Cash-based Medical Practice Archives - Marilyn Singleton, MD JD

America Out Loud PULSE: The Superhighway of Medical Progress or the Road to Nowhere?

From my America Out Loud Pulse podcast with Dr. Jane Orient –https://www.americaoutloud.com/the-superhighway-of-medical-progress-or-the-road-to-nowhere/

I used to enjoy watching medicine changing over the years. When I was an intern, we had to drill holes in the skull to diagnose a subdural hematoma. Now a quick CT scan without surgery gives a world of information. Ultrasound for pregnancy was a new thing. Surgery with the laparoscope (“belly button surgery”) was in its infancy. Now you are hard pressed to see a gallbladder removal done with a full abdominal incision.

I remember the days when humanity in medicine prevailed. You could get around the utilization reviewer’s bright green checkmarks that let you know that it was her opinion that the patient needed to be discharged from the hospital. We could exercise our empathy; the bean counters didn’t control us. I fondly remember letting an elderly patient stay a few extra days through Christmas because his only friend was also in the hospital.

The social changes in medicine are a far different story. It was a true step forward when all medical schools accepted not only women but students of all races. We saw all sorts of patients from many socioeconomic backgrounds, including patients on the prison and wards. We treated all of them to the best of our ability.

Now with schools latching on to this new twisted version of diversity and equality, I worry what happened to people merely treating one another like fellow human beings. What is motivating the rich and powerful to decide that we should be categorized in perpetuity by race instead of our individual characteristics? Divide and conquer comes to mind.

And what happened to the concept of not harming patients? What caused medicine to ignore science and like trained seals, agree that men can be women?

What caused educate persons to fall in line with grammatically incorrect and sometimes bizarre pronouns? Take for example, Dr. Jane Orient’s biography at Healthline.com: “Dr. Jane Orient, MD is an Internal Medicine Specialist in Tucson, AZ. “They” [emphasis added] specialize in Internal Medicine, has 47 years of experience, and is board certified in Internal Medicine.” I seriously doubt that wording was approved by Dr. Orient. Not only is she a she, ‘they’ is grammatically incorrect.

Bio

Dr. Jane Orient is the Executive Director of Association of American Physicians and Surgeons, a voice for patients’ and physicians’ independence since 1943. She has been in solo practice of general internal medicine since 1981 and is a clinical lecturer in medicine at the University of Arizona College of Medicine. Dr. Orient received her undergraduate degrees in chemistry and mathematics from the University of Arizona, and her M.D. from Columbia University College of Physicians and Surgeons. Dr. Orient’s op-eds have been published in hundreds of local and national newspapers, magazines, internet, followed on major blogs and covered in the Wall Street Journal and New York Times as well as several novels and non-fiction books, including Sapira’s Art and Science of Bedside Diagnosis in its fourth printing.

Association of American Physicians and Surgeons site: https://aapsonline.org/

Dr. Orient’s nonfiction and fiction writings: https://www.janemorient.com

America Out Loud PULSE: Is Cash King for Medical Care?

February 1, 2023 No Comments

From my America Out Loud Pulse podcast with Dr. Kathleen M. Brown – https://www.americaoutloud.com/kathleen-m-brown-md-is-cash-king-for-medical-care/

Governments, doctors, and patients are looking for ways to improve health care quality and lower costs. Legislators have made attempts with the No Surprises Act and Health Care PRICE Transparency Act. But these laws do not get to the core of the perverse medical care pricing system. Insurers bargain for prices with various health systems and hospitals. The negotiated price can be up to double the price offered to “self-pay” patients, that is patients who offer to pay cash even if they have insurance.

Additionally, insured patients are on the hook for more costs mainly because many employers have shifted to high-deductible insurance plans to lower their costs. According to the Kaiser Family Foundation, annual deductibles in 2021 were as high as $2,378, an amount that steadily increased over the last 10 years. Moreover, the insureds must pay a copayment when they see the doctor. This can be a fixed amount (average $25 for primary care and $42 for specialty care) or a percentage (generally 20 percent) of the cost of the visit. And remember, this percentage is based on the insurance rate—which is higher than the cash rate.

What is a patient to do to save money while still getting good medical care? When patients choose to receive care from a physician or other health care professional who has a cash-based practice, the fees can be very low. Why? They have cut out the middleman—the insurer. That means no salary for an office worker to sit on the phone all day with an insurance company trying to extract payments. Dealing with a cash-based practice also leads patients to other areas with reduced fees: X-rays, CT scans, MRIs, laboratory tests, and pharmaceuticals.

I urge you to take a look at websites that list folks who publish cash prices, such as the Free Market Medical Association, Association of American Physicians and Surgeons and sites that offer discount coupons such as GoodRx and Blink Health. The savings are well worth the time. Consumer Reports secret shoppers found the cost of 5 commonly prescribed medications cost $66 at HealthWarehouse.com, $105 at CostCo and a shocking $900 at CVS and RiteAid.

And why should physicians be more like veterinarians? The vets love their patients and many have this sign like this in their offices: You are invited to discuss frankly with us any question regarding our services or fees. The best medical services are based on a friendly mutual understanding between the patient and doctor.

My guest today has operated a caring, compassionate cash based medical practice and we’ll discuss how she got there. And we’ll also touch on human behavior and politics and how they influence the practice of medicine.