Re: Cash Only Practice Ideas Originally Posted by kiser56 
Hello All:
I am a family nurse practitioner student at The University of Virginia. I will graduate in May. This is not an idea that I would be comfortably with initially, but does anyone work in a cash only practice environment or owns his/her own cash only practice. I have read about an expert in this field named Brian Forrest. He is from North Carolina and provides consultations (1500 dollars per day) to teach individuals his practices in producing cash only practice centers across the country. He seems like a very interesting person to me, but I am not sure how this would work in my state (Virginia) and how I could find a valid collaborative agreement (my area is almost bounded fully by physicians in a health system environment who have established covenants to not work outside of the system). This type of system would eliminate much of the overflow of paperwork in a working environment and help the practitioner spread their wings and not feel confined by insurance companies (the elephant in the room). Does anyone have any information to offer about this practice environment?
Thank You
I disagree with the practice, and in fact, personally refuse to see any provider of healthcare that uses such a practice.
This is very common in the dental industry...you pay cash up front, and they will bill your insurance company. I have changed dentists over and over again when they change their policies.
Here are your issues with it.
1. If a patient has the choice between seeing you and paying up front, or another NP that will bill the insurance, which one will they see?
2. Moral issues regarding people telling YOU what tests they think they need run, the care that they need, etc...based on their ability to pay. You'll be a writer of "estimates" rather than a provider of care. Can you live with yourself if you knew they needed something done and couldn't afford it and something happened to them...if they had insurance?
More downsides:
Yes, it allows you freedom...but you are only looking at it in one direction. You are getting referrals without having to send out marketing and advertising because the physician you work for appears in tons of lists of "providers" and that overflow gets to you if he's booked or those patients that prefer you or just prefer an NP. That is why the insurance companies have the restrictions...it's a two way street as they have costs involved in providing this information, processing the claims, servicing the client, etc.
The other negative is that as a patient, how do I know you would be charging me what my insurance would cover? You don't know what people's insurance will cover...so every patient that sees you will be assuming that risk...the budgets of the general public are too tight to take that risk...when they can go to Nora Niceman, NP down the street and get a locked in deal from day one.
I don't agree with the business model. Yes, there are financial benefits, but I would also be interested in the moral ones.
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