More doctors are skipping insurance to offer cash-only care

As an internist, Dr. Marcy Zwelling’s aim is to treat the sick and maintain the healthy.

That’s why she got rid of the pain of health insurance.

In 2004, Zwelling turned her practice into what’s called concierge medicine, sometimes known as direct care. For an annual $2,000 fee, a patient can call Zwelling on her cellphone, drop into her Los Alamitos office anytime, or, for an additional cost, request a house visit. There are no insurance cards. Patients don’t wait long to see her, and Zwelling’s staff avoids drowning in hours of paperwork hoping for government reimbursements.

“I had to do this to be able to do my job,” said Zwelling who has been an internist since 1987. “I get to practice the way I think I can practice best. It’s capitalism at its best.”

In a post-Affordable Care Act enrollment landscape, some say a steady trickle of primary care physicians will abandon insurance companies and government regulations for the simplicity of charging patients directly. And more patients who have insurance may decide to also pay an additional fee on their own, because they want more one-on-one time.

For physicians, it’s not about money, but fulfillment, said Bill Ross, executive director for the newly formed American College of Private Physicians. The group’s goal is to educate the public and legislators about concierge medicine and to help physicians make the transition, Ross said.

“It’s been accelerating in the last two years, primarily as a result of the Affordable Care Act,” Ross said. “It’s not a major trend, but there is an undercurrent.”

A study conducted by Medscape found that 48 percent of all American physicians felt they were fairly compensated in 2013, a decrease from 51 percent in 2012.

The same study found that 6 percent of those surveyed had started a cash only or concierge medicine practice in 2013, up slightly from 4 percent in 2012.

“When this first started, it was seen as elitist,” Ross said. “Now, it’s not that at all. Many of the patients starting to do this are blue collar. While (physicians) do have an upfront fee, it’s a reasonable fee.”

But not all physicians are in the position to forgo insurance completely, said Wayne Lipton, founder and CEO of Concierge Choice Physicians, a firm that helps doctors transition into variations of the concierge medicine model.

The company has assisted physicians in Beverly Hills, Burbank, and Torrance among other areas in Los Angeles.

“The cash-only model is very interesting right now,” Lipton said. “Doctors are fed up with government regulations and insurance.”

But the trend toward cash-only, if it were to continue, might lead to some impacts across the country, Lipton said. During the recent recession, for example, patients couldn’t afford it.

“It’s not necessarily good for the entire country to go toward cash-only,” he added.

The firm encourages hybrid practices, those that include doctors open to patients who want to pay cash only or those who have insurance. It’s what Lipton calls a “kinder, gentler approach,” because it doesn’t leave out people who can’t afford care.

Both Ross and Lipton agree that the number of cash-only physicians are small in number. Patrick Johnston, president of the California Association of Health Plans, said concierge medicine will likely remain a niche market, especially in California, which is dominated by powerful health care systems.

“The overall pattern is Californians rely on a health plan to cover most of the costs of medical care, and most physicians don’t want to have a list of prices and bill the patients directly,” Johnston said. “It remains a small option that is fine, but doesn’t change the landscape for health plans.”

Johnston said he believes patients who choose concierge medicine are used to specialized services, or have a greater average income.

“They are likely to be busy people who have trouble scheduling regular appointments,” Johnston said.

Patient Karen Gibbs disagrees, saying she chose the cash-only model with Zwelling because she likes the extra care. Gibbs, 69, said she planned ahead for her health care needs, and does carry insurance for medications.

A Long Beach resident who has worked in the health care quality industry, Gibbs said she believes her cancer would not have been found had she visited a physician in the traditional model of care.

“I was diagnosed with cancer two and half years ago,” Gibbs said. “It would never would have been caught because I was asymptomatic.”

Gibbs said Zwelling had specialists lined up and ready to help her.

“Choice is an important thing to me,” Gibbs said. “I pay and for that, I get a physician who I trust, who I can call 24/7, and who takes care of me. It should be patient choice. It shouldn’t be waiting in line.”

Zwelling said she went into primary care because she wanted to help everyone.

At least once a week, she receives patients who have been told by doctors at other health care systems that there were no treatment options available for them.

“I get these patients who are told to go home and die,” Zwelling said. “I’m not denigrating my colleagues, but if you only have five minutes with a patient you don’t have time to find treatments.”

And many physicians are discouraged by that, she added, which is why she has helped some set up their own concierge practices.

“I’ve encouraged those who want to do it,” she said. “I’ve offered to help them. Most of them feel trapped by the system. It’s really quite sad. They are not happy doctors. I encourage them to get the government out of the room.”

Zwelling also said she’s working on legislation that would make it mandatory for hospitals to post costs. For example, she can get a chest X-ray for a patient for $35 while an insurance company would charge $330.

“The dishonesty in the system is just huge,” she said. “I think government is important to protect our borders and fix potholes. Government has a role, but they shouldn’t be delegating people’s lives. I favor people getting care, and I want lower cost and greater access.”

She also said people have become duped into believing that the traditional medical model in place now is the best.

“What we have done is minimize the expectations of the population,” she said. “They expect less from their physicians. We cannot be lowering the bar. We have to be raising the bar.”