How to Test the Waters of a Cash-Only Practice

Jeffrey J. Denning


UnCommon Sense 

In This Article

Take It in Stages

It's most prudent to ease into a cash practice as you would a hot bath: gradually. First, make yourself hard-to-get by patients with the worst paying discounted contracts to see if there is enough demand from patients covered by better contracts. When it works, signal your intent to resign the poor-paying contract. Then offer to see all of your existing and future patients who have that coverage on a cash-at-contact basis, providing everything they need to submit their claims (a copy of the superbill) and coaching them on how to do it if they need it.

Then, one at a time, resign your remaining insurance contracts on the same basis, allowing time for the practice to stabilize after each cut. This strategy allows the practice to reverse course if sufficient patients don't stay with the physician.

Are there any differences between "cash-only" and "concierge" medicine? Yes. Nothing much changes in the cash practice except getting out of the insurance billing business and collecting from patients.

In a concierge practice, the entire character of the practice changes to something most patients have never encountered. It's a practice that enters into a mini-HMO deal by charging an annual membership instead of fee-for-service itemized billing. It's only for primary care and, to us, not a very attractive idea for either the patient or doctor. It works in Canada and Great Britain where access to premium-service physicians is difficult. That's just not a problem here.

And, because of the small number of patients for each physician, the insurance concept of spreading utilization risk over large numbers doesn't apply, which means that either the patients won't get value for their money or the doctor could get hit hard by some heavy users. Nothing about it appeals to us.