By Shane Wernsing, M.D. (LPMN EC member and former candidate)
In 2010, one of my clinic patients asked me, “How much does it cost to see you?” Stumped, I gave him an answer that I gave as a physician-in-training when one of my teachers grilled me with tough questions: “I don’t know, but I will find out.” I’ve always heard that there are no dumb questions. However, I soon discovered that there definitely can be dumb answers.
I learned that the cost to see me varied wildly depending on who was paying. Was the patient paying the clinic directly? Was insurance paying? Even worse, which insurance was paying the bill? The difference in cost spanned an order of magnitude, and no two customers were paying the same price.
Such a pricing scheme guarantees that the free market cannot work to drive quality up and costs down. In the case of health care, the consumer (patient) usually has no ability to compare the price of an annual physical at Clinic A compared to Clinics B and C. Same with a hernia repair, X-ray, stitch removal, sore throat visit, etc. This has led to stagnation in quality of services and tremendous price inflation compared to other sectors.
In response to this problem, some physicians are returning to direct-pay, free market medical care. This includes surgery centers, primary care clinics, and psychiatrists. A brief example: a direct-pay practice in FL charges patients a flat $60 per month to join. That $720 per year includes tens of thousands of dollars of care (stitches, urgent care, joint injections, splinting fractures, up to 25 office visits per year, biopsies, nebulizers, and so on) provided free to members. That same practice has arranged for pharmacy, X-ray, MRI, CT, and other off-site procedures to cost pennies on the dollar for their patients. Their practice has attracted many patients who intentionally avoid traditional clinics for care that they can get as a member of the direct-pay clinic and save thousands of dollars.
What is the future? Think of the example above and consider how powerful it will be when another such clinic opens that is able to provide similar or better services for, say, only $55 per month. This is already happening in several states. Patients are benefiting as clinics compete to offer more services for less money instead of competing on filling out forms in a way to squeeze a little more money from an insurance company.