At Integrative and Functional Med practices all over the country, practitioners hear, “I wish you took my insurance,” from prospective patients on a daily basis. Many of us wish that we could!
Yes, contracting with health insurance plans leads to increased patient volume, yet working with insurance companies ultimately:
- increases overhead costs… significantly
- limits the number and range of diagnostic tests that patients receive
- slows the turnaround of test results
- interferes with the doctor-patient relationship on every level
For those of us who choose to not compromise our quality of care, here are 7 compelling reasons why cash-based arrangements are ideal.
7 Reasons Why Cash-Based Practices Work for Patients and Providers
1) Insurance reimbursement for Integrative, Functional and Anti-Aging physicians is too low.
In the insurance model, the type of doctor you are reflects how much insurance companies pay per visit.
- Surgeons and physicians who do a lot of procedures receive greater reimbursements than physicians who treat patients non-surgically.
- In the realm of non-surgical medicine, specialists like cardiologists and neurologists get paid better than internal medicine, family practice and pediatric physicians.
- Unfortunately, Integrative Medicine, Anti-Aging and Functional Medicine physicians are near the bottom of the reimbursement scale.
Even the American College of Physicians has criticized the way doctors are paid by insurance carriers, saying that it has warped the way medicine is practiced, devaluing vital services such as doctor-patient discussions while pumping up rewards for expensive procedures and bigger volumes.
2) Individualized medicine requires adequate time with each patient.
The knowledge that we impart to patients is critical to their journey back to health and balance. In the world of medicine, doctor-patient discussions are the lengthiest in Integrative, Anti-Aging and Functional Medicine treatment rooms. Those of us who practice these forms of individualized medicine evaluate all components in our patient’s lives. We understand the connection between mind, body and spirit, and know that problems in one area translate to problems in the entire system.
Addressing the patient means looking deeply into the person to tease out how much of the illness is being cause by nutritional deficiencies, lack of exercise, excessive stressors, lack of sleep, hormonal imbalances, toxins and medications, as well as other pillars of health.
We develop comprehensive plans with each patient to addresses both acute symptoms and long-term goals—all of which are incredibly time consuming and patient-centric.
3) Individualized, personalized care is effective.
Above all else, being a doctor means being available to the patient. The doctor-patient relationship only flourishes when the patient knows that the doctor has time, not only to spend with them in an appointment, but in availability to discuss issues that arise as well.
Some patients come to believe that their doctor doesn’t care because the doctor is not available. This may be true in rare cases, but from our view, the problem boils down to the insurance model: There are too many demands on the physician (charting, billing, pharmacy pre-authorizations, insurance pre-authorizations, etc.) to give the patient adequate time.
Integrative, Anti-Aging and Functional Medicine is time-consuming (for both patients and doctors). With that said, our practices produce excellent outcomes—all of the time and energy spent with patients is worth it!
4) Integrative, Anti-Aging and Functional Medicine involves advanced testing.
There are hundreds, if not thousands, of tests available that help us get a real understanding of each patient’s unique biology. Tests such as micronutrient panels, metabolomics (understanding the biochemistry of the individual on a cellular level), advanced cardiometabolic (looking much deeper into the processes that initiate and propagate cardiovascular diseases), cancer markers (understanding the genes and the initiating events that lead up to the development of cancer and detecting it before it becomes a problem), and messenger testing (understanding the full pathway of hormones, not just the end-result testing), are just a few that we use to dig deeper for the betterment of our patients’ health.
Insurance companies often tell patients that advanced diagnostic testing is “unnecessary” or “unproven.” In fact, insurance companies will penalize the physicians in their network who order such test by performing chart reviews! The physician must “prove” to the insurance company that the tests are “necessary” and “proven,” thus meeting the insurance company’s definition as defined by their research and impressions.
Failure to meet the insurance company’s criteria may subject physicians to penalties, which result in hundreds of thousands of dollars owed back to the insurance company. To avoid penalty risks, many physicians do not order tests or run them for free.
5) Integrative, Anti-Aging and Functional Medicine is about prevention.
The best way to prevent disease is to stay healthy. Sounds simple, right?
Unfortunately, most of our patients do not have the basic knowledge that they need to get and stay healthy. Or, if they do know, they are not acting on the knowledge. Over the decades I have seen marketing ads change a patient’s perspective on what is healthy and what isn’t.
Integrative, Anti-Aging and Functional Medicine physicians are often asked:
- Which foods should I eat? Which should I avoid?
- What type of exercise should I do and how often?
- How much sleep do I need?
- Are these vitamins good for me?
- Is there an alternative to these medications?
- Is it safe to take hormones?
The fact that we eat too many processed foods, are increasing sedentary, sleep less and are more stressed are exactly the hot-button topics that we address with each patient during every visit. As result, our patients are more empowered and better equipped to take health improvement into their own hands!
6) Integrative Medicine involves extensive on-going education.
There is no field as rapidly evolving, changing and growing as that of Integrative Medicine. Most Integrative and Functional Med physicians have to go “back-to-school” just to learn the basics of nutrition, stress management, psychology and supplements (which were not taught to us in medical school).
Even after learning the “basics,” the amount of new information being distributed grows exponentially each year. The time spent learning online and at conferences can be immense—and time out of the office means lost revenue. All this up-to-date learning would not be possible if we were in the insurance model.
7) Cash-only practices can qualify against the deductible.
Patients may submit an itemized invoice to their insurance company and ask that the expenses are applied against the insurance deductible, charged to a Health-Savings Account, or with the better insurance plans, considered for partial reimbursement.
The idea that insurance should (or could) cover all medical expenses is not rational. Insurance is a bet against the company that patients will get sick, and when they do, the company will pay their bills. Similar to homeowner insurance, the insurance company pays when a house is destroyed, but not to make upgrades.
When surveyed about our cash-based model, our clients agree: “It’s a lot more practical, a lot less expensive, and what’s important to me is getting better and staying well!”
Power2Practice, the first EMR and software solution for Integrative Medicine, was designed to help your cash-based practice achieve greater profitability.
P2P makes Integrative Medicine easier! The platform is a fully-functioning EMR plus…
- Ability to create, save and e-fax your favorite custom compounds.
- Specialty lab integration and the ability to create custom reference ranges.
- A robust patient portal with preloaded patient engagement tools, education resources and lifestyle tracking (diet, stress, sleep and Fitbit data).
- Online intake forms and health questionnaires.
- Access over 30 up-to-date IV Therapy Protocols.
- Over 30,000 nutraceuticals to choose from when charting.