The Cash-Pay Clinic

The fee-for-service model works quite well in some countries without leaving physicians burnt out. Some of our colleagues in Canada will blow through 50 patients in a day without breaking a sweat.

The key to the sustainable practice of medicine is doing what you like, which doesn’t leave you emotionally drained, and which benefits the recipient.

The goal of such a cash-pay clinic is:

1. access
2. fast turnaround
3. cost transparency

Access to Healthcare

Most individuals needing care probably need to discuss something with a physician. A piece of mind, a few words of reassurance, and maybe some home remedy advice. This is 90% of what I see in the urgent care.

Then some want the million-dollar workup. Interestingly, them folk usually have private health insurance. This is 1% of the population.

Then you have a smaller percentage who have a genuine medical emergency such as trauma or a life-threatening event. This is probably about 5% of the population.

Current Insurance Model

The current insurance model has people hiding from their health worries. The fear of getting a surprise bill is astronomical, even though people have less access to health care.

The average copay is supposedly $25, but the reality is that you rarely will come out will less than $100 by the time you go to the pharmacy and get the lab bill and arrange the follow-up.

You are limited to where you can go, and the law of the land is no cost transparency.

The Cash-Pay Model

I’ve written so many articles on urgent cares and cash-pay models that I will throw up. But it’s essential; healthcare is not improving, and you’re not getting younger.

We have cash-pay models such as same-day clinics, some urgent cares, fee-for-service practices, out-of-network physicians, aesthetic practices, and direct care clinics.

Many of these practices are still confusing when you look up their prices online. It’s as if they are dead set on recreating the insurance model’s confusing approach.

The cash-pay practice should ideally have one price point. At most, you can have 3, but why?

The Ideal Cash-Pay Client

Los Angeles County, California. Population of 10 million. 15% living in poverty. 10% without health insurance. 50% self-employed.

The cash-pay clinic is meant to address the problems our healthcare system has. Cost transparency is at the very top of it. Access is another. And, finally, wait times. The long, long wait times to get into a clinic.

The cash-pay clinic should ideally serve 20% of the 90% number referenced above. These patients are motivated patients who want what you want.

• present with simple medical problems
• their only agenda is receiving proper health care
• they value their time
• they value your time
• don’t have an emergency
• appreciate value and cost transparency

The Ideal Cash-Pay Clinic

Okay, I’ve used the cash-pay clinic term a few times. Let’s define it.

The cash-pay clinic is a clinic where the patient pays a single price for the services you offer. With the motto of:

1. access
2. fast turnaround
3. cost transparency

We are going to go with $50 per visit. Everything is included in this price to serve most of those who are the right fit for your clinic.

1. Low-Cost Visit

At $50 per visit, you can see 50 individuals with simple chronic or urgent issues per day without feeling burnt out or stressed. That’s $2,500 per day.

Because you will do relatively few urine dips or rapid strep tests, such POCs should be included in this price.

2. Free Patient Triaging

You can let anyone come in and still offer them a complete evaluation. Your opinion, after all, is still worth a lot.

Your check-in sign or QR code only needs to state that you don’t work up serious medical conditions, manage emergencies, handle trauma, and so don’t perform EKGs or chest xrays.

3. 30-Minute Turnaround

Each visit should take you 10 minutes. Even with a full waiting room in a small practice, the throughput should be less than 30 minutes.

You can give yourself a 60-minute window if you like, but the goal is access, transparency, and

4. No Surprise Bills

You won’t charge extra for IV fluids or xrays or some esoteric ear culture. That’s because you won’t do them. There are plenty of urgent cares and clinics where the patient can go for that.

They pay the $50, and that’s all they will pay or be charged. Imagine the look on someone’s face when it’s that simple.

5. Low-Overhead

You don’t need to stock injectables or IV bags or procedure trays. No medications to dispense or stock. No EKG or radiology equipment.

This is because these are hardly used except for maybe 20% of patients. So, why stock them if they aren’t going to add to your work satisfaction and clog the clinic flow?

6. Straightforward CCs

Only simple abscesses and lacerations, which only need skin adhesive, should be seen.

An elderly patient with 12 medications brought in by the caregiver, neither of which speaks English, is not the right fit.

7. 100% Refund

Why deal with someone who isn’t happy with your care? It’s not worth your time when you’ve structured such a straightforward practice.

Maybe the person misunderstood and was convinced that you would refill their #180 Percocets and #90 Xanax for their anxiety.

Here is your $50 back, and please never come back. Thank you. You’re welcome. Oh, and don’t send your friends. And do spread the word.

8. Easy Billing & Documentation

The patient scans the QR code, checks themselves in, and then you walk them to the exam room. If you need vitals, you do it. If not, you don’t.

The documentation is a simple voice dictation automatically transcribed into the chart. Any prescriptions are sent off, and rinse and repeat.

You aren’t billing anyone—no insurance documentation requirement or audits. The receipt is automatically generated when the patient receives a copy of what you typed into the EMR.

Income Potential

I don’t like to get too much into the weeds with the numbers. Could you create a cash cow for yourself with high volumes? Maybe. But you don’t want to burn yourself out.

I don’t see the need for a medical assistant but it will make life easier ($3k/mo). You also have malpractice insurance ($1k/mo) and rent & utilities ($2,500/mo).

What if you only see 10 people per day? $500/day, 5 days a week, and you have $10k/month. That leaves you with plenty of breathing room to improve your marketing.

Add Virtual Care

From your EMR, you will see the next booked patient – the person who checked in and paid their fee. You don’t need to worry if it’s a virtual patient or an in-person visit.

This will make it easier for you to accept patients in-person and virtually. Who knows, maybe one day you’ll be busy enough only to need to do the virtual part.

Marketing

Call it Same-Day Cash-Pay Clinic.

I know, super clever. But you don’t need anything fancy. Stay under the radar; that’s how you walk away with the most.

Let the word of mouth spread. And, if you want, you can see some people for less money. Nobody needs to know what you charge.