Cash Only Practice Ideas

[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

[kiser56]

BabyLady,

I respect your point of view.

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?

Usually one seeing his/her is required to pay some sort of copay (ranging from 1$-50$). Many offices that I have seen require a patient to pay this upfront before they can be seen. Patients receiving a socialized form of healthcare would probably not be interested in receiving a cash only practice as their source of primary care. These people are not required to often pay any significant copays and would not be willing to pay more for service. Unfortunately for our current social state and socioeconomic status of these individuals, this may also eliminate seeing many patients who are drug seeking individuals which may infringe upon the environment of your practice.

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?

To answer in one word "Yes". As stated earlier, these individuals may qualify for some form of socialized medicine and be able to receive it. If the need is acute, the individual could most certainly be seen in the ED without having to pay at that time. If they could not reach the ED on their own, an ambulance could be arranged to pick up the patient and take them to the ED. The need to marginalize the cost of healthcare is just as important today as it has ever been. Competition is how we as nurses make ourselves affordable as is always stated as one of the examples of being a nurse practitioner. Oftentimes, we are only affordable to the institution who is hiring us, not to the people we are providing care for.

The moral benefits would be to help individuals without health insurance as well as those who have high priced premiums on their health insurance be able to receive primary care in an environment where cost was not a mistifying cascade of charges that insurance companies send you back on a bill everytime you go see your PCP and you are charged for each fee included.

I believe that one (the business owner) would have to continually be aware of the costs of certain procedures as well as referrals for individuals without health insurance. Perhaps if the business became successful, one could work out deals with specialists in the area or companies with specialty equipment to see these patients because they are cash paying individuals. Networking throughout the community would be very important. Patients could also use insurance if need be if the situation arose. Especially those with HSA's that included high priced premiums. Continual review of performance would also be important and the community could hopefully answer you by mail based surveys or telephone based interviews. This would be a cash for service type of business in the sense that I believe where one would receive their health care service need at a price. Like David said though, one would have to possess a great rapport with the community and be a highly competent provider.

[kiser56]

ive never done this before, but bump

[nursetim, NP]

I did a clinical rotation with them at AHC in Apex. It is a great set up. Dr. Forest is a brilliant fellow and Stephanie is a great NP. If you want to talk about the practice I am at your service.

I to am looking for practice like this out west. Maybe I can partner with a pediatrician to see all the peds I can't.

I agree with David that no NP just starting should practice solo. That's just my belief. I want to be able to get a quick second opinion if I need to.

[Jo Dirt]

No matter how good of an idea it seems remember there are probably a lot of others who thought of the same thing and the big money that has its hand over it so there is no chance the little guy can get to it.

[Jo Dirt]

You all need to come to Altamont, TN to see the country doctor who takes cash only. His office visits+treatment/procedures+labwork+meds (which he mixes up in his office) costs $20-30.

For the whole deal.

His office it way out in the country, an old block building. He lives next door in a little run down house.

Up until he started getting more frail, he would deliver a baby for around $900. Now, he refers OB patients to the Mennonite midwife in the area.

[Phillip C]

Dr Harboldt delivered four of our children. Back in 1977, he charged $150. Their office was complete with delivery room and recovery room. Most of our children were born in the middle of the night. Sometimes, while we were waiting, we helped sweep and mop the floors. And we talked and talked.

A few years later he raised his price to $250.

Dr Harboldt was a great model of a doctor who loved the people he served. His office was simple. His wife was his nurse. He was a gentle, approachable, kindhearted person.

Sure, he wasn't a specialist. But in the poverty stricken area of Grundy County, Tennessee, Dr Harboldt deserves many accolades!!

[BarbaraNP]

As a independent business owner, I feel I can speak to a cash practice. There are several NP and PA owned practices that are cash only throughout the US. There are several advantages to a cash practice that actually are very cost effective.

For example, in my small practice, it takes nearly 1.5 FTE to handle all the issues of insurance and billing. By taking cash only, my overhead would be significantly reduced...a savings I would gladly pass on to my patients. When someone pays cash, I don't have to be concerned about getting paid or having them take the payment back in 6 months - like insurance companies will do. And they can have the procedures done that their insurance company will not pay for (usually something cosmetic).

Additionally, I see lots of folks with very high deductibles or those that are without insurance. Our rates are much better than the hospital, or even their attached urgent care. Yes there are tests they don't get and/or don't want...but that's true for insurance patients as well (managed care will often deny a request).

Being a business owner has opened my eyes to some very real challenges in providing care that I was unaware of as an employee. It's definitely not for everyone. That said, I think any NP or PA that wants to explore the idea, should seriously look into it. It can be a win-win-win for all concerned.

BarbaraNP