Cash Talks in Primary Care

Primary care doctors are struggling with their role in the new world of health care reform.

Many are increasing the number of patients they see during a day to bring in more cash.

Others are becoming employees of larger physician groups or hospitals that are increasingly acquiring clinics.

When a team of medical “mystery shoppers” tried to get primary care office visits as new patients, they discovered that they needed private insurance coverage or had to be willing to pay at least $75 in cash upfront — or the majority of providers wouldn’t see them.

In a recently published study, Karin V. Rhodes, MD, MS, of the Center for Emergency Care Policy & Research at the University of Pennsylvania, assessed new patient access to primary care physicians.

Their study, published in JAMA Internal Medicine, asked two primary questions: How financially flexible are primary care providers; and, are primary care providers ready to take on more Medicaid patients?

When callers identified themselves as uninsured, but willing to pay cash, 78.8% were able to set an appointment if they were able to make a payment over $75 at the time of the visit. If the payment at the time of the visit was likely to be less than $75, only 15.4% of callers were able to secure an appointment.

The market uncertainty is also affecting insurers.

Independence Blue Cross, which insures 2.2 million people in the Philadelphia region, is testing a strategy that paying doctors more money in exchange for more help keeping patients out of the hospital will work.

The insurance company is unveiling a joint venture with DaVita HealthCare Partners (DVA), which employs doctors in five sunbelt states.

The new company is called Tandigm Health and aims to recruit 300 doctors by end of 2015, according to Dr. Tony Coletta, a surgeon who will lead the venture.