Orient says the transition to a business model in which patients agree to pay doctors directly for the health care services they provide started before Obamacare was passed, but that the new law has accelerated the trend, especially among AAPS’ 4,000 or so members.
AAPS is the conservative alternative to the much larger American Medical Association (AMA), which endorsed Obamacare while AAPS opposed it.
“They like the freedom,” Orient, a Tucson-based internist, told CNSNews.com. “They don’t like third parties telling them why they can’t do what’s best for their patients. They’re tired of the constant threats of audits and prosecution, and they don’t like being owed money by government programs and many insurance programs.
“But the biggest complaint I hear is that they are tired of fighting people who don’t have a clue, and don’t even know how to spell the procedure they want to perform,” Orient added. “It just devours time and sometimes puts the patient’s life at risk.”
Some physicians never signed up with managed care insurance plans in the first place because the reimbursement levels didn’t cover their costs, she said.
But now even doctors who “agreed to accept the crumbs, whatever compensation the government or the insurance companies decide to send them,” are having second thoughts as the costs of practicing medicine continues to climb and government regulations become even more onerous.
“I get several calls a week from doctors seeking advice on how to opt out,” Orient told CNSNews.com. “They tell me that they either have to go out of business or go back to the old-fashioned practice of charging for their services.”
At least 100 physicians attend workshops and seminars AAPS sponsors twice a year on the subject. Former AAPS president Dr. Juliette Madrigal-Dersch, who started her cash-only practice in Texas 11 years ago, tells fellow physicians that she has more time and flexibility to spend with patients and is actually better compensated for it, even after offering a discount for “teachers and preachers” and free care for cancer patients.
“I see billionaires and migrant workers, and everybody gets the same care,” she says.
She charges $15 for a CBC (complete blood count), while the tax-subsidized “charity hospital” down the street charges $79. Medicare reimbursement is just $3.50 for the same test.
Madrigal-Dersch says that by not having to deal with third-party payers, she is able to establish “a true doctor-patient relationship,” enabling her to provide better care. For example, she says one of her patients would probably have died waiting for the Veteran’s Administration to approve an MRI for her brain tumor.
In June, the association’s website added a sample document AAPS members can use to opt out of Medicare.
“Once CMS [Centers for Medicare & Medicaid Services] unleashes its dreaded new program of ‘private auditors’ to shake down physicians in the Medicare program, far more physicians will likely opt out – and even more will wish they had,” the AAPS website states. It also includes a state-by-state list of physicians who have already done so.
Doctors who stop accepting insurance typically lose patients and experience a drop in income, Orient said. Some never recover the revenue, but because they don’t have to pay people to process insurance claims, their overhead costs also decrease. “Before too long, they often find the move very positive financially as well as professionally because they are working less and making more money,” she pointed out.
“I hope that this will spread,” she added. “Obamacare is turning the nation’s health care system into a Third World experience, just like the website. It doesn’t have to be this way.”