Cash-Only Healthcare at What Cost?
I saw my old New York doctor today. He was the main focus in a New York Times article about providing healthcare in a cash-only model. I really should point out that when he was my PCP, he was still accepting insurance and I was not paying the $25,000 annual fee for his services.
Frank Bruni, of the New York Times editorial staff, points out this practice is rife with potential for abuse and ethical dilemma. When a patient is paying $25,000 a year and demands an antibiotic for his viral infection or he will take his business elsewhere, it could be tempting to simply give him the drug he doesn't need.
What about testing? If someone demands a test that isn't warranted, could a doctor be tempted to order it anyway? So for that amount of money, one can get his toe held during a procedure (really, you have to read this article), but is he getting better quality care? What about the wrath of someone who has paid that much but has a negative outcome anyway? That should make for an interesting court case!
I should also disclose that I had a private clientele for a few years that paid on a cash-only basis. It worked well in that I was able to focus on rehab, spend whatever necessary time was required with each one, and not have to waste time arguing with insurance companies. My reputation was good enough that I never had to advertise and had a steady word-of-mouth referral base.
That being said, I charged a market-rate, reasonable fee for a house call, not the humongous retainer fee described in this article. I left that model of practice for a number of reasons, but primarily because I got bored with very similar presentations of my clientele (golf injuries and treatments around resuming the game or improving their performance at it).
How about your practice? Do you take insurance, a mix of insurance and cash, or cash only? Do you find any ethical issues arising if you have a cash-only business? I think the model can work, if reasonable fees are charged. Once outlandish fees are charged, I think that's where the ethical issues arise.