Cash Pain Practice?

[Ducttape]

Realize that people with high deductible health plans are defacto "cash patients."

If you're going to discriminate against people who want to pay for their own health care with cash, please be consistent and discriminate against people with high deductible health plans too.

while a matter of degrees, it is a significant matter of degrees.

they are not the same.

one group is paying for exclusive access that most americans cannot afford. the other group is paying to get the minimum level of treatment.

to continue with the Ritz Carlton analogy - concierge patients are paying for a vacation site so they can visit Rockefeller Center and see the tree and do their Christmas shopping at Saks Fifth Avenue. high deductible patients are paying so that they don't have to live on the street.

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[drusso]

while a matter of degrees, it is a significant matter of degrees.

they are not the same.

one group is paying for exclusive access that most americans cannot afford. the other group is paying to get the minimum level of treatment.

to continue with the Ritz Carlton analogy - concierge patients are paying for a vacation site so they can visit Rockefeller Center and see the tree and do their Christmas shopping at Saks Fifth Avenue. high deductible patients are paying so that they don't have to live on the street.

What does it matter? A dollar is a dollar. Who cares if it comes out your HSA, your checking account, or if you pawn some baseball cards to make a co-pay...

High deductible health plan patients are cash-pay patients. But, no one is saying "I won't see that patient because they have a $5,000 deductible." Only, "Cash patients suck." Please discriminate fairly.

 

[NJPAIN]

while a matter of degrees, it is a significant matter of degrees.

they are not the same.

one group is paying for exclusive access that most americans cannot afford. the other group is paying to get the minimum level of treatment.

to continue with the Ritz Carlton analogy - concierge patients are paying for a vacation site so they can visit Rockefeller Center and see the tree and do their Christmas shopping at Saks Fifth Avenue. high deductible patients are paying so that they don't have to live on the street.

No one is saying to charge people with high deductible plans some outrageous fee. They just won’t go to the cash only practice. Heck, I have a high deductible plan. I had hernia surgery 2 days ago. I went to an in-network surgeon who someone recommended. I would have liked to go to one of the surgeons I worked with at the University but none in my plan. I could have shelled out $$$ to go OON but I have a family and can’t afford that luxury. When I was single I went to the Ritz, now I go to the Hampton Inn.

 

[avalon10]

If you're economically credentialing patients based upon their method of payment, you're discriminating.

People have given their lives on the battlefield so YOU can discriminate against patients based upon service and method of payment. Health care is not a right.

No, I'm arguing for equitable discrimination.

View attachment 324824

I have no idea what you're talking about.

No, I'm arguing for equitable discrimination.

View attachment 324824

You said "If you're economically credentialing patients based upon their method of payment, you're discriminating"
Therefore if you don't accept ALL patients regardless of their ability/inability to pay, or their insurance, then YOU are discriminating, not to mention hypocritical.

 

[Pain Applicant1]

I am not saying that it is a better quality injection or doctor or whatever. I am saying that the patient believes that it is. Marketing and hand-holding play a very large role in these kinds of practices.

We agree 100% here!!!!

 

[avalon10]

What does it matter? A dollar is a dollar. Who cares if it comes out your HSA, your checking account, or if you pawn some baseball cards to make a co-pay...

High deductible health plan patients are cash-pay patients. But, no one is saying "I won't see that patient because they have a $5,000 deductible." Only, "Cash patients suck." Please discriminate fairly.

Some of these practices choose to be cash only so that they don't have to deal with insurance companies at all. They don't want to deal with deductibles etc as long as they have enough cash-paying patients.
And that is not "discriminating." It's their business model. You clearly have a problem with it, but that's pretty irrelevant and doesn't make it "discrimination".

 

[Pain Applicant1]

Because you have a pain medicine certificate, a DEA license and are considered "pain management" by everyone except your friends and family

I don't think that would be right. I imagine the DEA monitors prescriptions, PMP, arrests, overdoses, etc. not CPT codes or medical specialties. While I think the docs charging exorbitant fees are fleecing their pts, I don't think a cash pay procedure practice would set off any alarms with anyone or any agency. These procedures are elective and pts have the right to pay for it if they wish and docs have the right to charge whatever they want. Opioids for cash is another story.s

 

[NJPAIN]

I don't think that would be right. I imagine the DEA monitors prescriptions, PMP, arrests, overdoses, etc. not CPT codes or medical specialties. While I think the docs charging exorbitant fees are fleecing their pts, I don't think a cash pay procedure practice would set off any alarms with anyone or any agency. These procedures are elective and pts have the right to pay for it if they wish and docs have the right to charge whatever they want. Opioids for cash is another story.s

Agreed. Opioids for cash is a huge red flag. Much to my surprise, there are still many practices doing that.

 

[avalon10]

I don't think that would be right. I imagine the DEA monitors prescriptions, PMP, arrests, overdoses, etc. not CPT codes or medical specialties. While I think the docs charging exorbitant fees are fleecing their pts, I don't think a cash pay procedure practice would set off any alarms with anyone or any agency. These procedures are elective and pts have the right to pay for it if they wish and docs have the right to charge whatever they want. Opioids for cash is another story.s

100% agree. I have no idea what Centurion38 is talking about

 

[Ducttape]

What does it matter? A dollar is a dollar. Who cares if it comes out your HSA, your checking account, or if you pawn some baseball cards to make a co-pay...

High deductible health plan patients are cash-pay patients. But, no one is saying "I won't see that patient because they have a $5,000 deductible." Only, "Cash patients suck." Please discriminate fairly.

it matters because in one case you are doing procedures based on how much they are willing to pay, and on the other hand you are doing procedures only if they can pay.

to put it another way: in one case, I would be trying to rip someone off and trying to pocket as much of their $$$ as possible. they can afford it.

in the other case, ethically, I am causing significant economic hardship in trying to improve their pain. and that money doesn't even go to me.

(and yes, they are all offered financial assistance, and I try to limit costs of procedures by doing them in office etc.)

 

[drusso]

it matters because in one case you are doing procedures based on how much they are willing to pay, and on the other hand you are doing procedures only if they can pay.

to put it another way: in one case, I would be trying to rip someone off and trying to pocket as much of their $$$ as possible. they can afford it.

in the other case, ethically, I am causing significant economic hardship in trying to improve their pain. and that money doesn't even go to me.

(and yes, they are all offered financial assistance, and I try to limit costs of procedures by doing them in office etc.)

We offer our cash patients a 25% discount off our median reimbursement so it's not "whatever they're willing to pay..."

 

[avalon10]

it matters because in one case you are doing procedures based on how much they are willing to pay, and on the other hand you are doing procedures only if they can pay.

to put it another way: in one case, I would be trying to rip someone off and trying to pocket as much of their $$$ as possible. they can afford it.

in the other case, ethically, I am causing significant economic hardship in trying to improve their pain. and that money doesn't even go to me.

(and yes, they are all offered financial assistance, and I try to limit costs of procedures by doing them in office etc.)

Having a cash-based practice is not ripping someone off. This has already been discussed here.

 

[NJPAIN]

If we must remove “business” from healthcare because it is immoral to treat patients based on their ability to pay then we need Medicare for all or some other type of national health service. I have no problem with that. Pay me a fair wage, give me regular business hours, give me health insurance and a retirement plan and protect me from liability. I’m not convinced that would be so horrible on the physician side of things. Would that really be worse than hospital systems and insurance companies ruling?

 

[Ducttape]

Having a cash-based practice is not ripping someone off. This has already been discussed here.

i admit i was a little too aggressive in my example.

to rephrase: "to put it another way: in one case, I would be trying to rip someone off and trying to pocket as much of their $$$ as possible. they can afford it."

 

[Ligament]

Cash pay is the most ethical, non-conflicted model there is. The contract is between patient and physician, as it should be. To argue one must or should have a blood sucking leach-like third party (such as insurance companies) inserted between the patient and physician is brainwashed, distorted thinking. Cash pay patients are not going to waste their hard earned money on needless procedures. If they don't need treatment, they sure as hell will not pay for it. Also, they will follow your advice to the letter as they don't want to waste their money. Insurance patients however, have no such disincentive to avoid uneeded medical care nor do they have the financial incentive to follow instructions (after dedutible is met).

***As long as you are not trading cash for controlled substances, there is no medial board nor DEA issue.

 

[Dr. Ice]

Spine care has become a business. Lutz charges 5k for intradiscal stem cell. It might actually be more. His results are meh...I know we aren’t supposed to mention names on here but he is actually meh. Not so great personality or skill set. I know a bunch of docs at hss that think poorly of him and his “business model” and frankly not out of jealousy..cuz they ain’t hurtin. But at the end of the day if he’s selling a product and people want to buy the used car..let them pay.

My issue is more so the notion of superiority of care because of where he is or who he is. But the upper west side folk need something to talk about at their dinner swares..

 

[bpainless]

My practice is in blue collar town. Cash practice is not likely to be successful.

 

[mjl1717]

I have some pts that get shots and pay cash for it, but I do not recommend cash for meds despite my not having a good way to vocalize why I feel that way.

I just wouldn't do it.

Ill step in: For some reason. Taking cash for controlled substances just looks bad.

 

[oreosandsake]

Spine care has become a business. Lutz charges 5k for intradiscal stem cell. It might actually be more. His results are meh...I know we aren’t supposed to mention names on here but he is actually meh. Not so great personality or skill set. I know a bunch of docs at hss that think poorly of him and his “business model” and frankly not out of jealousy..cuz they ain’t hurtin. But at the end of the day if he’s selling a product and people want to buy the used car..let them pay.

My issue is more so the notion of superiority of care because of where he is or who he is. But the upper west side folk need something to talk about at their dinner swares..

you missed the 1 in front of 5k. 15k

 

[Agast]

I imagine it's likely the same practice if most of the pts are celebrities. Why is it a racket? Well, paying several thousand dollars for something you can pay a couple of hundred dollars for I think qualifies it. I do agree with you though, from a business perspective it is a great model.

Celebrities paying cash would be my personal nightmare. You’d end up being complicit in all kinds of crazy woo in order to keep the customer happy, not to mention ending up prescribing their sleep aids, pick me ups, getting called in the middle of the night because they stubbed their toe. Piss off the wrong guy and you’re blacklisted. And you can’t even brag about doing 50 cent’s SI joint because HIPAA.

 

[Status Sciaticus]

Celebrities paying cash would be my personal nightmare. You’d end up being complicit in all kinds of crazy woo in order to keep the customer happy, not to mention ending up prescribing their sleep aids, pick me ups, getting called in the middle of the night because they stubbed their toe. Piss off the wrong guy and you’re blacklisted. And you can’t even brag about doing 50 cent’s SI joint because HIPAA.

Unless you do it for a discount in exchange for a "shout-out" on instagram *rollseyes*

 

[Ligament]

Having treated a couple (just a couple) celebrities establishing very firm boundaries is critical. No, I will not refill your Oxycodone and sleeping pills. No, do not go to the ER to get your Oxys and sleeping pills. No, you cannot treat me as one of your assistants. The hard part is sticking needles in these folks you admire on screen and on the radio...

 

[drpainfree]

I imagine it's likely the same practice if most of the pts are celebrities. Why is it a racket? Well, paying several thousand dollars for something you can pay a couple of hundred dollars for I think qualifies it. I do agree with you though, from a business perspective it is a great model.

I have no problem milking celebrity status people if they're willing to pay for it. I wouldn't like it if it was taking advantage of the system which affects us all or lower SES folks. That would just be being a bully and no one likes bullies.

why do you think an epidural injection is only worth 200 bucks?

 

[Pain Applicant1]

why do you think an epidural injection is only worth 200 bucks?

I'm not sure exactly what it should be worth but something that only takes about 7 minutes to do without much overhead shouldn't cost that much. Plus, I don't see making money in medicine being as difficult as it could be. It's not really a level playing field. We artificially keep doctors in limited supply to keep demand much higher and the pts, once they trust you, will pretty much do anything you recommend. They're typically in a pretty vulnerable state when coming to you and chronic pain tends to make pts desperate.

I like to make money as much as the next guy but I just don't feel good about myself if it's just handed to me. I'd much rather be challenged and fight for it. That's why I play the market and why I've started other businesses.

 

[myrandom2003]

I'm not sure exactly what it should be worth but something that only takes about 7 minutes to do without much overhead shouldn't cost that much. Plus, I don't see making money in medicine being as difficult as it could be. It's not really a level playing field. We artificially keep doctors in limited supply to keep demand much higher and the pts, once they trust you, will pretty much do anything you recommend. They're typically in a pretty vulnerable state when coming to you and chronic pain tends to make pts desperate.

I like to make money as much as the next guy but I just don't feel good about myself if it's just handed to me. I'd much rather be challenged and fight for it. That's why I play the market and why I've started other businesses.

It only costs cents to a few dollars to manufacture all the drugs we prescribe but the hundreds to thousands if dollars charged is for the r&d and approval process etc.

The charge for the 7min procedure is for all the time effort schooling sacrifices that were made plus all the marketing and grind effort made to turn the practice into one that celebrities want to go to and top off with a little profit.

 

[Agast]

why do you think an epidural injection is only worth 200 bucks?

If an epidural steroid injection gave lasting relief I would have no qualms charging more. The reality is most patients avoiding surgery will get several shots throughout their lifetime. The limiting factor for these patients is their financial situation. I have people who wait until a specific time of month because that is when their checks roll in. When you realize people are giving up some of their subsistence to you it is very humbling.

 

[Pain Applicant1]

It only costs cents to a few dollars to manufacture all the drugs we prescribe but the hundreds to thousands if dollars charged is for the r&d and approval process etc.

The charge for the 7min procedure is for all the time effort schooling sacrifices that were made plus all the marketing and grind effort made to turn the practice into one that celebrities want to go to and top off with a little profit.

Right, and it would be hard to argue that drugs aren't overpriced as well despite R&D likely being in the millions and not hundreds of thousands. Not too bad for one year's salary.

Pfizer CEO Bourla’s Pay Climbed 17% to $21 Million in 2020

Pfizer Inc. paid Chief Executive Officer Albert Bourla $21 million in total compensation last year, as the pharmaceutical giant became the first to gain U.S. authorization for a coronavirus vaccine.

www.bloomberg.com

 

[Pain Applicant1]

When you realize people are giving up some of their subsistence to you it is very humbling.

Indeed.

Like I am, I know all of you are well into the 1%. Sometimes it's a strange place to be.

 

[RoloTomassi]

Nothing wrong with doing some at-cost or pro bono cases but let's not sell ourselves short undervaluing what we do. 7 min procedure but tons of time, money, training to do it effectively and safely. It's ease in trained hands does not take away from it's complexity.

 

[rexed]

Greg Lutz

I saw a patient who saw Dr. Lutz and was recommended for a stem cell injection for the lumbar spine. Price was $15,000 cash. Maybe that model can work...

 

[Dr. Ice]

I saw a patient who saw Dr. Lutz and was recommended for a stem cell injection for the lumbar spine. Price was $15,000 cash. Maybe that model can work...

It was 5k a few years ago, I guess he must be affected by inflation 🤦🏽‍♂️

 

[hyperalgesia]

Being on staff at HSS entitles its docs to almost royal status so sheiks and kings from afar will shower you with their oil and blood money...

There must be a critical inflection point when a businessman decides to bill people what the MARKET thinks his service is worth, instead of what HE thinks it's worth. For example, I think a LESI is worth about $200 but many patients would happily pay $1000 for it. I would only bill $200, which is why I am not a good businessman.

 

[Ferrismonk]

Nothing wrong with doing some at-cost or pro bono cases but let's not sell ourselves short undervaluing what we do. 7 min procedure but tons of time, money, training to do it effectively and safely. It's ease in trained hands does not take away from it's complexity.

Or my loans.

 

[nvrsumr]

I posted this some years ago but I paid 3k out of pocket with my bcbs high deductible plan for a cesi with an in network doc and asc without sedation

I couldn’t believe it and had my office admin do some legwork and that was the contracted rate.

The asc admin came to the pacu to ask me to bring cases. In hindsight I should have haha

 

[Ducttape]

Indeed.

Like I am, I know all of you are well into the 1%. Sometimes it's a strange place to be.

do you make over $737,000 salary? only those doctors making above that are in the 1% bracket.

How Much Income Puts You in the Top 1%, 5%, 10%?

To count yourself among the nation's top earners, it takes an income of at least six figures. Here's how the numbers break down for each group.

www.investopedia.com

i would hazard that most of us are not making that much.

i know im not anywhere in that ballpark. reading the posts of others, including the poster who talks the most about the virtues of private practice, im guessing he isnt either...

 

[Pain Applicant1]

do you make over $737,000 salary? only those doctors making above that are in the 1% bracket.

How Much Income Puts You in the Top 1%, 5%, 10%?

To count yourself among the nation's top earners, it takes an income of at least six figures. Here's how the numbers break down for each group.

www.investopedia.com

i would hazard that most of us are not making that much.

i know im not anywhere in that ballpark. reading the posts of others, including the poster who talks the most about the virtues of private practice, im guessing he isnt either...

I have multiple businesses. Are you sure most in here aren't in the ballpark of the top 1%? From what I've read on here, hospital-employed are in the $600 range and PP tends to do better. Am I wrong? Besides, are you sure that's what you need to be in the 1%? I guess it depends on what you're reading.

Either way, 1% or not, it would be difficult to argue that we're not higher up than almost everyone else. Better than the bottom 98% or 99%, what's the difference?

"Nationwide, it takes an annual income of $538,926 to be among the top 1%. Among the approximately 1.4 million taxpayers who meet this threshold, the average annual income is about $1.7 million – about 20 times the average income of $82,535 among all taxpayers."

How much do you need to make to be in the top 1% in every state? Here's the list

An annual income of $538,926 puts you in the top 1% of Americans. By state, it ranges from less than $350,000 to well more than double that in others.

www.usatoday.com

Here's how much money you need to make to be in the top 1 percent in 8 different countries

The threshold to be in the top 1 percent of earners looks different depending on where you live. In India, you need an annual income of $81,000. In the United States, it's $478,000.

www.cnbc.com

 

[drusso]

do you make over $737,000 salary? only those doctors making above that are in the 1% bracket.

How Much Income Puts You in the Top 1%, 5%, 10%?

To count yourself among the nation's top earners, it takes an income of at least six figures. Here's how the numbers break down for each group.

www.investopedia.com

i would hazard that most of us are not making that much.

i know im not anywhere in that ballpark. reading the posts of others, including the poster who talks the most about the virtues of private practice, im guessing he isnt either...

I think this is forum is 80% half-ballers and 20% full balls.

 

[Dr. Ice]

I think this is forum is 80% half-ballers and 20% full balls.

I think I’m 1/4 ball

 

[Ducttape]

we clearly make much more than the general populace, even those of us who are 1/4th ballers


im correcting the erroneous fallacy that we are the group of people that politicians target as being the super rich or ultra rich. we are not, and we contribute a minimscule amount to the overall income inequality gap.

 

[Laryngospasm]

I’m more like a ping pong ball.. does that count?

 

[Pain Applicant1]

we clearly make much more than the general populace, even those of us who are 1/4th ballers


im correcting the erroneous fallacy that we are the group of people that politicians target as being the super rich or ultra rich. we are not, and we contribute a minimscule amount to the overall income inequality gap.

We're definitely not making as much as the ultrarich but I always find it funny how people always say it's the guy above them who's making all and/or too much of the money and should be taxed more, etc. It's always the guy above, never the guy in the same income bracket.

I'm definitely not defending the ultrarich but I don't have strong feelings about income inequality either. I don't even really understand what that means.

 

[Laryngospasm]

We're definitely not making as much as the ultrarich but I always find it funny how people always say it's the guy above them who's making all and/or too much of the money and should be taxed more, etc. It's always the guy above, never the guy in the same income bracket.

I'm definitely not defending the ultrarich but I don't have strong feelings about income inequality either. I don't even really understand what that means.

That’s totally fair.. so let me know when billionaires pay THE SAME AS ME…

 

[Dr. Ice]

Many believe UBI will solve many problems. People who work in finance strongly believe UBI will be a definite thing in the near future

 

[Pain Applicant1]

That’s totally fair.. so let me know when billionaires pay THE SAME AS ME…

Are you referring to taxes from billionaires? If so, I'm not even going to waste my time defending them. Why would I?

It's just interesting that people always look above them when they want to focus on who is making too much. To me, it seems that people shouldn't be hypocritical. If you want a more equal distribution of wealth then quit complaining about the people above and give more of your money away to charity or to the government. If you donated 50% of your salary you'd still do just fine You'd have more than enough food and shelter and would probably still be making far more than most Americans. Reminds me of Bernie Sanders, the man who donated a tiny amount to charity and when asked about the royalties from his book said that he deserves it because he worked hard for it. It's always someone else who should give more.

 

[drusso]

we clearly make much more than the general populace, even those of us who are 1/4th ballers


im correcting the erroneous fallacy that we are the group of people that politicians target as being the super rich or ultra rich. we are not, and we contribute a minimscule amount to the overall income inequality gap.

The problem with America’s semi-rich

America’s upper-middle class works more, optimizes their kids, and is miserable.

www.vox.com

Amazon productfacebook[t]w[c]vox.social[r]l.facebook.com[d]D

 

[Pain Applicant1]

Many believe UBI will solve many problems. People who work in finance strongly believe UBI will be a definite thing in the near future

I don't know if it will be good or bad but I personally don't see how it can be avoided. If predictions are accurate and manual labor jobs will become automated I don't see what other options exist. There's nothing more dangerous than unemployed young males with too much time on their hands. That's one reason Rome had so many roads.

 

[Ducttape]

that argument about the top 9.9% is something to consider.

however, in terms of expendable income, and the argument that americans should be allowed to work hard to maximize their income, i find it harder to critique those not in the top 0.5%.

tax havens, off shore accounts, "funny money" laundering schemes and tax avoidance accountante et al are not typically available to those outside the top 0.5%.

Are you referring to taxes from billionaires? If so, I'm not even going to waste my time defending them. Why would I?

It's just interesting that people always look above them when they want to focus on who is making too much. To me, it seems that people shouldn't be hypocritical. If you want a more equal distribution of wealth then quit complaining about the people above and give more of your money away to charity or to the government. If you donated 50% of your salary you'd still do just fine You'd have more than enough food and shelter and would probably still be making far more than most Americans. Reminds me of Bernie Sanders, the man who donated a tiny amount to charity and when asked about the royalties from his book said that he deserves it because he worked hard for it. It's always someone else who should give more.

this argument is not consequential. 1 individual in this middle income group is not going to do anything to correct the income inequality. however, taxing the 16,000 people who are in the 0.01% group appropriately will make a significant difference.

 

[Laryngospasm]

Unfortunately the bottom line is that the 0.01% will never be taxed to the extent they should because they rub elbows with the politicians and our system is inherently corrupt.

 

[Pain Applicant1]

that argument about the top 9.9% is something to consider.

however, in terms of expendable income, and the argument that americans should be allowed to work hard to maximize their income, i find it harder to critique those not in the top 0.5%.

tax havens, off shore accounts, "funny money" laundering schemes and tax avoidance accountante et al are not typically available to those outside the top 0.5%.


this argument is not consequential. 1 individual in this middle income group is not going to do anything to correct the income inequality. however, taxing the 16,000 people who are in the 0.01% group appropriately will make a significant difference.

I'm not sure about that but I do know that there are a lot of starving and homeless children in this world and your donation certainly would not be inconsequential to them. You can provide much food, clean water, and medicine if you were to donate a good chunk of your paycheck. You definitely do not need your entire salary to get by. You can make a difference. ----"Be the change you wish to see in the world" -Gandhi --- "and don't be a hypocrite" -me

 

[hyperalgesia]

Many believe UBI will solve many problems. People who work in finance strongly believe UBI will be a definite thing in the near future

I think UBI is kind of what we've been getting during COVID and it's contributing to inflation. Lots of jobs but people don't want/need to work. Unemployment is toxic to civilization imo.