Paying cash to doctors affects the treatment plan

If we really want to find out how to damn near perfectly manage any medical problem as efficiently and cost-effectively as possible, we should be studying how doctors manage the medical problems of the cash-paying doctors they see in their own practice.

Read part one here.

My visit with Dr. Grubman was fairly simple. We discussed allergy shots and how they could possibly help significantly with my dust allergy. Since I always take Claritin (an antihistamine for my allergies), he couldn’t do a skin test to test for all the various common allergies (tree pollen, grasses, dog, etc) to include in the shots.

Claritin would inhibit the skin reaction that appears when your skin is pricked with something you’re allergic to. I’d have to be off Claritin for a week and then return to get tested. The other option is a blood test to determine if I’m allergic to other things. However, they are much more expensive than a simple skin test.  I decided to wait for the skin test when I can go off my Claritin for a week. Therefore, I did not get the expensive blood tests.

So here is where it gets interesting. Allergists get paid by the visit and by the various things they do, like skin tests— the more tests they do on you, the more they get paid. If a person is not taking any antihistamines and has insurance, many allergists often test for as many allergies as possible. They simply get paid more. I could have also gotten a CT scan of my sinuses to diagnose the sinus infection.

Instead, Dr. Grubman did it the “old school” way and simply examined me and listened to my story. I would have had to pay for the CT scan out of my own pocket, something that would have been anywhere from $350 to $1000 depending on which radiologist I randomly chose. Therefore, I did not get a CT scan.

Dr. Grubman also said to call him in three weeks to let him know how I am doing. He didn’t want to reschedule me for an office visit (where he would have gotten paid), he just wanted to communicate with me and make sure I am doing better. Therefore, I didn’t have the extra added expense of another office visit when a two minute conversation over the phone would suffice.

If I would have had traditional co-pay insurance, not been a doctor, and not seen a doctor who wanted to partner with me to do the right thing, I probably would have gotten a CT test and an array of expensive blood tests. The visit would have cost someone probably on order of $2000. And then the follow-up visit would have been scheduled, adding another $200 to the bill.

Because I paid cash, because Dr. Grubman and I are knowledgeable about my options, and because we both wanted to manage my problem efficiently and cost-effectively… we did the right things and the best things for managing my problem.

Also, on the way to Kings Pharmacy to drop off my prescription for Augmentin where I was quoted $144, I stopped in another mom & pop pharmacy and asked how much Augmentin would be. They quoted $79, almost half as much as three other pharmacies I called.

Jay Parkinson is a pediatrician and preventive medicine specialist and founder of The Future Well. He blogs at his self-titled site, Jay Parkinson + MD + MPH.

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