: Dr. Boots Tries A No-Insurance Model

by Rose

Listen Now [5 min 1 sec] add to playlist

Rose/NPR

Some of Dr. Crowley's patients call her Boots because she wears Doc s to work.

Day to Day, December 23, 2008 · We only have radio to give you this holiday season. With that in mind, Kathleen Tacelosky asked us to produce a story on her sister-in-law — a doctor in New Jersey who doesn't accept health insurance from her clients.

http://www.npr. org/blogs/ daydreaming/ 2008/12/radio_ gift_dr_boots. html

Radio Gift: Dr. Boots

Rose

--Steve Proffitt

This season we asked listeners what they wanted to hear for the holidays, and we responded to their requests with a few "radio gifts."

This one goes out to listener Kathleen Tacelosky.

She wrote us this letter:

Crowley, M.D. is a family practice/primary care physician in New Jersey who is intensely dedicated to her craft and her patients. But healthcare has become an industry in our country, and it is out of whack. She was spending an insane amount of time negotiating with the insurance companies trying to get approvals and trying to get paid.

Instead of letting her frustration get her down, she has come up with a gutsy, creative solution: As of October 1, she dropped all insurance and Medicare and went all cash. She had a meeting with her patients about it. She's lost some patients, of course, and she's gained new ones. She's keeping a blog about it where she shares what led up to this, her fears, her occasional feelings of guilt, what others are saying to her etc.

She's been writing about her experiences on a blog.

Note that her blog name is "bootscrowley. " Some of her patients call her Boots because she wears Doc s to work. She's unconventional, determined and has a lot of pluck! I think she'll inspire your listeners as she has me and others who know her.

We sent reporter Rose to visit Dr. Boots, and his story is today's radio gift. Happy holidays to all who wrote us, and thanks for letting us give you a little radio.

Avruskin (nevadaPT) wrote:

As a physical therapist, I know several practitioners who have gone this cash-based-business route. I had a very small cash-based practice myself for a short while, when I lived in a very rural area. And some of the medical professionals I choose for my own healthcare do not take insurance. So I can see the situation from both the receiver and giver viewpoints.One of the first dilemmas that arise in a no-insurance office is patient "sticker shock" versus covering overhead expenses and being paid for your time and expertise. In my current practice, many patients regard even a $25 copay as prohibitively expensive, so asking $100, like Dr. Crowley does...may indeed cause customer loss.Hopefully, a solution may be found in the middle. Charging less than $100, or offering shorter visit times for a reduced fee, may allow greater accessibility. I would have been very interested to hear how Dr. Crowley decided on her

visit fee amount, what the considerations were and how it was calculated. And, although a doctor can determine the fee he/she will accept for their services, lab tests and diagnostic procedures can be enormously costly; I am interested as to how these could be handled in a no-insurance situation.

Wednesday, December 24, 2008 3:53:54 PM

Recommend (0)

Report abuse

(themarycarter) wrote:

Dr. Crowley joins many other doctors who have decided to go it without the insurance companies. The tone of this program was very upbeat and positive, but the ultimate result of patients' having to pay for services out of pocket is that only people with money will be able to afford medical care. Is this right? Is this okay? Is this fair? What about those of us who cannot afford to pay out of pocket for our medical care? Are we just supposed to go away and be sick without any medical care?

Tuesday, December 23, 2008 9:13:50 PM

http://www.njafp. org/njafp_ custom/practice. aspPractice: Crowley Name: Crowley Email: bootscrowley@ yahoo.com Job Title: Physician Address: 307 Stone Harbor Boulevard

Cape May Courthouse, NJ 08210 County: Cape May Business Phone: Business Fax: Home Phone:

December 29, 2008

ok, that was me on the radio. to try to respond, (and thanks for your questions)

I picked $100 because I am hoping to average 10 patients a day (50 a week) and my budget is based on that amount of income ($5000 a week)-its incredibly freeing to have some ablility to predict cashflow btw, even if it is a struggle, at least its an understandable one.

I do have a sliding fee scale for patients who are already established who can document income less than 3x poverty, until i am more financially stable i can't offer that to new patients. even without that, i don't just see rich people (ie people who can afford to pay). people make choices in life based on what is important to them, they have been to doctors who are all about seeing enough patients a day to make ends meet, and they don't always like the feeling they get there. they have decided that like the plumber and electrician and mechanic, my services are a necessary expense for wellbeing. and some didn't, they decided the doc down the street was perfectly fine, and that's ok.

and, to the person who said "what about those who can't afford to pay, are we supposed to just go away and be sick", i'm really not evil, and i don't think that this is the answer to the health care problem, but for me, in my town, right now, it's what i had to do to stay afloat. feel free to take your health insurance and go elsewhere. but for many of my patients, they've done that, paid their $50 copay at the er and a specialist or 2, and realized it was cheaper and more efficient to go to a good family doc. i think, sincerely, that most of us here get that, and if we can't convince the legislature of that, we can remind our patients, and they will take action before the government will. patients value our good care, we should not allow anyone to devalue it (ourselves included.)

more thoughts on the blog, if you're interested bootscrowley.blogspot.com

boots

Crowley, MD307 Stone Harbor Blvd, Ste 2Cape May Courthouse, NJ 08210P: F:

Dr. Crowley joins many other doctors who have decided to go it without the insurance companies. The tone of this program was very upbeat and positive, but the ultimate result of patients' having to pay for services out of pocket is that only people with money will be able to afford medical care. Is this right? Is this okay? Is this fair? What about those of us who cannot afford to pay out of pocket for our medical care? Are we just supposed to go away and be sick without any medical care?

Tuesday, December 23, 2008 9:13:50 PM

http://www.njafp. org/njafp_ custom/practice. aspPractice: Crowley Name: Crowley Email: bootscrowley@ yahoo.com Job Title: Physician Address: 307 Stone Harbor Boulevard

Cape May Courthouse, NJ 08210 County: Cape May Business Phone: Business Fax: Home Phone:

December 29, 2008

that's pretty cool. You're "that doctor on TV!" I was thinking of trying to get Alice to do a radio spot. TV in NYC is pretty much taken

To: Sent: Sunday, December 28, 2008 4:09:32 PMSubject: Re: Cash Only -- another in a trend?

Not blatantly. I do a spot on our local NBC every Wednesday Noon News. I pick a topic and the anchor and I discuss for 2-3 minutes. I get some calls from that. Word of mouth, usually. But, I will ask for anyone's creative input in marketing this...

To: Sent: Sunday, December 28, 2008 11:10:31 AMSubject: Re: Cash Only -- another in a trend?

, are you doing any "outbound" marketing for your practice--the self-pay part I mean?

From: nancy blake <nancycblake@ yahoo.com>To: Practiceimprovement 1yahoogroups (DOT) comSent: Friday, December 26, 2008 10:08:12 PMSubject: Re: [Practiceimprovemen t1] Cash Only -- another in a trend?

I have quite a few cash paying patients. Some of them I do not par with their insurance, but they come anyway. Some have no insurance. And the Urgent Care 4 hour wait is not worth it, since they have to pay there anyway. They love the half-hour they get for their $125. And then there's the HSAs. But, their visits can go well beyond my fee - labs, Xrays, mammograms, etc. I try to do without all the tests in all my patients anyway, but the self-payers certainly resist much more than the "can I have every tests done? My insurance will cover it if you say it is necessary?".

I am slowly making my way toward dropping insurances. Today I had 2 self pay patients, $265 combined. Ah, I can finally pay the phone bill!

From: Locke <lockecolorado@ gmail.com>To: Locke <lockecolorado@ gmail.com>Sent: Friday, December 26, 2008 6:08:00 PMSubject: [Practiceimprovemen t1] Cash Only -- another in a trend?

Story on a cash only practice.

The responders again miss the point -- they point out that nobody can afford healthcare visits of a $100 when they forget they are paying $200-500/month to the insurance company.

Why not pay the doctor directly?

Anyway, interesting info.

Locke, MD

============ ========= ========= ========= ======

Radio Gift: Dr. Boots Tries A No-Insurance Model

by Rose

Listen Now [5 min 1 sec] add to playlist

Rose/NPR

Some of Dr. Crowley's patients call her Boots because she wears Doc s to work.

Day to Day, December 23, 2008 · We only have radio to give you this holiday season. With that in mind, Kathleen Tacelosky asked us to produce a story on her sister-in-law — a doctor in New Jersey who doesn't accept health insurance from her clients.

http://www.npr. org/blogs/ daydreaming/ 2008/12/radio_ gift_dr_boots. html

Radio Gift: Dr. Boots

Rose

--Steve Proffitt

This season we asked listeners what they wanted to hear for the holidays, and we responded to their requests with a few "radio gifts."

This one goes out to listener Kathleen Tacelosky.

She wrote us this letter:

Crowley, M.D. is a family practice/primary care physician in New Jersey who is intensely dedicated to her craft and her patients. But healthcare has become an industry in our country, and it is out of whack. She was spending an insane amount of time negotiating with the insurance companies trying to get approvals and trying to get paid.

Instead of letting her frustration get her down, she has come up with a gutsy, creative solution: As of October 1, she dropped all insurance and Medicare and went all cash. She had a meeting with her patients about it. She's lost some patients, of course, and she's gained new ones. She's keeping a blog about it where she shares what led up to this, her fears, her occasional feelings of guilt, what others are saying to her etc.

She's been writing about her experiences on a blog.

Note that her blog name is "bootscrowley. " Some of her patients call her Boots because she wears Doc s to work. She's unconventional, determined and has a lot of pluck! I think she'll inspire your listeners as she has me and others who know her.

We sent reporter Rose to visit Dr. Boots, and his story is today's radio gift. Happy holidays to all who wrote us, and thanks for letting us give you a little radio.

Avruskin (nevadaPT) wrote:

As a physical therapist, I know several practitioners who have gone this cash-based-business route. I had a very small cash-based practice myself for a short while, when I lived in a very rural area. And some of the medical professionals I choose for my own healthcare do not take insurance. So I can see the situation from both the receiver and giver viewpoints.One of the first dilemmas that arise in a no-insurance office is patient "sticker shock" versus covering overhead expenses and being paid for your time and expertise. In my current practice, many patients regard even a $25 copay as prohibitively expensive, so asking $100, like Dr. Crowley does...may indeed cause customer loss.Hopefully, a solution may be found in the middle. Charging less than $100, or offering shorter visit times for a reduced fee, may allow greater accessibility. I would have been very interested to hear how Dr. Crowley decided on her

visit fee amount, what the considerations were and how it was calculated. And, although a doctor can determine the fee he/she will accept for their services, lab tests and diagnostic procedures can be enormously costly; I am interested as to how these could be handled in a no-insurance situation.

Wednesday, December 24, 2008 3:53:54 PM

Recommend (0)

Report abuse

(themarycarter) wrote:

Dr. Crowley joins many other doctors who have decided to go it without the insurance companies. The tone of this program was very upbeat and positive, but the ultimate result of patients' having to pay for services out of pocket is that only people with money will be able to afford medical care. Is this right? Is this okay? Is this fair? What about those of us who cannot afford to pay out of pocket for our medical care? Are we just supposed to go away and be sick without any medical care?

Tuesday, December 23, 2008 9:13:50 PM

http://www.njafp. org/njafp_ custom/practice. aspPractice: Crowley Name: Crowley Email: bootscrowley@ yahoo.com Job Title: Physician Address: 307 Stone Harbor Boulevard

Cape May Courthouse, NJ 08210 County: Cape May Business Phone: Business Fax: Home Phone:

December 30, 2008

It's cool until some creepy guy started shoutng out in the parking lot, so someone in his car "HEY! It's Dr. ! From TV! Look honey!" I had to grab the mail real fast and get back in. Likely the only person he has ever seen on TV then live in person. He WAS creepy...

To: Sent: Monday, December 29, 2008 3:06:26 PMSubject: Re: Cash Only -- another in a trend?

that's pretty cool. You're "that doctor on TV!" I was thinking of trying to get Alice to do a radio spot. TV in NYC is pretty much taken

From: nancy blake <nancycblake@ yahoo.com>To: Practiceimprovement 1yahoogroups (DOT) comSent: Sunday, December 28, 2008 4:09:32 PMSubject: Re: [Practiceimprovemen t1] Cash Only -- another in a trend?

Not blatantly. I do a spot on our local NBC every Wednesday Noon News. I pick a topic and the anchor and I discuss for 2-3 minutes. I get some calls from that. Word of mouth, usually. But, I will ask for anyone's creative input in marketing this...

From: Wayne Coghill <cwayne59verizon (DOT) net>To: Practiceimprovement 1yahoogroups (DOT) comSent: Sunday, December 28, 2008 11:10:31 AMSubject: Re: [Practiceimprovemen t1] Cash Only -- another in a trend?

, are you doing any "outbound" marketing for your practice--the self-pay part I mean?

From: nancy blake <nancycblake@ yahoo.com>To: Practiceimprovement 1yahoogroups (DOT) comSent: Friday, December 26, 2008 10:08:12 PMSubject: Re: [Practiceimprovemen t1] Cash Only -- another in a trend?

I have quite a few cash paying patients. Some of them I do not par with their insurance, but they come anyway. Some have no insurance. And the Urgent Care 4 hour wait is not worth it, since they have to pay there anyway. They love the half-hour they get for their $125. And then there's the HSAs. But, their visits can go well beyond my fee - labs, Xrays, mammograms, etc. I try to do without all the tests in all my patients anyway, but the self-payers certainly resist much more than the "can I have every tests done? My insurance will cover it if you say it is necessary?".

I am slowly making my way toward dropping insurances. Today I had 2 self pay patients, $265 combined. Ah, I can finally pay the phone bill!

From: Locke <lockecolorado@ gmail.com>To: Locke <lockecolorado@ gmail.com>Sent: Friday, December 26, 2008 6:08:00 PMSubject: [Practiceimprovemen t1] Cash Only -- another in a trend?

Story on a cash only practice.

The responders again miss the point -- they point out that nobody can afford healthcare visits of a $100 when they forget they are paying $200-500/month to the insurance company.

Why not pay the doctor directly?

Anyway, interesting info.

Locke, MD

============ ========= ========= ========= ======

Radio Gift: Dr. Boots Tries A No-Insurance Model

by Rose

Listen Now [5 min 1 sec] add to playlist

Rose/NPR

Some of Dr. Crowley's patients call her Boots because she wears Doc s to work.

Day to Day, December 23, 2008 · We only have radio to give you this holiday season. With that in mind, Kathleen Tacelosky asked us to produce a story on her sister-in-law — a doctor in New Jersey who doesn't accept health insurance from her clients.

http://www.npr. org/blogs/ daydreaming/ 2008/12/radio_ gift_dr_boots. html

Radio Gift: Dr. Boots

Rose

--Steve Proffitt

This season we asked listeners what they wanted to hear for the holidays, and we responded to their requests with a few "radio gifts."

This one goes out to listener Kathleen Tacelosky.

She wrote us this letter:

Crowley, M.D. is a family practice/primary care physician in New Jersey who is intensely dedicated to her craft and her patients. But healthcare has become an industry in our country, and it is out of whack. She was spending an insane amount of time negotiating with the insurance companies trying to get approvals and trying to get paid.

Instead of letting her frustration get her down, she has come up with a gutsy, creative solution: As of October 1, she dropped all insurance and Medicare and went all cash. She had a meeting with her patients about it. She's lost some patients, of course, and she's gained new ones. She's keeping a blog about it where she shares what led up to this, her fears, her occasional feelings of guilt, what others are saying to her etc.

She's been writing about her experiences on a blog.

Note that her blog name is "bootscrowley. " Some of her patients call her Boots because she wears Doc s to work. She's unconventional, determined and has a lot of pluck! I think she'll inspire your listeners as she has me and others who know her.

We sent reporter Rose to visit Dr. Boots, and his story is today's radio gift. Happy holidays to all who wrote us, and thanks for letting us give you a little radio.

Avruskin (nevadaPT) wrote:

As a physical therapist, I know several practitioners who have gone this cash-based-business route. I had a very small cash-based practice myself for a short while, when I lived in a very rural area. And some of the medical professionals I choose for my own healthcare do not take insurance. So I can see the situation from both the receiver and giver viewpoints.One of the first dilemmas that arise in a no-insurance office is patient "sticker shock" versus covering overhead expenses and being paid for your time and expertise. In my current practice, many patients regard even a $25 copay as prohibitively expensive, so asking $100, like Dr. Crowley does...may indeed cause customer loss.Hopefully, a solution may be found in the middle. Charging less than $100, or offering shorter visit times for a reduced fee, may allow greater accessibility. I would have been very interested to hear how Dr. Crowley decided on her

visit fee amount, what the considerations were and how it was calculated. And, although a doctor can determine the fee he/she will accept for their services, lab tests and diagnostic procedures can be enormously costly; I am interested as to how these could be handled in a no-insurance situation.

Wednesday, December 24, 2008 3:53:54 PM

Recommend (0)

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(themarycarter) wrote:

Dr. Crowley joins many other doctors who have decided to go it without the insurance companies. The tone of this program was very upbeat and positive, but the ultimate result of patients' having to pay for services out of pocket is that only people with money will be able to afford medical care. Is this right? Is this okay? Is this fair? What about those of us who cannot afford to pay out of pocket for our medical care? Are we just supposed to go away and be sick without any medical care?

Tuesday, December 23, 2008 9:13:50 PM

http://www.njafp. org/njafp_ custom/practice. aspPractice: Crowley Name: Crowley Email: bootscrowley@ yahoo.com Job Title: Physician Address: 307 Stone Harbor Boulevard

Cape May Courthouse, NJ 08210 County: Cape May Business Phone: Business Fax: Home Phone:

December 30, 2008

gross. I think I'll stick with radio... :)ec Crowley, MD

307 Stone Harbor Blvd, Ste 2

Cape May Courthouse, NJ 08210

P: F:

Dr. Crowley joins many other doctors who have decided to go it without the insurance companies. The tone of this program was very upbeat and positive, but the ultimate result of patients' having to pay for services out of pocket is that only people with money will be able to afford medical care. Is this right? Is this okay? Is this fair? What about those of us who cannot afford to pay out of pocket for our medical care? Are we just supposed to go away and be sick without any medical care?

Tuesday, December 23, 2008 9:13:50 PM

http://www.njafp. org/njafp_ custom/practice. aspPractice: Crowley Name: Crowley Email: bootscrowley@ yahoo.com Job Title: Physician Address: 307 Stone Harbor Boulevard

Cape May Courthouse, NJ 08210 County: Cape May Business Phone: Business Fax: Home Phone:

December 30, 2008

I believe you if he was creepyOn the other hand it SOUNDS hysterically funny ,Dr from TV!

It's cool until some creepy guy started shoutng out in the parking lot, so someone in his car " HEY! It's Dr. ! From TV! Look honey! " I had to grab the mail real fast and get back in. Likely the only person he has ever seen on TV then live in person. He WAS creepy...

To:

Sent: Monday, December 29, 2008 3:06:26 PMSubject: Re: Cash Only -- another in a trend?

that's pretty cool. You're " that doctor on TV! " I was thinking of trying to get Alice to do a radio spot. TV in NYC is pretty much taken

From: nancy blake <nancycblake@ yahoo.com>To: Practiceimprovement 1yahoogroups (DOT) com

Sent: Sunday, December 28, 2008 4:09:32 PMSubject: Re: [Practiceimprovemen t1] Cash Only -- another in a trend?

Not blatantly. I do a spot on our local NBC every Wednesday Noon News. I pick a topic and the anchor and I discuss for 2-3 minutes. I get some calls from that. Word of mouth, usually. But, I will ask for anyone's creative input in marketing this...

From: Wayne Coghill <cwayne59verizon (DOT) net>To: Practiceimprovement 1yahoogroups (DOT) comSent: Sunday, December 28, 2008 11:10:31 AM

Subject: Re: [Practiceimprovemen t1] Cash Only -- another in a trend?

, are you doing any " outbound " marketing for your practice--the self-pay part I mean?

From: nancy blake <nancycblake@ yahoo.com>To: Practiceimprovement 1yahoogroups (DOT) com

Sent: Friday, December 26, 2008 10:08:12 PMSubject: Re: [Practiceimprovemen t1] Cash Only -- another in a trend?

I have quite a few cash paying patients. Some of them I do not par with their insurance, but they come anyway. Some have no insurance. And the Urgent Care 4 hour wait is not worth it, since they have to pay there anyway. They love the half-hour they get for their $125. And then there's the HSAs. But, their visits can go well beyond my fee - labs, Xrays, mammograms, etc. I try to do without all the tests in all my patients anyway, but the self-payers certainly resist much more than the " can I have every tests done? My insurance will cover it if you say it is necessary? " .

I am slowly making my way toward dropping insurances. Today I had 2 self pay patients, $265 combined. Ah, I can finally pay the phone bill!

From: Locke <lockecolorado@ gmail.com>To: Locke <lockecolorado@ gmail.com>

Sent: Friday, December 26, 2008 6:08:00 PMSubject: [Practiceimprovemen t1] Cash Only -- another in a trend?

Story on a cash only practice.

The responders again miss the point -- they point out that nobody can afford healthcare visits of a $100 when they forget they are paying $200-500/month to the insurance company.

Why not pay the doctor directly?

Anyway, interesting info.

Locke, MD

============ ========= ========= ========= ======

Radio Gift: Dr. Boots Tries A No-Insurance Model

by Rose

Listen Now [5 min 1 sec] add to playlist

Rose/NPR

Some of Dr. Crowley's patients call her Boots because she wears Doc s to work.

Day to Day, December 23, 2008 · We only have radio to give you this holiday season. With that in mind, Kathleen Tacelosky asked us to produce a story on her sister-in-law — a doctor in New Jersey who doesn't accept health insurance from her clients.

http://www.npr. org/blogs/ daydreaming/ 2008/12/radio_ gift_dr_boots. html

Radio Gift: Dr. Boots

Rose

--Steve Proffitt

This season we asked listeners what they wanted to hear for the holidays, and we responded to their requests with a few " radio gifts. "

This one goes out to listener Kathleen Tacelosky.

She wrote us this letter:

Crowley, M.D. is a family practice/primary care physician in New Jersey who is intensely dedicated to her craft and her patients. But healthcare has become an industry in our country, and it is out of whack. She was spending an insane amount of time negotiating with the insurance companies trying to get approvals and trying to get paid.

Instead of letting her frustration get her down, she has come up with a gutsy, creative solution: As of October 1, she dropped all insurance and Medicare and went all cash. She had a meeting with her patients about it. She's lost some patients, of course, and she's gained new ones. She's keeping a blog about it where she shares what led up to this, her fears, her occasional feelings of guilt, what others are saying to her etc.

She's been writing about her experiences on a blog.

Note that her blog name is " bootscrowley. " Some of her patients call her Boots because she wears Doc s to work. She's unconventional, determined and has a lot of pluck! I think she'll inspire your listeners as she has me and others who know her.

We sent reporter Rose to visit Dr. Boots, and his story is today's radio gift. Happy holidays to all who wrote us, and thanks for letting us give you a little radio.

Avruskin (nevadaPT) wrote:

As a physical therapist, I know several practitioners who have gone this cash-based-business route. I had a very small cash-based practice myself for a short while, when I lived in a very rural area. And some of the medical professionals I choose for my own healthcare do not take insurance. So I can see the situation from both the receiver and giver viewpoints.

One of the first dilemmas that arise in a no-insurance office is patient " sticker shock " versus covering overhead expenses and being paid for your time and expertise. In my current practice, many patients regard even a $25 copay as prohibitively expensive, so asking $100, like Dr. Crowley does...may indeed cause customer loss.

Hopefully, a solution may be found in the middle. Charging less than $100, or offering shorter visit times for a reduced fee, may allow greater accessibility. I would have been very interested to hear how Dr. Crowley decided on her

visit fee amount, what the considerations were and how it was calculated. And, although a doctor can determine the fee he/she will accept for their services, lab tests and diagnostic procedures can be enormously costly; I am interested as to how these could be handled in a no-insurance situation.

Wednesday, December 24, 2008 3:53:54 PM

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(themarycarter) wrote:

Dr. Crowley joins many other doctors who have decided to go it without the insurance companies. The tone of this program was very upbeat and positive, but the ultimate result of patients' having to pay for services out of pocket is that only people with money will be able to afford medical care. Is this right? Is this okay? Is this fair? What about those of us who cannot afford to pay out of pocket for our medical care? Are we just supposed to go away and be sick without any medical care?

Tuesday, December 23, 2008 9:13:50 PM

http://www.njafp. org/njafp_ custom/practice. aspPractice: Crowley Name: Crowley

Email: bootscrowley@ yahoo.com Job Title: Physician Address: 307 Stone Harbor Boulevard

Cape May Courthouse, NJ 08210 County: Cape May Business Phone: Business Fax:

Home Phone:

-- If you are a patient please allow up to 24 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD

ph fax

December 30, 2008

I also get a lot of stares on line at the supermarket. Then they say, "are you a doctor". Sometimes I'm in a mood, and say, No, but I play one on TV, or "I just told NBC I am to get the job" or no I'm an undertaker, or something like that. BUT, back to cash only, I seem to be getting more over time. Mostly uninsured. If I can pick up a few more it will compensate for my Dead Zone.

To: Sent: Tuesday, December 30, 2008 7:53:13 AMSubject: Re: Cash Only -- another in a trend?

I believe you if he was creepyOn the other hand it SOUNDS hysterically funny ,Dr from TV!

On Mon, Dec 29, 2008 at 9:59 PM, nancy blake <nancycblake@ yahoo.com> wrote:

It's cool until some creepy guy started shoutng out in the parking lot, so someone in his car "HEY! It's Dr. ! From TV! Look honey!" I had to grab the mail real fast and get back in. Likely the only person he has ever seen on TV then live in person. He WAS creepy...

From: Wayne Coghill <cwayne59verizon (DOT) net>To: Practiceimprovement 1yahoogroups (DOT) comSent: Monday, December 29, 2008 3:06:26 PMSubject: Re: [Practiceimprovemen t1] Cash Only -- another in a trend?