Medically Reviewed by Charlotte E. Grayson Mathis, MD on April 28, 2004 From the WebMD Archives
April 28, 2004 — Some doctors who are fed up with overregulation by private insurance companies and the government are turning their offices into cash-only businesses that don’t accept payment from third parties. The move gives new freedom to doctors and, they say, better care for patients. But is it a good prescription for the nation’s health care system?
Several doctors told lawmakers Wednesday that cash-for-treatment medical practices have allowed them to care for patients without interference from HMOs or Medicare. They say that those bureaucracies waste money enforcing rules and get in the way of the best treatment.
“We are no longer willing to tolerate anyone intruding into the sacred doctor-patient relationship,” Robert S. Berry, MD, director of the PATMIS EmergiClinic, told members of the congressional Joint Economic Committee.
His Greenville, Tenn., clinic does not accept insurance or Medicare payment, but instead posts prices for stitches ($95) and poison ivy treatments ($25) the same way a beauty salon does for shampoos and haircuts. That has freed Berry and his colleagues from HMO rules that he says forced him to see up to 30 patients per day.
It has also allowed him to avoid payment levels set by Medicare, which many doctors say are too low to cover the cost of complying with the program’s regulations.
“I avoid the crushing overhead and hassles of processing medical claims,” Berry says.
Other clinics charge patients a fee to join but then guarantee 24-hour-per-day access to doctors on a cash basis — service few managed care companies can provide. They do it by using the fees to limit the number of patients who can join.
“I really feel like a doctor again, a confidant, an advisor,” says Bernard Kaminetsky, MD, who’s Boca Raton, Fla., practice is affiliated with the a medical group that focuses on preventive care and tests designed to keep people out of the hospital.
Undermining the System?
Some policy makers — mostly republicans — like the way that cash-only medical practices simplify care for doctors and patients. Many, including President Bush, want to expand the use of tax-exempt medical savings accounts that would allow consumers to put money away and spend it later on boutique services of their choosing.
But that policy worries critics, who see the accounts and the boutiques as steps toward a divided health care system where wealthier people can afford to pay cash for better care, leaving everyone else to the mass insurance market. Even worse, they say, the boutiques and specialized plans to pay for them tend to attract healthier people, leaving only the sicker — and more expensive — patients to HMOs and the government.
“‘Concierge care’ is kind a new country club for us rich folks,” says Rep. Fortney (Pete) Stark, a California democrat. “We don’t have to sit around with the riff-raff,” he said.
Almost everyone who spoke on Capitol Hill agreed that the U.S. health system’s financing is rife with waste and that costs are rising beyond control. And most agreed that for some patients, being able to shop around for the best prices for a CAT scan or a mammogram could lower costs.
But Robert A. Berenson, MD, an internist who is now a senior fellow at the Urban Institute think tank, warned against promoting boutique care as a cure-all for the health system. He told lawmakers that Medicare spends 79% of its money on patients with four or more chronic diseases.
Letting people shop only for the care they want would just make it harder to insure those ill people, he says. “It would not make a dent in what is driving our health care spending, which is really spending on the very sick.”
Still, others see the trend as a way to return doctor visits to the days before patients were rushed out the door after seven minutes. “[It’s] an older style of medical practice, a patient-focused approach that used to be the norm,” says Utah republican Sen. Robert F. Bennett.
