Some Doctors Turn to Cash-Only Policies

[Guest guest]

Some Doctors Turn to Cash-Only Policies

By REBECCA COOK

RENTON, Wash. (AP) - When Chuck O'Brien visits his doctor, they talk about

his aches and pains, his heart problems and his diet, but never about his

health

insurance. That's because Dr. Vern Cherewatenko is one of a small but

growing

number of physicians across the country who are dumping complicated

insurance

contracts in favor of cash.

Is this the health care wave of the future? Probably not, experts say. Most

people are content with monthly premiums and $10 copays; nine out of 10

doctors

contract with managed-care companies. But cash-only medicine is becoming an

increasingly attractive option for doctors frustrated by red tape and for

the

43 million Americans who lack health insurance.

``It's a terrible indictment of the collapsing health care system,'' said

Arthur Caplan, chairman of the medical ethics department at the University

of

Pennsylvania Medical School. ``Insurance and managed care were supposed to

streamline - instead what they've done is add so much paperwork and

bureaucracy

they're driving some doctors out.''

When O'Brien leaves the exam room, he writes a check for $50 and he's done -

no forms, no ID numbers, no copayments.

``This is traditional medicine. This is what America was like 30 years

ago,''

said O'Brien, 55 and self-employed, who believes he has saved thousands of

dollars by dropping his expensive insurance policy and paying cash. ``It's a

whole world of difference.''

Health insurers downplay the trend, while emphasizing recent efforts to mend

tattered relationships between doctors and managed care companies.

``I don't look at it as a threat,'' said Mohit Ghose, spokesman for the

industry group America's Health Insurance Plans. ``It's just a different way

of

practicing.''

Medical establishment leaders don't object to doctors working for simple

cash.

``This is America. One size does not fit all,'' said Dr. C. ,

president-elect of the American Medical Association. ``We certainly support

the

physicians' right to do that.''

An obstetrician-gynecologist in Salt Lake City, easily recalled times

when he believed managed care rules prevented his patients from getting the

best treatment. He said cash-only doctors are driven by the desire to

practice

medicine without interference.

``There is a great intrusion by third parties into the patient-physician

relationship,'' said. ``We can understand their frustration.''

Cherewatenko, a broad-shouldered 45-year-old who wears black jackets and red

stethoscopes at work, switched to cash out of desperation six years ago. His

suburban Seattle practice was hemorrhaging money, and he and his partners

realized they were spending hundreds of thousands of dollars just to process

insurance paperwork.

``We said, 'Let's cut out this administrative waste,''' Cherewatenko said.

Before, he charged $79 for an office visit and got $43 from an insurance

company

months later, minus the $20 in staff time it took to collect the payment.

Now

he charges $50 - and he never worries about collection costs, because

patients pay in full after every visit.

Cherewatenko sees fewer patients now. His whole office would probably fit

inside his old waiting room. But he says the freedom is worth it.

``Accounts receivable is zero. It's a great feeling,'' Cherewatenko said.

``I

feel like I'm a real doctor again.''

He started a group called SimpleCare to spread the gospel of cash-only

medicine. The organization steers patients to doctors who offer cash

discounts, and

gives technical and moral support to doctors who want to start cutting their

ties to insurance. Membership has grown to 22,000 patient members and 1,500

doctors. Some reject all insurance and take only cash, while others continue

to

accept insurance while offering discounts of 15 percent to 50 percent for

cash-paying patients.

Independent of SimpleCare, doctors in California, Colorado, Minnesota,

Texas,

Mississippi and other states have also quit the insurance game. Some tired

of

the paperwork and administrative expenses. Some wanted to spend more time

with patients without managed care bean-counters peering over their

shoulders.

The patients who pay cash range from poor to wealthy, with most in the

blue-collar middle.

``When I first started, I thought it would be the elite. That's not the

case,'' said Dr. Giebel, an obstetrician-gynecologist in Temple,

Texas, who

washed her hands of insurance eight years ago.

Her standard, hour-long annual checkup costs $140. Everyone pays cash.

If a patient needs extra tests or treatment, Giebel tells them upfront what

it will cost.

``If it is an urgent test, we'll go ahead and do it. We're not going to

delay

medical care because they don't have the money in hand,'' she said. Often,

patients return later with the money.

``It has usually not been a problem that people forgo medical care,'' she

said.

The cash-only movement isn't just changing the way people pay, it's changing

the way these doctors work. Because of managed care's low reimbursement

rates,

doctors on insurance contracts must limit their time with each patient.

Giebel, a typical example, said she would have to double her patient load to

make ends meet if she relied on insurance - something she can't imagine.

``How

can you possibly talk about prevention of cancer and heart disease when

you're seeing patients every 12 minutes?'' she asked.

Cash-only patients rave about the quality of care.

``They take time here with you,'' said Rainwater, a 59-year-old church

pastor from Bellevue, Wash., who credits Cherewatenko with teaching him to

manage his diabetes. ``They don't just bring you in and run you out like a

bunch

of cattle. You feel like you're loved.''

The cash-only approach evokes Norman Rockwell-tinged visions of country

doctors being paid with chickens. The simplicity is tempting, but the truth

is many

people went without preventive health care in those ``good old days.'' A $50

charge can be powerful incentive to delay seeing a doctor until you're in

pain

- which can lead to more expensive health problems later.

``Medicine used to be a cash-only business, and there were certainly many

people who didn't have the cash,'' said Caplan, the medical ethicist.

Doctors who

insist on cash also have an ethical obligation to help people who can't

afford the fee, he said - even if it means accepting chickens.

Cash crusaders acknowledge the need for some type of insurance. Without it,

expensive surgery or hospitalization would force most people into

bankruptcy.

But they think health insurance should work more like car insurance: you pay

for the routine maintenance and little dings yourself, and insurance pays

for

more expensive repairs.

O'Brien, a freelance marketing specialist, switched from a comprehensive

health plan with $300 monthly premiums to a catastrophic plan that costs $75

a

month, with a $2,000 deductible. He pays out-of-pocket for routine checkups,

and

his insurance will kick in if he ever needs expensive care.

The promise of a simple cash payment lured him to Cherewatenko's office, but

the doctor's personal attention keeps him coming back. The $50 exams are

just

part of the bargain for O'Brien. Cherewatenko recently met him for coffee to

talk about improving his diet - including an admonition to cut back on

caffeine.

``How often does your doctor go out and have a cup of coffee with you?''

O'Brien asked.

On the Net:

http://www.simplecare.com

04/04/04 17:28

© Copyright The Associated Press. All rights reserved. The information

contained In this news report may not be published, broadcast or otherwise

distributed without the prior written authority of The Associated Press.

_______________________________________________

SIP Mailing List

http://www.sticklers.org/list/

------ End of Forwarded Message