Cash Only Practice Ideas

zenman · Jan 30, 2009

There have been some physicians, fed up with insurance, who have done this successfully. Maybe you can google and see if you can find any info.

ANPFNPGNP · Jan 30, 2009

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

Wow, talk about coincidence! I was just getting ready to start a new thread on this very subject. I've been a NP for close to 4 years now and I'm sick and tired of working my butt off for doctors, while they collect the cash.

There is a large "super" grocery store here and when it was built 2 years ago, there were several spaces for rent. One of the large hospitals in town rented a space and had a NP run urgent care/minor emergency clinic. Some docs got mad and got a petition going and had over 50 docs in town sign it, basically threatening to never admit a patient at that hospital unless they closed the clinic. One of the docs told me that it was a conspiracy and they were afraid the hospital would start opening clinics like that all over town, putting the primary care docs out of business. Anyway, the space has been empty for over a year and I called about it today. It's only 300 sq ft, but it's only $1,500 per month and that includes all bills. They require a $1,500 deposit with a one year lease.

I would only be interested in a cash only clinic and I've looked at some of the price lists at some of the urgent care clinics throughout the U.S. I can see where I could get away with charging $50 per visit. Obviously, since the clinic is in a grocery store, I wouldn't be able to do procedures...I&D's, lacerations, etc. I work in urgent care and the ER, so I know there's plenty of patients that can be taken care of with a script.

Unfortunately, I would need a collaborative physician, so I'm looking at that right now. Also, I would obviously have to get insured...all kinds of things to look at. Let me know what you've heard about a cash only clinic. With all these people out of work with no insurance, it sounds like a good thing.

kiser56 · Jan 31, 2009

ANPFNPGNP,

Where are you located and what type of legislature do you have for practice?

ANPFNPGNP · Jan 31, 2009

ANPFNPGNP,
Where are you located and what type of legislature do you have for practice?

I live in Texas. Currently, we have to have a collaborative agreement with a physician. However, a bill was just introduced into the TX legislature that, if passed, would give us independence. The docs are already fighting the bill tooth and nail...as you can imagine. PLEASE SAY A PRAYER FOR US HERE IN TEXAS!

al dente · Feb 1, 2009

I live in Texas. Currently, we have to have a collaborative agreement with a physician. However, a bill was just introduced into the TX legislature that, if passed, would give us independence. The docs are already fighting the bill tooth and nail...as you can imagine. PLEASE SAY A PRAYER FOR US HERE IN TEXAS!

That is good news! What's your thought on its chance of passing? I know Texas had a moratorium on NPs advancing scope of practice until this legislative session. Is there a way to monitor the progress of the bill (legislative bill number)?

n_g · Feb 1, 2009

Doesn't Texas have thousands of physicians waiting to get into the state to practice? Since tort reform, Texas has been a very popular destination for physicians. In fact, they had to expand the medical licensing department to handle all the paperwork. It's kinda hard to make the "physician shortage" argument now.

kiser56 · Feb 1, 2009

Yeah we will keep you in our thoughts; always a good opportunity. Anyone from Virginia have their own practice whether it be cash or traditional practice?

core0 · Feb 1, 2009

I'll make a couple of points here:

1. It is a very bad idea for a new grad to try to establish their own practice. The transition from school to practice is just the start of life long learning. It takes between three months and two years for a provider to be fully effective in a practice including experience providers that move to different practices. I have yet to see a new grad NP or PA that is fully up to speed inside a year. I know several PAs that own their own practice including one that went to PA school with the intention of opening their own rural practice. None seriously considered actually opening the practice until they had at least six years experience (n~20).

2. There are essentially two types of cash only practices. The urgent care type practices and "boutique" type practices. The boutique practices are usually the result of goodwill built up over years that translates into patient wanting to pay cash for premium service.

3. In an urgent care type setting speed is paramount. This is the result of experience. See number one.

I think that cash only practices are possible in today's environment. However, as AFPFNPGNP stated there are a lot of obstacles. One that was not addressed is that another entity may decide to offer the same services that you are at a reduced price. More than a few deep pocketed companies have gone bankrupt trying to impliment this "simple" business model.

David Carpenter, PA-C

BabyLady, BSN, RN · Feb 1, 2009

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.

zenman · Feb 2, 2009

I've also read about physicians that just make cash only house calls. And one psychotherapist (can't remember if it was a MD or psychologist) that did his therapy in a van. He would pick clients up outside their office building and do therapy in his "office" while his driver drove around town. Only $175 an hour!

kiser56 · Feb 2, 2009

I'll make a couple of points here:
1. It is a very bad idea for a new grad to try to establish their own practice. The transition from school to practice is just the start of life long learning. It takes between three months and two years for a provider to be fully effective in a practice including experience providers that move to different practices. I have yet to see a new grad NP or PA that is fully up to speed inside a year. I know several PAs that own their own practice including one that went to PA school with the intention of opening their own rural practice. None seriously considered actually opening the practice until they had at least six years experience (n~20).
2. There are essentially two types of cash only practices. The urgent care type practices and "boutique" type practices. The boutique practices are usually the result of goodwill built up over years that translates into patient wanting to pay cash for premium service.
3. In an urgent care type setting speed is paramount. This is the result of experience. See number one.
I think that cash only practices are possible in today's environment. However, as AFPFNPGNP stated there are a lot of obstacles. One that was not addressed is that another entity may decide to offer the same services that you are at a reduced price. More than a few deep pocketed companies have gone bankrupt trying to impliment this "simple" business model.
David Carpenter, PA-C

David,

1. I resoundingly agree that a new grad should not even consider an

individual practice until they are sufficiently ready to provide good quality

patient care and be able to handle the volume of patients that he/she might

see during the course of the day and remain treading above water.

2. You should check out this guy's website who I found on the net surfing

about being practice owner: http://www.acchealth.com/ . I guess this

could be considered a boutique type of practice, but in the same regard, it

is reasonable if a patient were using HSA's as their primary source of

payment for healthcare. Using a mixed income model, I believe that profiting from business would not be much of a problem. Also, this is very dependent on the amount of overhead that would come from owning this type of practice including but not limited to property leases or ownership prices, one's own Liability Insurance, supplies and equipment, ancilliary staff, one's own health insurance, and coverage for days to be off so the practice could continue to run in your absence. I in no way intend to open my own practice right now, but am checking the weather on my community for the need and the demand of this type of practice in the future. If I can become sufficient enough to practice independently, it may one day be an option. Thanks for your insight, I always enjoy reading your posts to consider a different vernacular.