Question about Cash Only Practices

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Zap Rowsdower

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Has anyone encountered cash only GROUP practices, or is this something that only solo docs do? I'm wondering if it is possible to start or join a cash only practice following residency, or do most build a patient base by partnering with insurance companies and medicare/medicaid first?

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Cash-only practice certainly isn't limited to solo practitioners. To date, however, those I've heard about have been small practices rather than larger groups. I suspect this has to do with the fact that groups tend to be better equipped to play the insurance game than many small practices, making cash-only less attractive. Depending on how things shape up with health insurance reform, of course, that could change.

There are lots of previous threads here as well as articles online about issues related to cash-only practice. At present, I think it's a risky proposition that takes considerable planning. Given the fact that most physicians continue to accept insurance, cash-only practices will appeal only to a subset of patients.
 
I kind of have a question in the same category blue dog ...

I know that some practices are switching over to a model where they 'take insurance,' but instead of having a co-pay or doing the paper work themselves, they take cash from the patient for the full service, then have the patient bill the insurance company and get reimbursed. How viable is this model? Also, is it legal for the physician to say perform a procedure, charge the patient 100 dollars, even though when they bill the insurance company, it will only pay them say 80 dollars?
 
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From what I've read, a lot of cash only practices will give their patients a copy of the bill so that they can try to collect from the insurance companies themselves.

Overall, I think it would be pretty intimidating to start off in this area by yourself. Ideally, it would be nice to someday join a small cash only group, where you're not alone and you get to practice with others who share the same philosophy. But I am a few years away from the real world so I'm just trying to get a feel for things now.
 
some practices are switching over to a model where they 'take insurance,' but instead of having a co-pay or doing the paper work themselves, they take cash from the patient for the full service, then have the patient bill the insurance company and get reimbursed. How viable is this model?

That's not "taking insurance." That's cash-only.

If you sign a contract with an insurance company, you are obligated to file claims, accept the agreed-upon fee schedule, and you can't balance-bill the patient. It's not "illegal" to do otherwise (unless we're talking Medicare), but it'll get you kicked off the insurance panel for sure.
 
That's not "taking insurance." That's cash-only.

If you sign a contract with an insurance company, you are obligated to file claims, accept the agreed-upon fee schedule, and you can't balance-bill the patient. It's not "illegal" to do otherwise (unless we're talking Medicare), but it'll get you kicked off the insurance panel for sure.

Oh, gotcha. It seems like it would be easier to get patients/ they would be less adverse to the cash based model if they knew they would receive compensation back in some form from the insurance companies. Especially if the doctor gave out forms or helped explain how to go about getting it back. Dunno though ...
 
On this topic, sort of: How long would it take to build a decent sized patient panel, say 1000 patients, being cash only?

I know that this is a highly varible issue, but I'm looking for some "best guesses". Let's assume that there is some marketing (but not tons) and some word of mouth happening, say through church, etc.

Let's also assume that the cash only prices are not terribly expensive. Cash only, not concierge.

Any guesses? 1 year? 2 years? My personal guess is on the shorter end, especially if ObamaCare passes and wait times increase drastically.
 
Too many variables. Any guess would be meaningless.

Your best bet to grow a cash only practice quickly would be to locate in a relatively underserved area with a high percentage of working but uninsured patients, and market yourself as "affordable primary care for all." Do urgent care, walk-ins, have "job-friendly" late night and weekend hours, etc.
 
Anyone interested in this topic should read this article from medical economics. This guy is my hero.

edit:
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
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Jan 22, 2010
By: Morgan Lewis Jr.
Medical Economics
 
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Anyone interested in this topic should read this article from medical economics. This guy is my hero.

edit:

Interesting. I really hope models like this catch on, but I just don't see them working everywhere. It seems like that newspaper article really made his practice take off, and I'm wondering if he would have received necessary volume in the beginning without it.
 
Interesting. I really hope models like this catch on, but I just don't see them working everywhere. It seems like that newspaper article really made his practice take off, and I'm wondering if he would have received necessary volume in the beginning without it.

This guy has made it successful and even helps people set up similar practices around the country. This uses the exact precepts that BlueDog mentions. 1) High working, uninsured population, 2) Reasonable prices that are listed and given ahead of time, 3) Self-billed as Access for Everyone.
 
This guy has made it successful and even helps people set up similar practices around the country. This uses the exact precepts that BlueDog mentions. 1) High working, uninsured population, 2) Reasonable prices that are listed and given ahead of time, 3) Self-billed as Access for Everyone.

Got to love seeing more of this.
 
Brian Forrest is pretty much my hero. He's been mentioned on this forum a few times before.

He really has destroyed a lot of stigma surrounding the cash-only practices, with the prices he charges and the population he sees.
 
Brian Forrest is pretty much my hero. He's been mentioned on this forum a few times before.

He really has destroyed a lot of stigma surrounding the cash-only practices, with the prices he charges and the population he sees.

Yeah, he really markets himself as a full-access doctor in a cash-only practice. So, it's not the "boutique" medicine that people usually associate with cash-only.

One thing that interested me though, was that his practice kinda stabilized at ~60% insured people who wanted more time with a doctor and about 40% working uninsured.
 
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