Get Out & Stay Out: starting a cash based medical practice

Presentation by AAPS President Juliette Madrigal-Dersch, MD at AAPS Feb 1, 2013 meeting in Austin, TX.

[@drhutube]

Juliette: You are 6 years ahead of me. I dropped all insurance plans in January 2008, and opted out of Medicare in July 2012. I have never looked back. Everything you said in this video is true, 100%!!! Keep spreading the word!!

[@rufussweeneymd]

Man, this is so inspiring. I am headed to medical school in the fall, and it’s this kind of model that really confirms the reason I am going to medical school. Thanks, Juliette. You’re wonderful.

[@medicalalternativescorp2597]

It's great to see more than just chiropractors and acupuncturist doing this type of business model. Our patients love this - and is why we always have such a high patient satisfaction. Congrats - keep spreading the message.

[@amandastephanie3584]

I just found my mentor... God bless!

[@Kenton-Habiba]

If you liked this video please feel free to see & hear our perspective on private practice after 10yrs in a small southern town !

[@OmarAbdulMalikDHEdMPASPACPAPro]

I want to do this in underserved areas! We have people who simply CANNOT get to the clinic because of financial problems, lack of public transportation and, physical ability. My plan was to accept what little bit of cash they could pay and supplement my office with non-profit grants.

[@linchpinconsultancy1041]

Beautifully said! Have subscribed to your page.

[@Ot-ej5gi]

Omar Abdul-Malik, this is wonderful but as a PA you cannot opt-out of Medicare because your supervising physician would have to opt-out first? Am I right? Additionally, is PA - doctor tandem considered a group practice? Because I don't think group practice is allowed to opt-out of Medicare... Your response would be appreciated..

[@genghisrex]

Great work! This is a hard and long battle, but possible. Not every State has a good Medicaid Program. In the mean time, Medicaid is the only option for them.

[@OmarAbdulMalikDHEdMPASPACPAPro]

@@Ot-ej5gi Hi. I apologize for the late response. 😳 I honestly don't know. 🤔 I worked at a non-profit clinic for years and had nothing to do with the financial administration. We were grant funded. I know some of the patient didn't pay. I don't if a PA-MD is considered a group practice. I don't think it is.

[@MrBluesluver]

Great information. As a retired nurse, I got a real laugh out of the DC-10 codes you covered.

[@AleksandrVasilenko93]

Remove Medicaid and deposit money directly into an HSA. It would save tax payers money and give the poor much better outcomes

[@eleganz]

Most people have no idea what this woman is doing is extremely important. Her model, if widely adopted, lowers the cost of healthcare dramatically, makes healthcare more affordable and we wouldn't be in such a contentious debate in this country. The market approach always works, let the customers know the prices upfront so they can choose you or your competitors.

[@prayerforthesick1713]

You make a lot of sense. I will love to devote more time to my patients instead of talking about productivity.

[@linchpinconsultancy1041]

So true!

[@cotton9595]

Dr. Jules is very inspiring if we only had more people like her in this world

[@LaughingBuddhaNOLA]

This is very inspiring. Thank you! Keep up the great work, AAPS!

[@MakaiMauka]

Thank you, excellent!

[@rachelwhitemiller813]

Where can I find a doctor that has a practice like this? I live in the southwest suburbs of Chicago.

[@mamaduck6845]

Anyone doing this where patients pay monthly, as they would for insurance (lower monthly amounts to be sire) this to cover their family, then see and test as needed without them having to worry about not having enough all at once? Seems less risky for both physician and patients.

[@tinaanderson7812]

I’m an occupational therapist and we suffer the same struggle

[@masethephotoguy]

Now, perhaps someone with more knowledge on this subject can help me out here; with the currently government mandated healthcare, is there still a market for cash based practices? Or has this field become null and void due to this legislation? Thank you in advance for your help

[@deforestgregg616]

Our current healthcare system is over-run with lies , corruption , greed and human suffering. I hope you can change that for the better. Good Luck !

[@ECGDoc]

I really loved this video. You are charming, and I'd probably like to have you be my doctor. However, this model really only works for primary care. I am a cardiac electrophysiologist, and people would be reluctant to pay me cash for their pacemaker or implantable defibrillator surgery.

[@OmarAbdulMalikDHEdMPASPACPAPro]

ECGDoc That's a good point!

[@tobyw9573]

Doctors of different specialties could form groups, but how not to be considered insurers or hospitals and how do sick patients be sure they are not dropped?

[@linchpinconsultancy1041]

So true

[@Tina06019]

I can’t “opt out” of Medicare yet because I still need to do locums assignments a few times a year. If I have sent that “2-year letter” to Medicare, then it will be illegal if ANY entity charges for my services. My new private practice is (going to be) entirely housecalls for the elderly. (I am a geriatrician.) I am struggling through & trying to figure out how to do this by taking cash-only, but giving my patients a bill on a CMS-1500, so that they can submit this to Medicare themselves for reimbursement. My personality is also entirely different from hers. I am an introvert and almost “allergic” to self-promotion. Can anyone here suggest a resource (book, program, paid advisor) so that I don’t break laws which I don’t even know about?

[@aapsonline]

As it stands right now, unless you opt out, you are required to send in the claim on behalf of the Medicare patient: "Unless a doctor or non-physician practitioner opts out of Medicare or a facility is non-participating, when furnishing a Medicare covered service, the provider is subject to the mandatory claim submission provisions of section 1848(g)(4) of the Act. ... Professionals who did not opt out and are not enrolled in Medicare and asking beneficiaries to submit claims on their own, using the form CMS-1490S, violate the Medicare law. Unenrolled providers engaging in this practice are subject to the penalties referenced above." See: bit.ly/2WlePSF

[@kcc3090]

Get lawyers involved in supreme court

[@user-my2eo9lo1y]

I would put together compliance plan that will act as an additional security to flag billing and coding errors. Introduce the compliance plan policies, rules, and disciplinary actions. I would have internal audits by one or two staff that is comprehensive in the paericularfield regularly and will call an external source to check if the internal audit was done properly. Thinking logically, this is a cheaper plan to utilize compared to not having no security. If the office was flagged with with no measures of security, office would most likely be fined and or face prosecution. Insurance companies are more likely to believe the clinic that uses the extra security and usuay will decide the error was just that, an error. Shows them and the community the clinis are honest.

[@h.d.mcconaha5452]

Dr. Dersch's office does not perform billing or coding. She accepts no insurance. She accepts no money from CMS. This is really the beauty of her system--no need for all the checking and auditing because it is so simple. Your hairdresser doesn't need "compliance plan policies, rules, and disciplinary actions." A hairdresser has a simple interface with their client--cash for services rendered, which is exactly how a fee-for-service, cash-based medical practice operates. It is elegantly simple, and it is that simplicity and the lack of any bureaucracy to hide behind, along with her personal skill that inspires the trust of her community--a concept that resonates at hundreds of cash-based medical offices around the country!

[@cotton9595]

This is what needs to happen we might even cure a lot of things that are keeping us sick

[@RokOD]

Can someone explain to me why it would be better to drop medicare (from the patient's perspective)? I understand that you get a more personable doctor-patient relationship and whatnot, but wouldn't only a small portion of the population weight that as being more important than a less expensive doctor?

[@bjthinkingclearlygal4968]

Medical professionals, including nurses, need to get creative with how you practice medicine. I mean real, compassionate medicine where you and your patients respect each other and work as a team for your health. Bravo to this lovely doctor.

[@lauralijames6316]

BRABOOO!

[@damienr3086]

your doing awesome. my only question is if everyone opts out. then how much will surgeries cost or life saving surgeries with rehab?

[@eleganz]

The cost of care will drop dramatically across the board. If some people need intensive care or surgeries I believe there would be financing programs available just like how people buy cars. Most people change cars every 5-10 years, how often do you suppose a person would need a major surgery? Right now everybody just relies on insurance and those premiums keep going up. As long as insurance is the first answer, people won't get creative with solutions.

[@amygarza1571]

Do you have a simple resource for making sure I do the right process for opting out of Medicare? Should be so simple, yet seems so hard. It is scary , like you say.

[@rockyself]

Nice

[@tomjkoby2605]

We need to lobby for freedom to choose to accept Medicare in day jobs for hospital or government and not to accept Medicare/insurance in after-hours supplemental practice. It works for physicians and patients all over the world. It solves problems with lack of fast access to medical care in government/insurance run facilities. Why US government is allergic to this simple solution?

[@Tina06019]

How does “the government” make any money off of imprisoning doctors? I very rarely hear a news story about a doctor going to jail for Medicare fraud, and, felony or not, I don’t know of any case of a doctor going to jail for seeing someone for free. If any of you know of a case like this, please inform me of it. Nonetheless, a lot of the information she presents is very useful, and I wish her continued success.

[@JennWest-Liberty]

Your email on your website does not work. There is no way to contact you. Where are your doctors that accept cash? How do i get a list? I prefer doctors who are NOT licensed through the federal government because they are free to actually "hear" me, and prescribe holistic as well as pharmacuticals and are not bound by the rules of the corrupt.

[@Ultravate]

Your business plan and cash only is very attractive, but how do you proceed with a patients that needs a Biologic for plaque psoriasis in your practice.

[@marykayandelle]

i wish she had a web site!

[@dlourdes4743]

not just doctors but for nurses too...a nightmare

[@zulfiqarhashim1376]

Try doing this in Chicago, good luck ! no thanks Probably a great idea in small towns , there is no one size fits all Plus not everyone is good at promoting themselves like the speaker doctor

[@nathaelstrange8667]

Very interesting to see and understand that the health system is based on profit and a good conscience When people have to sell their homes to get surgery Patients are not consumers!! Doctors are not traders This explains why so many Americans come to France for treatment

[@Cheapers-Vac]

Missing...compassion. Pain is a very private concern. Being sick is a cry for help and Compassionate Care . Government is devoid of compassion and in practice..Forbids it.