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The buzz phrase in medicine these days is "cash pay." You see it everywhere: in online physician forums, in the pages of medical magazines, and in brochures mailed to the office. Presumably, the idea is that if we all went to a cash-only system it would fix the ills of modern medicine.
I don’t know if it would or not, but I do think every private practice doc has at least kicked the idea around, including me.
I’d love to go cash only. I think it would make everyone’s life easier, both mine and the patients’. I have no idea what my realistic rates would be, but I know they’d be less than the inflated amounts we all charge insurances (knowing that we’ll see maybe half of what we charge, if we’re lucky).
I’m also not sure how well it would work for a specialist. Unlike internists, not all patients are with us for the long haul. Some certainly are, but many we may see just a few times before solving whatever ails them.
The other issue is competition. Cash pay offers a lot of incentives for fairness and transparency in pricing, but (at least in neurology) it flies out the window if you’re the only one doing it. In my immediate area there are seven other neurologists, all of whom take insurance. If I were to suddenly go cash only, I’m pretty sure most patients would quickly migrate elsewhere. Paying a $25 copay down the street is going to outweigh loyalty to me for most of them. Sure, there will be some who will stay with me, but realistically, it’s not likely to be enough to keep my door open. And by the time you’ve figured out if it’s going to work, it’s too late to go back if you guessed wrong.
I know only one other neurologist who tried opening a cash-only general neurology practice. He lasted slightly less than 5 months before frantically trying to get on every insurance plan he could. He folded after 2 years, unable to pay off the debt he’d accumulated in trying to start up.
Another way to do cash only is if you have some special skill that attracts people, such as being world famous at something or the only doc in your area that does a specific procedure. Then you might have a marketing angle. But for most of us it would probably settle out to a practice full of wealthy migraineurs and chronic pain patients. And I don’t want that.
So, without any better ideas right now, I plug along with the insurance companies, hoping (but not particularly hopeful) that things will improve.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
The buzz phrase in medicine these days is "cash pay." You see it everywhere: in online physician forums, in the pages of medical magazines, and in brochures mailed to the office. Presumably, the idea is that if we all went to a cash-only system it would fix the ills of modern medicine.
I don’t know if it would or not, but I do think every private practice doc has at least kicked the idea around, including me.
I’d love to go cash only. I think it would make everyone’s life easier, both mine and the patients’. I have no idea what my realistic rates would be, but I know they’d be less than the inflated amounts we all charge insurances (knowing that we’ll see maybe half of what we charge, if we’re lucky).
I’m also not sure how well it would work for a specialist. Unlike internists, not all patients are with us for the long haul. Some certainly are, but many we may see just a few times before solving whatever ails them.
The other issue is competition. Cash pay offers a lot of incentives for fairness and transparency in pricing, but (at least in neurology) it flies out the window if you’re the only one doing it. In my immediate area there are seven other neurologists, all of whom take insurance. If I were to suddenly go cash only, I’m pretty sure most patients would quickly migrate elsewhere. Paying a $25 copay down the street is going to outweigh loyalty to me for most of them. Sure, there will be some who will stay with me, but realistically, it’s not likely to be enough to keep my door open. And by the time you’ve figured out if it’s going to work, it’s too late to go back if you guessed wrong.
I know only one other neurologist who tried opening a cash-only general neurology practice. He lasted slightly less than 5 months before frantically trying to get on every insurance plan he could. He folded after 2 years, unable to pay off the debt he’d accumulated in trying to start up.
Another way to do cash only is if you have some special skill that attracts people, such as being world famous at something or the only doc in your area that does a specific procedure. Then you might have a marketing angle. But for most of us it would probably settle out to a practice full of wealthy migraineurs and chronic pain patients. And I don’t want that.
So, without any better ideas right now, I plug along with the insurance companies, hoping (but not particularly hopeful) that things will improve.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
The buzz phrase in medicine these days is "cash pay." You see it everywhere: in online physician forums, in the pages of medical magazines, and in brochures mailed to the office. Presumably, the idea is that if we all went to a cash-only system it would fix the ills of modern medicine.
I don’t know if it would or not, but I do think every private practice doc has at least kicked the idea around, including me.
I’d love to go cash only. I think it would make everyone’s life easier, both mine and the patients’. I have no idea what my realistic rates would be, but I know they’d be less than the inflated amounts we all charge insurances (knowing that we’ll see maybe half of what we charge, if we’re lucky).
I’m also not sure how well it would work for a specialist. Unlike internists, not all patients are with us for the long haul. Some certainly are, but many we may see just a few times before solving whatever ails them.
The other issue is competition. Cash pay offers a lot of incentives for fairness and transparency in pricing, but (at least in neurology) it flies out the window if you’re the only one doing it. In my immediate area there are seven other neurologists, all of whom take insurance. If I were to suddenly go cash only, I’m pretty sure most patients would quickly migrate elsewhere. Paying a $25 copay down the street is going to outweigh loyalty to me for most of them. Sure, there will be some who will stay with me, but realistically, it’s not likely to be enough to keep my door open. And by the time you’ve figured out if it’s going to work, it’s too late to go back if you guessed wrong.
I know only one other neurologist who tried opening a cash-only general neurology practice. He lasted slightly less than 5 months before frantically trying to get on every insurance plan he could. He folded after 2 years, unable to pay off the debt he’d accumulated in trying to start up.
Another way to do cash only is if you have some special skill that attracts people, such as being world famous at something or the only doc in your area that does a specific procedure. Then you might have a marketing angle. But for most of us it would probably settle out to a practice full of wealthy migraineurs and chronic pain patients. And I don’t want that.
So, without any better ideas right now, I plug along with the insurance companies, hoping (but not particularly hopeful) that things will improve.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
