Re: Re: Cash based vs. Insurance based practice

[Guest guest]

Well said, . Thanks for your perspective.

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>

> Dear ,

> Don't feel like the lone ranger. There are plenty of other docs out there

> who are sick of colleagues who look at medicine as just a way to make a

> buck. (I might add, most of them are not in primary care!) But making a buck

> is an important piece of the puzzle. This IMP movement is a great petri

> dish. Unfortunately (from my perspective) most of the movement is stuck

> quibbling about reimbursement from third-party payers. Some try to change

> the system from within. Not my choice, but hey, if you're extremely

> patient, why not? However, getting out of this dysfunctional insurance

> system does not equal greed. There are lots of innovations that are filled

> with balance, charity and compassion. You just have to look for them:

>

> http://www.aafp.org/fpm/20070600/19brea.html

>

> http://www.aafp.org/fpm/20080200/12anew.html

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>

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>

> If that isn't enough, look at Tim Mahlia's deaf patients. Look at Shari

> 's " scholarship patients " . Beyond the examples listed above is the far

> more common scenario of a doctor who makes a good living on most of their

> patients and just do a smaller amount of charitable stuff on the side. When

> I entered medicine it was standard practice to have about 13% " bad debt "

> that you just wrote off because you were a family doctor. With the advent of

> managed care and tighter reimbursements that " bad debt " segment evolved from

> " a doctor's moral duty " to something to be eradicated!

>

> Aim high, ! Show us the way!

> Bob Forester

>

> wrote:

>

>

> I am discouraged by the apparent direction that the IMP

> model seems to be adopting, that the only way to survive

> financially is to provide care only to the financially well off

> part of the population, not offering health care service or options

> to the old and the poor. I dont claim to have the answer, but feel

> we have an ethical obligation as physicians not to simply ignore

> the weak and the underprivledged. Balance, charity, compassion.

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> >

> >

> >

> >

> >

> > Another consideration - it takes much more time to

> > build up a cash practice, because in most areas

> > (unless you are the " only game in town " ) a cash only

> > practice is more comparable to a traditional retail or

> > non-physician service small business instead of a

> > typical doctor practice. This means you have to be

> > financially prepared to weather the 1-2 year start up

> > phase.

> >

> > We opened our doors in October, 2005, in an affluent

> > retirement area with many doctors (but most are

> > traditional insurance-based high overhead high

> > volume). It was 6 months before we broke even

> > (meaning we were able to pay our expenses - rent,

> > utilities, malpractice, etc.). At the end of the

> > first year we had basically broken even for the whole

> > year.

> >

> > Through the second year our revenue grew and we took

> > small distributions from the corporation to help with

> > living expenses, but I did not start to draw a regular

> > salary until the last quarter of the second year.

> >

> > Now we are full, the only new patients we see are

> > family members of existing patients (and a few choice

> > others), and we have built a reputation in the

> > community and at the hospital. We are still the only

> > true IMP in town (in the spirit of service, access,

> > full-spectrum family medicine and continuity).

> >

> > So if you need cash-flow immediately or in the near

> > future, then start with some insurance at least.

> >

> > One thing we have noticed - once patients " get " the

> > fact that our service and access blows away any other

> > practice, and our quality equals or exceeds any other

> > practice, they really don't care about reimbursement

> > as much. If your fees are reasonable, people will pay

> > happily out of pocket. Most of our patients don't even

> > submit to insurance.

> >

> > My wife and I have never been happier and our practice

> > continues to grow in terms of revenue and income.

> >

> >

> > Rancho Mirage, CA

> > --- raye11 wrote:

> >

> > > Yes, I think the locale and physician supply and

> > > pricing will depend on what can work.

> > > Sounds like you're doing very well. It's

> > > interesting to hear what has worked in different

> > > areas. Thanks for sharing!

> > >

> > >

> > > >

> > > > Located in eastern Montana in a HPSA (health

> > > professional shortage area), I

> > > > decided to be cash based when I opened 11 months

> > > ago. I am now on the verge

> > > > of closing to new patients because I am busier

> > > than I want to be to take

> > > > good care of my patients and to take good care of

> > > myself. I believe your

> > > > decision will be driven by physician supply and

> > > your pricing.

> > > >

> > > >

> > > >

> > > > All patients pay me up front. Because of the

> > > geriatric population here, my

> > > > one concession was that I will submit the claim to

> > > Noridian (my local

> > > > Medicare intermediary) for them but the patient is

> > > the one who waits for the

> > > > 70% reimbursement, not me. I'm non-participating.

> > > Office Ally isn't free

> > > > for medicare claims (they take 5%), so I have the

> > > hassle of doing it and it

> > > > has been a steep learning curve.

> > > >

> > > >

> > > >

> > > > My charges for services are " very affordable " and

> > > less than

> > > > insurance/medicare re-imbursement. 99213 is $30

> > > and 99214 is $45. 99204 is

> > > > $60. I can do this because of my very low

> > > overhead (thanks to all on this

> > > > list who have taught me how to function this way

> > > :-))

> > > >

> > > >

> > > >

> > > > My insured patients often don't bother to submit

> > > their invoices to their

> > > > insurance. I tell them " your choice. " They value

> > > my service and availability

> > > > and (I guess) figure submitting it is too much of

> > > a hassle. When United

> > > > wrote me and wanted me to take a discount on my

> > > charge, I forwarded the

> > > > letter to the patient, who gave them an ear full

> > > when she called to demand

> > > > full payment.

> > > >

> > > >

> > > >

> > > > My psychiatric patients also pay cash; those

> > > charges are relatively high

> > > > with a 90801 (psych eval) costing $200. I did

> > > this to have more FP patients

> > > > than psych . I am the only prescriber able to rx

> > > Suboxone in a 500 miles

> > > > radius; I would encourage new PCP practices to

> > > take the internet course to

> > > > be able to prescribe it. Patients on Suboxone are

> > > generally very grateful

> > > > and contrary to popular belief, are not a PITA.

> > > >

> > > >

> > > >

> > > > Just one very rural FM/shrink's opinion.....

> > > >

> > >

> > >

> > >

> > >

> >

> >

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>

>

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