Re: Anyone doing cash only business?

[Guest guest]

You have to be careful what you are asking….. Doctors cannot share fee schedules as that may be considered collusion and possibly violate anti-trust laws….. You need to find a consultant like Sage Consulting or Borglum….They can get expensive for their expertise…. If you want to get some ideas refer to Medical Economics or Family Practice Management….they usually have articles on these topics…. Good Luck From: [mailto: ] On Behalf Of dshep0127@...Sent: Friday, February 04, 2011 9:09 PMTo: Subject: Anyone doing cash only business? I'm contemplating a cash direct pay business model. Anyone out there doing this and would you mind letting me look at your fee schedule? Do you give insured patients a coded bill so they can submit your care as out-of-network? With high deductible plans becoming more common and out of pocket costs increasing, I'm wondering if the time is coming for this type of practice.

[Guest guest]

You have to be careful what you are asking….. Doctors cannot share fee schedules as that may be considered collusion and possibly violate anti-trust laws….. You need to find a consultant like Sage Consulting or Borglum….They can get expensive for their expertise…. If you want to get some ideas refer to Medical Economics or Family Practice Management….they usually have articles on these topics…. Good Luck From: [mailto: ] On Behalf Of dshep0127@...Sent: Friday, February 04, 2011 9:09 PMTo: Subject: Anyone doing cash only business? I'm contemplating a cash direct pay business model. Anyone out there doing this and would you mind letting me look at your fee schedule? Do you give insured patients a coded bill so they can submit your care as out-of-network? With high deductible plans becoming more common and out of pocket costs increasing, I'm wondering if the time is coming for this type of practice.

[Guest guest]

Many docs list there fees on their websites

 

I'm contemplating a cash direct pay business model. Anyone out there doing this and would you mind letting me look at your fee schedule? Do you give insured patients a coded bill so they can submit your care as out-of-network?

With high deductible plans becoming more common and out of pocket costs increasing, I'm wondering if the time is coming for this type of practice.

-- M.D.www.elainemd.comOffice: Go in the directions of your dreams and live the life you've imagined.

This email transmission may contain protected and privileged, highly confidential medical, Personal and Health Information (PHI) and/or legal information. The information is intended only for the use of the individual or entity named above.

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[Guest guest]

Many docs list there fees on their websites

 

I'm contemplating a cash direct pay business model. Anyone out there doing this and would you mind letting me look at your fee schedule? Do you give insured patients a coded bill so they can submit your care as out-of-network?

With high deductible plans becoming more common and out of pocket costs increasing, I'm wondering if the time is coming for this type of practice.

-- M.D.www.elainemd.comOffice: Go in the directions of your dreams and live the life you've imagined.

This email transmission may contain protected and privileged, highly confidential medical, Personal and Health Information (PHI) and/or legal information. The information is intended only for the use of the individual or entity named above.

 If you are not the intended recipient of this material, you may not use, publish, discuss, disseminate or otherwise distribute it. If you are not the intended recipient, or if you have received this transmission in error, please notify the sender immediately and confidentially destroy the information that email in error.

[Guest guest]

I am slowly building a cash-only practice part time. My fees are clearly stated

in my web site as price transparency is important in this model. Feel free to

check my site:

www.truecaremedicine.com

Also look at Forrest's practice:

http://acchealth.forrestdirectpay.com/

My hope is to transition from the house-call only practice to a physical space

as I save up some money. Many patients who are interested in my practice have

checked and will not be reimbursed by their plans for house calls...period. For

that reason, I would like some space.

I would be happy to discuss more with you off list.

Jack

>

> I'm contemplating a cash direct pay business model. Anyone out there doing

this and would you mind letting me look at your fee schedule? Do you give

insured patients a coded bill so they can submit your care as out-of-network?

> With high deductible plans becoming more common and out of pocket costs

increasing, I'm wondering if the time is coming for this type of practice.

>

[Guest guest]

I need to update my website, as I just tweaked my fees for 2011, but

my old schedule is up there. (Simplified schedule for this year by

making only one option - dollar a day membership includes physical,

first 4 visits discounted at $20, additional visits at $120/hr with

sliding scale for financial need.)

http://www.meliorafamilymedicine.com

There are also resources at http://www.dpcare.org/practices - most

of them probably have fees listed.

And AAPP the membership organization which I haven't joined yet (my

heart lies with IMP principles and I can't afford too many

memberships!)

http://www.aapp.org

I give patients a quickbooks receipt with ICD-9 and CPT codes. They

have to figure out how to file with insurance. Have only had 1

person pursue and succeed with reimbursement (for acupuncture, no

less!) Most have no out of network benefits. And half my practice

is uninsured.

Good luck...I'm happy to be available for future guidance, though I

got most of my guidance from , Sharon McCoy ,

Michele Eads, Marty Schulman all on this listserv, and their

webpages should be able to be found on the IMP map. Moyer

has a traditional insurance practice with the dollar-a-day type plan

available for his uninsured patients.

-jess

I'm contemplating a cash direct pay business model.

Anyone out there doing this and would you mind letting me

look at your fee schedule? Do you give insured patients a

coded bill so they can submit your care as out-of-network?

With high deductible plans becoming more common and out of

pocket costs increasing, I'm wondering if the time is

coming for this type of practice.

-- -Jess

MD

jdavis1732@...

[Guest guest]

I offer three "payment methods" on my website. First, if I'm contracted, I will bill their insurance, and if not, I give them a CMS 1500 and an invoice (prints from the accounts page in Amazing Charts) and they can try to access their out-of-network benefits.

2nd, they can pay cash on the day of service -- my fees for most things are listed on the payment page on my website at www.head2toehc.com. About half my practice have no insurance or huge deductibles. One lady who came in last week has a $20,000 deductible. Per year.

3rd, they can join my membership plan. $75 to join (for everyone in the same household), and $25/month per individual, billed to their credit card/HSA card/Flex account card.

Deanna Tolman, FNP-BC

I need to update my website, as I just tweaked my fees for 2011, but my old schedule is up there. (Simplified schedule for this year by making only one option - dollar a day membership includes physical, first 4 visits discounted at $20, additional visits at $120/hr with sliding scale for financial need.) http://www.meliorafamilymedicine.comThere are also resources at http://www.dpcare.org/practices - most of them probably have fees listed. And AAPP the membership organization which I haven't joined yet (my heart lies with IMP principles and I can't afford too many memberships!) http://www.aapp.orgI give patients a quickbooks receipt with ICD-9 and CPT codes. They have to figure out how to file with insurance. Have only had 1 person pursue and succeed with reimbursement (for acupuncture, no less!) Most have no out of network benefits. And half my practice is uninsured. Good luck...I'm happy to be available for future guidance, though I got most of my guidance from , Sharon McCoy , Michele Eads, Marty Schulman all on this listserv, and their webpages should be able to be found on the IMP map. Moyer has a traditional insurance practice with the dollar-a-day type plan available for his uninsured patients. -jess

I'm contemplating a cash direct pay business model. Anyone out there doing this and would you mind letting me look at your fee schedule? Do you give insured patients a coded bill so they can submit your care as out-of-network? With high deductible plans becoming more common and out of pocket costs increasing, I'm wondering if the time is coming for this type of practice.-- -Jess

MD

jdavis1732@...

[Guest guest]

As stated before: doctors can't share fee schedules but patients can, i.e. patients tallied my charge for.... was x$...Subject: RE: Anyone doing cash only business?To: Date: Saturday, February 5, 2011, 9:57 AM

You have to be careful what you are asking….. Doctors cannot share fee schedules as that may be considered collusion and possibly violate anti-trust laws….. You need to find a consultant like Sage Consulting or Borglum….They can get expensive for their expertise…. If you want to get some ideas refer to Medical Economics or Family Practice Management….they usually have articles on these topics…. Good Luck From: [mailto: ] On Behalf Of dshep0127@...Sent: Friday, February 04, 2011 9:09 PMTo: Subject: Anyone doing cash only business? I'm contemplating a cash direct pay business model. Anyone out there doing this and would you mind letting me look at your fee schedule? Do you give insured patients a coded bill so they can submit your care as out-of-network? With high deductible plans becoming more common and out of pocket costs increasing, I'm wondering if the time is

coming for this type of practice.

[Guest guest]

I have been at a modified cash only since 2008.I still take traditional Medicare.I have two other options:1) self pay for each office visit. This is good for patients who do not visit frequently.2) wellness plans - one fee for the year, with prices as listed on my website atwww.drhorvitz.comI consider my wellness plans to be strong on prevention, and very moderate in cost.Individuals range from $399-549 per yearCouples are $999 per yearFamilies are $1199 per year.I have about an 85-90% renewal rate on these plans year to year.I see primary care going in a few directions.1) bigger centralization in hospital and large group systems. I will let you decide if that is good for patient care.2) small offices or solo practices who go outside of this system with cash practices, boutique or concierge. If done right, and priced to be affordable, this system can really take off. Horvitz, D.O.Founder of the Institute for Medical WellnessWww.drhorvitz.com

[Guest guest]

I have been at a modified cash only since 2008.I still take traditional Medicare.I have two other options:1) self pay for each office visit. This is good for patients who do not visit frequently.2) wellness plans - one fee for the year, with prices as listed on my website atwww.drhorvitz.comI consider my wellness plans to be strong on prevention, and very moderate in cost.Individuals range from $399-549 per yearCouples are $999 per yearFamilies are $1199 per year.I have about an 85-90% renewal rate on these plans year to year.I see primary care going in a few directions.1) bigger centralization in hospital and large group systems. I will let you decide if that is good for patient care.2) small offices or solo practices who go outside of this system with cash practices, boutique or concierge. If done right, and priced to be affordable, this system can really take off. Horvitz, D.O.Founder of the Institute for Medical WellnessWww.drhorvitz.com

[Guest guest]

I have been at a modified cash only since 2008.I still take traditional Medicare.I have two other options:1) self pay for each office visit. This is good for patients who do not visit frequently.2) wellness plans - one fee for the year, with prices as listed on my website atwww.drhorvitz.comI consider my wellness plans to be strong on prevention, and very moderate in cost.Individuals range from $399-549 per yearCouples are $999 per yearFamilies are $1199 per year.I have about an 85-90% renewal rate on these plans year to year.I see primary care going in a few directions.1) bigger centralization in hospital and large group systems. I will let you decide if that is good for patient care.2) small offices or solo practices who go outside of this system with cash practices, boutique or concierge. If done right, and priced to be affordable, this system can really take off. Horvitz, D.O.Founder of the Institute for Medical WellnessWww.drhorvitz.com

[Guest guest]

I agree, . One of the great benefits of having an organization is the ability to lobby and hire lawyers to fight this nonsense -- of course, that requires some fundage, but when you spread it among many ....

But here is my problem with all of this for years... These laws and their enforcement policies are geared in a way that by their very nature unfairly punish the smallest and most personal of practioners... Why is it any more proper that 100 doctors can form some huge Mega Group and that allows them the leverage that comes with that, and within that they are allowed to talk to their hearts delite.... Colluding all the way and self refering til they're too full to eat another bite. But if the same number of docs from small and solo practices attempted to do the same exact thing we'd all get 10 years in Silver Steel Bracelets??? Just as half a dozen small docs and practices are not allowed to purchase and co-own a small lab or imaging center and make honest money on the services they create and need each and every day, but again the same number of docs in a "Single Entity" can self refer and send their tests and treatments internally until they choke on it???

It's time to insist on leveling the playing field on these things so a group of small and solo practices can finally reap the same rewards of their own labor as the big boys are allowed to do without one person saying "Boo" at all... Just like this sharing of fees and payments... In every other part of the business world, Walmart and K-Mart, Sear and Target, all know what they other guy is charging and probably have a pretty good idea at what kind of a wholesale price they get their goods at as well. Sunshine and honesty is probably the best option in almost all cases. It is not illegal for one gas station to know what the other is charging nor is it illegal for plumbers, carpenters, electricians, auto mechanics and I would bet even lawyers too...

As someone else here said in all other lines of business the mere sharing or discussion about prices or fees is NOT a crime. It is the overt intentional, planned attempt to control prices paid by openly colluding together agreeing in principle to charge exact same or the functionally same amount as the other guy... The fact that we both might charge the same price for the same goods or services is not in and of itself any sort of proof that we have acted in any sort of a deliberate, coordinated, manipulative manner in an attempt to control prices most likely in our favor of keeping them high, although some might collude to drive out other competition by agreeing to drop prices down to a lose level to thin out the herd as well.... But for some reason ONLY in Medicine do we have rules and laws written that even take away the smallest possibility of such behavior to the point that many legal and even needed actions and behaviors are restricted and illegal... And of course the kicker is that the parties on the opposite side of the negotiating table from us, they have that totally insane Anti-trust waiver, so that they have complete access to all this information from ALL sides of the industry and they are allowed to discuss such things and share such data freely and readily... As though Aetna or UHC need some sort of Protection and Relief from a modest sized group of one or two hundred docs from various small groups negotiating as a single well informed group.... Just insane and boggles the mind, makes me ill when I think about it too long...

To: Sent: Mon, February 7, 2011 4:28:04 PMSubject: Re: Anyone doing cash only business?

of note there was testimony last week before the House Judiciary Committee about the snit doctors get in caught in--between working together in ACOs and vs being accused of collusion/antitrust issues

I think that's a great idea

Cote' RE: Anyone doing cash only business?

You have to be careful what you are asking…..

Doctors cannot share fee schedules as that may be considered collusion and possibly violate anti-trust laws…..

You need to find a consultant like Sage Consulting or Borglum….

They can get expensive for their expertise….

If you want to get some ideas refer to Medical Economics or Family Practice Management….they usually have articles on these topics….

Good Luck

From: [mailto: ] On Behalf Of dshep0127@...Sent: Friday, February 04, 2011 9:09 PMTo: Subject: Anyone doing cash only business?

I'm contemplating a cash direct pay business model. Anyone out there doing this and would you mind letting me look at your fee schedule? Do you give insured patients a coded bill so they can submit your care as out-of-network? With high deductible plans becoming more common and out of pocket costs increasing, I'm wondering if the time is coming for this type of practice.

-- MD ph fax impcenter.org

[Guest guest]

I agree, . One of the great benefits of having an organization is the ability to lobby and hire lawyers to fight this nonsense -- of course, that requires some fundage, but when you spread it among many ....

But here is my problem with all of this for years... These laws and their enforcement policies are geared in a way that by their very nature unfairly punish the smallest and most personal of practioners... Why is it any more proper that 100 doctors can form some huge Mega Group and that allows them the leverage that comes with that, and within that they are allowed to talk to their hearts delite.... Colluding all the way and self refering til they're too full to eat another bite. But if the same number of docs from small and solo practices attempted to do the same exact thing we'd all get 10 years in Silver Steel Bracelets??? Just as half a dozen small docs and practices are not allowed to purchase and co-own a small lab or imaging center and make honest money on the services they create and need each and every day, but again the same number of docs in a "Single Entity" can self refer and send their tests and treatments internally until they choke on it???

It's time to insist on leveling the playing field on these things so a group of small and solo practices can finally reap the same rewards of their own labor as the big boys are allowed to do without one person saying "Boo" at all... Just like this sharing of fees and payments... In every other part of the business world, Walmart and K-Mart, Sear and Target, all know what they other guy is charging and probably have a pretty good idea at what kind of a wholesale price they get their goods at as well. Sunshine and honesty is probably the best option in almost all cases. It is not illegal for one gas station to know what the other is charging nor is it illegal for plumbers, carpenters, electricians, auto mechanics and I would bet even lawyers too...

As someone else here said in all other lines of business the mere sharing or discussion about prices or fees is NOT a crime. It is the overt intentional, planned attempt to control prices paid by openly colluding together agreeing in principle to charge exact same or the functionally same amount as the other guy... The fact that we both might charge the same price for the same goods or services is not in and of itself any sort of proof that we have acted in any sort of a deliberate, coordinated, manipulative manner in an attempt to control prices most likely in our favor of keeping them high, although some might collude to drive out other competition by agreeing to drop prices down to a lose level to thin out the herd as well.... But for some reason ONLY in Medicine do we have rules and laws written that even take away the smallest possibility of such behavior to the point that many legal and even needed actions and behaviors are restricted and illegal... And of course the kicker is that the parties on the opposite side of the negotiating table from us, they have that totally insane Anti-trust waiver, so that they have complete access to all this information from ALL sides of the industry and they are allowed to discuss such things and share such data freely and readily... As though Aetna or UHC need some sort of Protection and Relief from a modest sized group of one or two hundred docs from various small groups negotiating as a single well informed group.... Just insane and boggles the mind, makes me ill when I think about it too long...

To: Sent: Mon, February 7, 2011 4:28:04 PMSubject: Re: Anyone doing cash only business?

of note there was testimony last week before the House Judiciary Committee about the snit doctors get in caught in--between working together in ACOs and vs being accused of collusion/antitrust issues

I think that's a great idea

Cote' RE: Anyone doing cash only business?

You have to be careful what you are asking…..

Doctors cannot share fee schedules as that may be considered collusion and possibly violate anti-trust laws…..

You need to find a consultant like Sage Consulting or Borglum….

They can get expensive for their expertise….

If you want to get some ideas refer to Medical Economics or Family Practice Management….they usually have articles on these topics….

Good Luck

From: [mailto: ] On Behalf Of dshep0127@...Sent: Friday, February 04, 2011 9:09 PMTo: Subject: Anyone doing cash only business?

I'm contemplating a cash direct pay business model. Anyone out there doing this and would you mind letting me look at your fee schedule? Do you give insured patients a coded bill so they can submit your care as out-of-network? With high deductible plans becoming more common and out of pocket costs increasing, I'm wondering if the time is coming for this type of practice.

-- MD ph fax impcenter.org

[Guest guest]

I've got a question for the greater wisdom here.... What is the "Legal" difference between a private fee paid consultant who is allowed to know what their many doctors charge and what the carriers and gov't pays these same docs giving advice to the next doc in line based on this collection of data, even to the point of perhaps sending out updates via emails or upping all their "Customer" docs charges if they are also a billing company, verses a group such as ours, Not for Profit, Membership joined and dues paid organization???? It seems to me that the same exact data and process is going on here other than the fact that it costs the doctor WAY more to pay the consultant and "retain" their services then it would to join some local, regional or even national organization such as ours or even AAFP

or the AMA.... I don't ask this to be funny or play dumb, but honestly when looked at objectively, the more I think about it, the more they seem too much alike other than Joined Membership based group verses retained pay cash on the barrel client... As though the consultant lobby got this included as a political pay back, "Carve Out" just forn themselves. Otherwise both ways would be just about equally legal or illegal....

On that note was a member of an organization, IPO, IPA in this area for many years when we first opened up and the ladies that worked there were top notch and the one held regular quarterly Practice Managers' Meetings where I learned so much of what I know today... the dues were not great but almost bearable... but one of the great things that came with this was that part of the membership, annual dues bought the individual doc a couple of hours per year of "already Paid" or free consultant time with this probably legally separate in some important fashion consultant time.... now in this case as our IPA they knew all too well what the carriers were offering and paying based on negotiations and standing contracts in place, messenger model kind of communications that they middleman'ed... Now again this worked a little bit better because this was all regional... But yet again, it might behoove us to find some manner of legal and acceptable shared

knowledge on a larger national scale because clearly some regions are getting screwed while others are certainly doing better and such shared knowledge might allow for some better informed negotitions for those it the poorer regions...

Perhaps we should consider doing similar, having some sort of an IMP based "Consulting" service or Arm which would then allow for the legal guidance of us small guys from a source that understands Our Unique business models and needs of ourselves and our patients???? If allowed it might even be a great way to help support the opposite side of IMP or the greater cause and organization as a whole.... On the same idea can one have such a thing like some of the more Legit Consumer Counseling centers, a Not for Profit, Medical Consulting Firm, that would benefit from the same carved out protections and allowances? In this way the fees could be more reasonable even to us poor small guys, perhaps we could even apply for some grants from time to time to support us in our needs to stay current and properly informed and represented against our common fow here???

To: Sent: Sat, February 5, 2011 9:57:23 AMSubject: RE: Anyone doing cash only business?

You have to be careful what you are asking…..

Doctors cannot share fee schedules as that may be considered collusion and possibly violate anti-trust laws…..

You need to find a consultant like Sage Consulting or Borglum….

They can get expensive for their expertise….

If you want to get some ideas refer to Medical Economics or Family Practice Management….they usually have articles on these topics….

Good Luck

From: [mailto: ] On Behalf Of dshep0127@...Sent: Friday, February 04, 2011 9:09 PMTo: Subject: Anyone doing cash only business?

I'm contemplating a cash direct pay business model. Anyone out there doing this and would you mind letting me look at your fee schedule? Do you give insured patients a coded bill so they can submit your care as out-of-network? With high deductible plans becoming more common and out of pocket costs increasing, I'm wondering if the time is coming for this type of practice.

[Guest guest]

I've got a question for the greater wisdom here.... What is the "Legal" difference between a private fee paid consultant who is allowed to know what their many doctors charge and what the carriers and gov't pays these same docs giving advice to the next doc in line based on this collection of data, even to the point of perhaps sending out updates via emails or upping all their "Customer" docs charges if they are also a billing company, verses a group such as ours, Not for Profit, Membership joined and dues paid organization???? It seems to me that the same exact data and process is going on here other than the fact that it costs the doctor WAY more to pay the consultant and "retain" their services then it would to join some local, regional or even national organization such as ours or even AAFP

or the AMA.... I don't ask this to be funny or play dumb, but honestly when looked at objectively, the more I think about it, the more they seem too much alike other than Joined Membership based group verses retained pay cash on the barrel client... As though the consultant lobby got this included as a political pay back, "Carve Out" just forn themselves. Otherwise both ways would be just about equally legal or illegal....

On that note was a member of an organization, IPO, IPA in this area for many years when we first opened up and the ladies that worked there were top notch and the one held regular quarterly Practice Managers' Meetings where I learned so much of what I know today... the dues were not great but almost bearable... but one of the great things that came with this was that part of the membership, annual dues bought the individual doc a couple of hours per year of "already Paid" or free consultant time with this probably legally separate in some important fashion consultant time.... now in this case as our IPA they knew all too well what the carriers were offering and paying based on negotiations and standing contracts in place, messenger model kind of communications that they middleman'ed... Now again this worked a little bit better because this was all regional... But yet again, it might behoove us to find some manner of legal and acceptable shared

knowledge on a larger national scale because clearly some regions are getting screwed while others are certainly doing better and such shared knowledge might allow for some better informed negotitions for those it the poorer regions...

Perhaps we should consider doing similar, having some sort of an IMP based "Consulting" service or Arm which would then allow for the legal guidance of us small guys from a source that understands Our Unique business models and needs of ourselves and our patients???? If allowed it might even be a great way to help support the opposite side of IMP or the greater cause and organization as a whole.... On the same idea can one have such a thing like some of the more Legit Consumer Counseling centers, a Not for Profit, Medical Consulting Firm, that would benefit from the same carved out protections and allowances? In this way the fees could be more reasonable even to us poor small guys, perhaps we could even apply for some grants from time to time to support us in our needs to stay current and properly informed and represented against our common fow here???

To: Sent: Sat, February 5, 2011 9:57:23 AMSubject: RE: Anyone doing cash only business?

You have to be careful what you are asking…..

Doctors cannot share fee schedules as that may be considered collusion and possibly violate anti-trust laws…..

You need to find a consultant like Sage Consulting or Borglum….

They can get expensive for their expertise….

If you want to get some ideas refer to Medical Economics or Family Practice Management….they usually have articles on these topics….

Good Luck

From: [mailto: ] On Behalf Of dshep0127@...Sent: Friday, February 04, 2011 9:09 PMTo: Subject: Anyone doing cash only business?

I'm contemplating a cash direct pay business model. Anyone out there doing this and would you mind letting me look at your fee schedule? Do you give insured patients a coded bill so they can submit your care as out-of-network? With high deductible plans becoming more common and out of pocket costs increasing, I'm wondering if the time is coming for this type of practice.

[Guest guest]

I've got a question for the greater wisdom here.... What is the "Legal" difference between a private fee paid consultant who is allowed to know what their many doctors charge and what the carriers and gov't pays these same docs giving advice to the next doc in line based on this collection of data, even to the point of perhaps sending out updates via emails or upping all their "Customer" docs charges if they are also a billing company, verses a group such as ours, Not for Profit, Membership joined and dues paid organization???? It seems to me that the same exact data and process is going on here other than the fact that it costs the doctor WAY more to pay the consultant and "retain" their services then it would to join some local, regional or even national organization such as ours or even AAFP

or the AMA.... I don't ask this to be funny or play dumb, but honestly when looked at objectively, the more I think about it, the more they seem too much alike other than Joined Membership based group verses retained pay cash on the barrel client... As though the consultant lobby got this included as a political pay back, "Carve Out" just forn themselves. Otherwise both ways would be just about equally legal or illegal....

On that note was a member of an organization, IPO, IPA in this area for many years when we first opened up and the ladies that worked there were top notch and the one held regular quarterly Practice Managers' Meetings where I learned so much of what I know today... the dues were not great but almost bearable... but one of the great things that came with this was that part of the membership, annual dues bought the individual doc a couple of hours per year of "already Paid" or free consultant time with this probably legally separate in some important fashion consultant time.... now in this case as our IPA they knew all too well what the carriers were offering and paying based on negotiations and standing contracts in place, messenger model kind of communications that they middleman'ed... Now again this worked a little bit better because this was all regional... But yet again, it might behoove us to find some manner of legal and acceptable shared

knowledge on a larger national scale because clearly some regions are getting screwed while others are certainly doing better and such shared knowledge might allow for some better informed negotitions for those it the poorer regions...

Perhaps we should consider doing similar, having some sort of an IMP based "Consulting" service or Arm which would then allow for the legal guidance of us small guys from a source that understands Our Unique business models and needs of ourselves and our patients???? If allowed it might even be a great way to help support the opposite side of IMP or the greater cause and organization as a whole.... On the same idea can one have such a thing like some of the more Legit Consumer Counseling centers, a Not for Profit, Medical Consulting Firm, that would benefit from the same carved out protections and allowances? In this way the fees could be more reasonable even to us poor small guys, perhaps we could even apply for some grants from time to time to support us in our needs to stay current and properly informed and represented against our common fow here???

To: Sent: Sat, February 5, 2011 9:57:23 AMSubject: RE: Anyone doing cash only business?

You have to be careful what you are asking…..

Doctors cannot share fee schedules as that may be considered collusion and possibly violate anti-trust laws…..

You need to find a consultant like Sage Consulting or Borglum….

They can get expensive for their expertise….

If you want to get some ideas refer to Medical Economics or Family Practice Management….they usually have articles on these topics….

Good Luck

From: [mailto: ] On Behalf Of dshep0127@...Sent: Friday, February 04, 2011 9:09 PMTo: Subject: Anyone doing cash only business?

I'm contemplating a cash direct pay business model. Anyone out there doing this and would you mind letting me look at your fee schedule? Do you give insured patients a coded bill so they can submit your care as out-of-network? With high deductible plans becoming more common and out of pocket costs increasing, I'm wondering if the time is coming for this type of practice.

[Guest guest]

I think that's a great idea

Cote' RE: Anyone doing cash only business?

You have to be careful what you are asking…..

Doctors cannot share fee schedules as that may be considered collusion and possibly violate anti-trust laws…..

You need to find a consultant like Sage Consulting or Borglum….

They can get expensive for their expertise….

If you want to get some ideas refer to Medical Economics or Family Practice Management….they usually have articles on these topics….

Good Luck

From: [mailto: ] On Behalf Of dshep0127@...Sent: Friday, February 04, 2011 9:09 PMTo: Subject: Anyone doing cash only business?

I'm contemplating a cash direct pay business model. Anyone out there doing this and would you mind letting me look at your fee schedule? Do you give insured patients a coded bill so they can submit your care as out-of-network? With high deductible plans becoming more common and out of pocket costs increasing, I'm wondering if the time is coming for this type of practice.

[Guest guest]

of note there was testimony last  week before the House Judiciary Committee about the snit  doctors get in caught in--between working together in ACOs and   vs being accused of collusion/antitrust issues

 

I think that's a great idea

 

Cote' RE: Anyone doing cash only business? 

You have to be careful what you are asking…..

 

Doctors cannot share fee schedules as that may be considered collusion and possibly violate anti-trust laws…..

 

You need to find a consultant like Sage Consulting or Borglum….

They can get expensive for their expertise….

 

If you want to get some ideas refer to Medical Economics or Family Practice Management….they usually have articles on these topics….

 

Good Luck

 

 

From: [mailto: ] On Behalf Of dshep0127@...

Sent: Friday, February 04, 2011 9:09 PMTo: Subject: Anyone doing cash only business?

 

I'm contemplating a cash direct pay business model. Anyone out there doing this and would you mind letting me look at your fee schedule? Do you give insured patients a coded bill so they can submit your care as out-of-network?

With high deductible plans becoming more common and out of pocket costs increasing, I'm wondering if the time is coming for this type of practice.

--      MD          ph    fax impcenter.org

[Guest guest]

But here is my problem with all of this for years... These laws and their enforcement policies are geared in a way that by their very nature unfairly punish the smallest and most personal of practioners... Why is it any more proper that 100 doctors can form some huge Mega Group and that allows them the leverage that comes with that, and within that they are allowed to talk to their hearts delite.... Colluding all the way and self refering til they're too full to eat another bite. But if the same number of docs from small and solo practices attempted to do the same exact thing we'd all get 10 years in Silver Steel Bracelets??? Just as half a dozen small docs and practices are not allowed to purchase and co-own a small lab or imaging center and make honest money on the services they create and need each

and every day, but again the same number of docs in a "Single Entity" can self refer and send their tests and treatments internally until they choke on it???

It's time to insist on leveling the playing field on these things so a group of small and solo practices can finally reap the same rewards of their own labor as the big boys are allowed to do without one person saying "Boo" at all... Just like this sharing of fees and payments... In every other part of the business world, Walmart and K-Mart, Sear and Target, all know what they other guy is charging and probably have a pretty good idea at what kind of a wholesale price they get their goods at as well. Sunshine and honesty is probably the best option in almost all cases. It is not illegal for one gas station to know what the other is charging nor is it illegal for plumbers, carpenters, electricians, auto mechanics and I would bet even lawyers too...

As someone else here said in all other lines of business the mere sharing or discussion about prices or fees is NOT a crime. It is the overt intentional, planned attempt to control prices paid by openly colluding together agreeing in principle to charge exact same or the functionally same amount as the other guy... The fact that we both might charge the same price for the same goods or services is not in and of itself any sort of proof that we have acted in any sort of a deliberate, coordinated, manipulative manner in an attempt to control prices most likely in our favor of keeping them high, although some might collude to drive out other competition by agreeing to drop prices down to a lose level to thin out the herd as well.... But for some reason ONLY in Medicine do we have rules and laws written that even take away the smallest possibility of such behavior to the point that many legal and even needed actions and behaviors are restricted and

illegal... And of course the kicker is that the parties on the opposite side of the negotiating table from us, they have that totally insane Anti-trust waiver, so that they have complete access to all this information from ALL sides of the industry and they are allowed to discuss such things and share such data freely and readily... As though Aetna or UHC need some sort of Protection and Relief from a modest sized group of one or two hundred docs from various small groups negotiating as a single well informed group.... Just insane and boggles the mind, makes me ill when I think about it too long...

To: Sent: Mon, February 7, 2011 4:28:04 PMSubject: Re: Anyone doing cash only business?

of note there was testimony last week before the House Judiciary Committee about the snit doctors get in caught in--between working together in ACOs and vs being accused of collusion/antitrust issues

I think that's a great idea

Cote' RE: Anyone doing cash only business?

You have to be careful what you are asking…..

Doctors cannot share fee schedules as that may be considered collusion and possibly violate anti-trust laws…..

You need to find a consultant like Sage Consulting or Borglum….

They can get expensive for their expertise….

If you want to get some ideas refer to Medical Economics or Family Practice Management….they usually have articles on these topics….

Good Luck

From: [mailto: ] On Behalf Of dshep0127@...Sent: Friday, February 04, 2011 9:09 PMTo: Subject: Anyone doing cash only business?

I'm contemplating a cash direct pay business model. Anyone out there doing this and would you mind letting me look at your fee schedule? Do you give insured patients a coded bill so they can submit your care as out-of-network? With high deductible plans becoming more common and out of pocket costs increasing, I'm wondering if the time is coming for this type of practice.

-- MD ph fax impcenter.org