As CMS and private insurance hurdles persist, some spine and orthopedic surgeons see a solution in cash pay options.
This model has already been successful despite early obstacles, for surgeons like Ara Deukmedjian, MD.
“Initially when I opted out, there was a significant decline in my business because Medicare patients represented 50 percent of my patients and they basically decided they would just go elsewhere for care,” Dr. Deukmedjian said. “However, as my reputation in the community grew as a high quality provider, Medicare patients became more determined that they would have me as their surgeon because they did not want complications with their surgery. So they chose to pay me cash for their services. The cash rate was usually somewhere between 200 percent to 400 percent of the Medicare fee.”
David Bailie, MD, owner of Scottsdale-based Arizona Institute for Sports Knees and Shoulders, also moved to a cash basis model and has thrived without insurance contracts. One important piece of advice is to be fair but not greedy.
“Be fair and transparent — don’t price gouge,” Dr. Bailie said. “If you’ve been in practice long enough, you know what you’re getting paid from insurance, and you know what you think is fair. So for rotator tear costs, I have a small, medium, large and massive fee schedule. If I get into a medium-sized tear and I already charged the patient, and it’s way worse, I don’t change the [price]. That’s my risk for not being able to figure that out ahead of time. I’m fair and transparent with everything. I turn a lot of people away from surgery who are willing to pay because I don’t think they need it … Over time, that reputation gets even stronger.”
And with more recent concerns, such as Elevance Health’s plan to penalize facilities with out-of-network providers, out-of-pocket pay may be the only option for some patients.
“If physicians don’t take their insurance, because of this anti competitive behavior, then their patients will lose access to their doctors, and it will drive up their out-of-pocket costs,” Brian Gantwerker, MD, said. “Some patients can’t afford that, but a lot of patients will opt to maybe even pay out of pocket until they can go to open enrollment and then drop Blue Cross as a carrier. Blue Cross will then lose the premiums from those patients and then have to raise the premiums on the remaining patients, which will again drive up costs and drive patients out of their networks. It’s a very foolish behavior that’s going to only end up hurting their bottom line, and I think, drive us faster and faster to a single payer system.”
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