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Governments, doctors, and patients are looking for ways to improve healthcare quality and lower costs. Legislators have made attempts with the No Surprises Act and Health Care PRICE Transparency Act. But these laws do not get to the core of the perverse medical care pricing system. Insurer’s bargain for prices with various health systems and hospitals. The negotiated price can be up to double the price offered to “self-pay” patients, that is, patients who offer to pay cash even if they have insurance.
Additionally, insured patients are on the hook for more costs mainly because many employers have shifted to high-deductible insurance plans to lower their costs. According to the Kaiser Family Foundation, annual deductibles in 2021 were as high as $2,378, an amount that steadily increased over the last 10 years. Moreover, the insureds must pay a copayment when they see the doctor. This can be a fixed amount (an average of $25 for primary care and $42 for specialty care) or a percentage (generally 20 percent) of the cost of the visit. And remember, this percentage is based on the insurance rate — which is higher than the cash rate.
What is a patient to do to save money while still getting good medical care? When patients choose to receive care from a physician or other healthcare professional who has a cash-based practice, the fees can be very low. Why? They have cut out the middleman — the insurer. That means no salary for an office worker to sit on the phone all day with an insurance company trying to extract payments. Dealing with a cash-based practice also leads patients to other areas with reduced fees: X-rays, CT scans, MRIs, laboratory tests, and pharmaceuticals.
I urge you to take a look at websites that list folks who publish cash prices, such as the Free Market Medical Association, Association of American Physicians and Surgeons, and sites that offer discount coupons, such as GoodRx and Blink Health. The savings are well worth the time. Consumer Reports secret shoppers found the cost of 5 commonly prescribed medications cost $66 at HealthWarehouse.com, $105 at Costco and a shocking $900 at CVS and RiteAid.
And why should physicians be more like veterinarians? The vets love their patients, and many have this sign like this in their offices: You are invited to discuss frankly with us any question regarding our services or fees. The best medical services are based on a friendly mutual understanding between the patient and doctor.
My guest today has operated a caring, compassionate cash-based medical practice, and we’ll discuss how she got there. And we’ll also touch on human behavior and politics and how they influence the practice of medicine.
Kathleen M. Brown, MD is a clinical dermatologist who has innovated in developing and promoting the direct pay model of clinical practice. She graduated from The College of William and Mary in Virginia with majors in biology and music and earned her MD degree from Eastern Virginia Medical School and completed both dermatology (Washington [D.C] Hospital Center) and internal medicine (Johns Hopkins Bayview) residencies. After practicing in a multi-specialty group, she opened a solo direct-pay dermatology practice and loved practicing medicine in that manner. She enjoys mentoring other dermatologists who are interested in direct pay practice and networking with others who have an interest in free market solutions to health care problems.
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