Money Talks, Obamacare Walks: Some Doctors to Accept Cash Only

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If you can’t afford “Affordable Care” and do not have employer-provided health insurance, what are your options when you need to see a doctor?

The answer may be to find a physician who offers “concierge” or direct care (also referred to as membership medicine, cash-only practice, direct practice, or boutique medicine). Doctors who use this business model charge patients a monthly or annual membership fee or retainer for unlimited office access (usually including 24-hour email and/or telephone accessibility), and bill patients for tests and supplies that are used.

This business model is a win-win for doctors and patients – both parties avoid having to deal with insurance companies and the associated high costs, paperwork, and red tape.

According to data from a national survey of nearly 14,000 physicians conducted by physician staffing firm Merritt Hawkins for The Physicians Foundation, 9.6 percent of “practice owners” are planning to convert to concierge practices in the next one to three years.

“Physicians have been running for cover for several years now,” said Mark Smith, president of Merritt Hawkins. “There is a lot of uncertainty in health care now and the only certainty is there is a lot of talk about cutting physicians fees. One way to get out of it is to go off the grid.”

After accepting insurance for five years, Dr. Doug Nunamaker and his partner switched to a membership-based practice. Their patients pay a flat monthly fee to have unlimited access to the doctors and any service that is provided in the office. Their fees vary depending on age. For children, it’s $10 a month. For adults up to age 44, it’s $50 a month, and senior citizens pay $100.

Dr. Nunamaker’s practice, which is located in Wichita, Kansas, has negotiated pricing for services that aren’t offered in their office. He can get cholesterol tests done for $3 instead of the $90 labs typically bill to insurance companies. And MRIs, which normally cost $2000, can be done for $400.

In April 2013, Dr. Michael Ciampi of South Portland, Maine, stopped accepting all forms of health insurance. Insurance companies no longer dictate how much he charges, he can offer discounts to patients who are struggling, and he can make house calls. His prices are listed on his website.

“I’m freed up to do what I think is right for the patients,” Ciampi said. “If I’m providing them a service that they value, they can pay me, and we cut the insurance out as the middleman and cut out a lot of the expense. If more doctors were able to do this, that would be real health care reform. That’s when we’d see the cost of medicine truly go down.”

Dr. Kevin Wacasey of Colleyville, Texas, runs what he calls a cash clinic. On the Colleyville Medical Clinic website, Dr. Wacasey says he “took an oath to do no harm to my patients. To me, that includes financial harm.”

When Congress was busy debating about Obamacare, a small group of doctors formed the Direct Primary Care Coalition. Dr. Erika Bliss, a coalition leader, said she receives monthly alerts about new concierge practices or converting practices. She now estimates there is a direct primary care practice in nearly every state.

In March, the American Academy of Family Physicians issued a statement in favor of the direct care model.

The DPC website provides a list of direct primary care practices in the United States.

Perhaps if more doctors and patients shift to this model, we’ll get the truly affordable, high-quality healthcare we need.

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Contributed by Lily Dane of The Daily Sheeple.

Lily Dane is a staff writer for The Daily Sheeple. Her goal is to help people to “Wake the Flock Up!”

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