Direct primary care - cash only doctors say no to your health insuranc...

MONEY: Under the traditional system, most medical practices need a large staff to ensure that they are reimbursed by health insurers. This results in higher overhead — which eats up to 60

percent of a typical practice's revenue — and forces doctors to see more patients in order to cover costs. At the same time, some insurance reimbursements to physicians have decreased

in recent years. "Most estimates show that a medical practice spends 30 percent or more of its time and money just trying to collect payments from insurance companies," says Ryan

Neuhofel, D.O. who operates a pay-as-you-go family medicine practice in Lawrence, Kan., consisting of himself and a nurse. (Both answer the phone.) "And when we're taking notes

about patient visits or care, it's mostly about checking off boxes to satisfy insurance requirements." FREEDOM: To get reimbursed, insurers may dictate how doctors must treat each

patient based on their concern. "Sometimes, in order to get paid — and meet the insurance metrics model — all a doctor can do is order a test, refer the patient to a specialist or

prescribe medication," says researcher Dave Chase. "Communication with patients is their most valuable tool, but they know that if they get into detailed discussions, it blows

their productivity numbers." BETTER CARE FOR PATIENTS: Without insurance mandates, doctors treat patients as they deem fit. The membership model provides a steady income, allowing

doctors to see fewer patients each day — and therefore freeing the doctors to spend more time with each. Established direct primary care practices average 800 to 1,000 patients; a comparable

insurance-dependent practice averages 2,500 to 4,000. WHO'S INVOLVED? An estimated 5,000 doctors in half of the states have already adopted this model — and as the name implies, most

are primary care physicians (sometimes known as general practitioners), the frontline caregivers who handle an estimated 85 percent of the most common conditions. Chase, who runs a software

company that makes electronic forms for doctors and patients, predicts that 16 percent of primary care physicians will adopt a no-insurance model in coming years, with expected growth among

cardiologists, pediatricians and more outpatient surgery centers. CAN I SEE THIS TYPE OF PHYSICIAN IF I'M ON MEDICARE OR MEDICAID? Usually, no. These doctors opt out of all insurance —

including Medicare and Medicaid. However, some practices provide special rates for Medicare patients. In 2011, U.S. Rep. Bill Cassidy (R-La.) introduced a bill to allow beneficiaries to use

these physicians by paying their monthly fees ($100 for Medicare recipients and $125 for those on Medicaid). Despite garnering some bipartisan cosponsors, H.R. 3315 has gone nowhere thus

far.