Dish Model At The Doctor’s Office

Andrew Sullivan —  Mar 8 2013 @ 3:11pm

Dr. Rob Lamberts recently left his old practice to experiment with an insurance-less, subscription-based practice of his own. After his first month, he is surprised by the response:

We are up to nearly 150 patients now, and aside from the cost to renovate my building, our revenue has already surpassed our spending.  The reason this is possible is that a cash-pay practice in which 100% of income is paid up front has an incredibly low overhead. …

[And] as the enthusiasm for my new type of practice grows in the community, it may spur a boom in cash-paying patients.  Why?  One of the provisions in the Accountable Care Act (ACA) is that small businesses (with over 50 employees) who want to avoid the penalty for not having insurance can opt to contract with a direct-care physician like myself in conjunction with a high-deductible health care plan.  Even though I have made no effort to attract such interest, I’ve already been approached by 2 businesses of 100 employees to make such an arrangement.

He’s also been contacted by specialists interested in partnering with him to take advantage of this model:

This seems quite ironic to me – a sort of “trickle-up economics,” where I am spreading the benefit of offering discounted care in exchange for cash to the higher-paid specialists.  It is a win-win-win arrangement, though, as the specialists benefit from reducing their overhead while getting guaranteed payment, I benefit by increasing the value of my type of practice even more to my patients, and the patient benefits by getting cheaper care.  This, of course, raises the likelihood that more businesses will opt for this payment model, and the movement gains momentum. Who loses?  The “increased overhead” comes in the form of the front-office staff doing billing, coding, and collections.  This is the staff my simple-minded approach to finances has heretofore avoided, and hopes to continue avoiding.