Cash-only clinic gaining ground

OXFORD – Want to see Dr. Tom Fowlkes at his clinic in Oxford?
Bring cash.
It sounds odd – maybe even a bit sinister – at first, since most Americans are accustomed to filling out reams of forms when they visit a doctor, and many expect to pay a co-pay. But the whole fee up front?
Fowlkes, a board-certified emergency physician, says prices at many clinics are set artificially high because insurance companies and government programs usually get a discount.
That leaves the uninsured or self-insured paying far more out of pocket.
Fowlkes’ typical office visit costs $40 – not much more than some people’s co-pay.
“I thought if I could open a clinic,” he said, “I could charge a fair and reasonable price for my expertise and my services that people would be willing to pay.”
Without a staff to file insurance and government program claims, and with a storefront clinic that shares a parking lot with discount stores, a grocery and a bank in the Oxford East shopping center, Fowlkes keeps his overhead low.
“I wanted to be away from the main part of the medical community – over here in a shopping center, where working people are,” he said.
He sends blood and other samples by courier to an independent lab, getting the results back overnight on his laptop computer. The lab can bill insurance companies, or patients can pay Fowlkes directly for lab work at discounted rates clearly visible in his office.
Fowlkes also leans heavily toward generic drugs. Especially in his role as medical director at the Lafayette County Detention Center and a residential drug- and alcohol-abuse facility, he has seen the ravages of high blood pressure, diabetes or other chronic conditions that went untreated because patients could not afford high-cost prescriptions after their free samples were gone.
“I keep the generic $4 drug list that most pharmacies have, and 90 percent of conditions can be treated off that list,” he said.

Growing trend
Fowlkes is not the first to use the cash-only model for his practice. Dr. Todd Coulter has operated his Midway Family Care in Ocean Springs on a cash basis for eight years.
“Number one, people like the predictability,” Coulter said. “They know exactly what it’s going to cost when they come in. We have a set fee of $40 a visit; in December we’re going to have our first increase in eight years to $50.”
Convenience is another plus: Long waits are rare, and there’s no mountain of insurance forms. Coulter also is hearing from specialists who want to reform their practices by the same model.
“I’ve been very successful at this,” he said. “Everybody wants to do this now.”
In some parts of the nation, the model has given rise to networks of physicians who provide discounted services on a cash basis; one, PATMOS, takes its name from the concept “payment at the time of service.”
Ted Epperly, president of the American Academy of Family Physicians, told U.S. News & World Report in July that 500 to 1,000 family medicine practices across the nation now operate on a cash-only basis.

Fiscal fitness?
Fowlkes said such a trend can strongly promote health care affordability.
“You can go to the emergency department today and say, ‘I believe I’m having a heart attack,’ and you’re going to get excellent care,” he said. “The problem is, you’re going to get a $10,000 bill from the ER. If your credit’s good and you don’t want to be turned over to collections, that’s a problem for you – but you will get the care.
“Over the years I’ve seen lots of people in the emergency room who were there simply because they didn’t have insurance and a private doctor wouldn’t see them,” he said. “They had to come to the emergency department for their emergency care, and they end up with a big bill. What I’m trying to do is charge a reasonable price to those people and expect them to pay.”
Fowlkes said that while neither he nor most family clinics can treat heart attacks or other life-threatening medical crises, letting patients and physicians decide together what makes medical and economic sense on routine care and small emergencies would spare many bankruptcies that stem from medical bills.
As a bonus, he often steers uninsured patients toward low-cost catastrophic medical coverage, the kind he has for himself.
“If they come here, get their routine health care, and pay $40, that’s a doable thing – and then have a big, high-deductible policy for the big things,” Fowlkes said. “What are the chances of America’s adopting this on a bigger scale? Probably not much – but it would work.”

Errol Castens/NEMS Daily Journal