Friday, May 21, 2010

Markets In Everything: Cash-Based Medicine

WEEKLY STANDARD -- "On a wall inside Dr. Brian Forrest’s medical office in a suburb of Raleigh, North Carolina, is something you won’t find in most doctors’ offices, a price list:

Office visit: $49

Wrist splint: $41

Pap-smear: $51.

Those are the prices patients pay for the services, and they pay on the spot. Forrest doesn’t take insurance. If he did, the prices would be far higher and not nearly as transparent. He says listing prices up front is about trying to do business in a straightforward way, “like a Jiffy Lube.”

Forrest’s practice, Access Healthcare, was born out of his frustration with the bureaucratic system run by major health care providers and insurance companies. His epiphany came about 10 years ago, as he was completing his family medicine residency at Wake Forest University. “I was basically being told I needed to see 30 patients a day every day, and that’s what we had to do,” he recalls, speaking with a soft drawl. He didn’t care for that pace, preferring to spend 45 minutes to an hour with each patient.

At one job interview, he was told he would be required to sign a contract saying he’d see a patient every seven minutes or have his pay cut. Most new physicians sign those contracts. Forrest, 38, wouldn’t. “I’ll borrow a term from McCain: I’m ‘mavericky,’ ” he says. “I like to fix things that are broken.”

He spent some time researching alternative business models and found inspiration in People magazine, of all places, which profiled a Vermont doctor who carried a stopwatch, charged patients $2 a minute, and didn’t take insurance.

Forrest decided to take a similar approach—minus the stopwatch. Clients pay him cash when they’re seen, known in the industry as “fee-for-service.” He sees a maximum of 16 patients a day and leaves the office at 5 p.m. Because he doesn’t have to file insurance forms, he only needs a single office assistant, and the low overhead allows him to charge less than other doctors. Occasionally, his charges wind up being less than just the co-pays for Medicare or private insurance."

HT: Russel Harris


At 5/22/2010 7:02 AM, Anonymous Anonymous said...

That's my exact office profile for the last 10 years. 1 office assistant-if she doesn't show up (occasionally), the patient not being seen has to come around and type or help. My lab prices, office visits are less than the big store "specials" advertised in the paper. Min paperwork, no insurance, no credit cards, no BS, no 3rd party parasites.

At 5/22/2010 7:28 AM, Blogger bob wright said...

Dr. Forrest's comment about “like a Jiffy Lube" reminds me of the Jay Leno story about the plastic surgeon in L.A. that was considering adding a drive through to his building.

He was going to call his practice "Jiffy Boob".

At 5/22/2010 11:22 AM, Anonymous Anonymous said...

Several non doctor support personnel for every doctor is unaffordable for citizens. All we really need are the doctors and nurses.

We don't need the actuaries, lawyers, pencil pushers, pharmacists, etc... driving costs up to the moon.

At 5/22/2010 1:05 PM, Anonymous Anonymous said...

This blog is great. I would never have known about things like the MinuteClinics at CVS without it. The local CVS stores didn't seem to advertise it when they opened up.

At 5/22/2010 5:30 PM, Anonymous Anonymous said...

A fellow M.D. speaking here; I've had a home medical office for 2 years and it works. I'd like to know the special circumstances that make your cash practice feasible. For example, is there a shortage of doctors or a shortage of patients with insurance? Have you cancelled your malpractice insurance or is it cheap? How long did it take to break even? Are you financially independent? Do they all pay at time of service? Etc Etc Etc.

At 5/23/2010 10:34 AM, Blogger marketdoc said...

Maybe this is not the perfect solution for everyone's medical problems but it serves as an example of the free market using creativity to solve a problem, rather than leaving things up to the government.

At 5/23/2010 6:18 PM, Anonymous Die Fledermausmann said...

fellow M.D. speaking here

Our granddad had swollen ankles before he started blood-pressure pills. Now his ankles are normal, but his feet are swollen. Was there one thing accumulating in the ankle but something else accumulating in the foot? Is it the molecules from the pills that have deposited into the feet? But why it is mostly in the right foot? It took about 4 months to do that to feet.

Sorry for the interruption; but I couldn't find answer on internet.

Thanks in advance



At 5/28/2010 1:11 PM, Anonymous Michelle Cherewatenko said...

It is so refreshing to see a blog that sheds a positive light on Doctors who are brave enough to go against the grain. Bravo to you all!

My Huband Vern S. Cherewatenko,MD established a non-profit member based organization called the American Association of Patients and Providers and the educational/membership network SimpleCare in 1997. His goal is to teach providers how to treat their patients the way they feel best, not how the insurance comapany's will allow. He also wanted patients to understand that they could see the doctors of their choice for the care they desired, paying a reasonable rate in cash at the time of service, that is established by each individual provider. Check out our website for more information,

I applaud anyone, patient or provider, who steps outside the box of managed care, or should I say managed administration. ( over 50% of insurance premiums paid to Insurance companies dont go toward health care, it goes towards admin, oh and sports arena's, sky-srapers etc.)

"Any intelligent fool can make things bigger, more complex and violent. It takes a touch of genius, and a lot of courage, to move in the opposite direction."
Albert Einstien


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