It seems so radical: a primary-care clinic where the health-care prices are posted in advance, and everyone knows what they’ll pay going in.
You pay per visit (maybe $40, maybe $89, depending on your plan) and per lab test (often $10 or $20). No insurance is accepted.
It’s the GracePointe Healthcare Clinic in Franklin, Tenn., and it may be the future (as well as the past) of medicine. Same-day or next-day appointments. House calls. And the doctor — well, actually, he’s a physician’s assistant, Rob Tomsett — says he spends at least a half-hour with each patient.
Oh, and he takes no insurance.
This means that his patients are responsible for the charges, and they have to file insurance claims with their insurers, if they’re covered, for out-of-network care, because he’s not in any network. Because the charges for visits, treatment and lab tests are so modest, Tomsett says, many patients tell him they come out better financially than with a $20 or $30 copay for an in-network provider.
Tomsett spent some time on the phone the other day explaining.
First, here’s his fee schedule. The office visit is the starting point (and often the ending point) — a $40 (or $89) charge for an office visit resulting in a sore throat diagnosis, for example. If he is biopsying a lesion, the charge is $150; sewing up a minor laceration costs $150. Then the patient submits the bill to an insurance company — or, if the patient’s uninsured, that is where the transaction starts and stops. There are plans that can lower the per-visit fee.
For a patient who’s given the choice of an $1,899 monthly insurance premium for a family, that might seem pretty appetizing. That, for example, is my Cobra premium; I could get a lot of $89 visits monthly for that $1,899.
This is not the same as an urgent-care clinic, the name for walk-in places like the Minute Clinic. It’s also not the same as concierge care, in which a patient pays an annual up-front fee for special individualized service, though there are GracePointe plans that are annualized “SmartCare” options giving a higher level of service.
Tomsett, who served as a medic in the military for 24 years, retired to Franklin, which is where he met Dr. Ted Leichner, who then owned the clinic. Dr. Leichner, an osteopath, frequently deployed overseas with the National Guard. Tomsett says he found it hard to keep the clinic running while he was gone. Dr. Leichner asked Tomsett if he would like to take over the practice. Dr. Leichner now practices with the VA and is also a part-owner (he has 1 percent of the GracePointe clinic) and is the supervising physician.
Tomsett took over the practice in April of this year and on July 1 went to full self-pay. “We wanted to be able to serve anybody, from uninsured or self-employed or high-deductible, anyone who wanted to have that transparency and who wanted better service,” he said. “I loook at this as if I want to be like your favorite restaurant or trusted mechanic, that you know you’re paying your hard-earned money to because you’re getting great service and that’s why you’re coming back here–not that this is who your insurance company says you have to go to because they’re in network.”
Tomsett says he enjoys practicing medicine more. And he says his patients are happier with the care they get.
GracePointe doesn’t have a big staff to handle insurance matters, and he says that reduces his overhead. That means he’s able to schedule two patients an hour, and deliver personalized service.
When Tomsett was looking for a lab to do his lab work, he says, “we auditioned them.” They offered the labs the opportunity to cut their fees and get paid directly by GracePointe for lab work. The providers contracted with GracePointe, which pays them directly. Tomsett says he charges $10 for a comprehensive metabolic panel, to the patient, he can’t tell me what the lab charges him because his contract is written that way. We found prices online of about $120 to $150, depending on provider and location.
For comparison’s purposes, Tomsett says he has a patient who came in for three lab tests and who was charged $35 by GracePoint. Inadvertently he checked the wrong box on a form, saying “bill the patient,” and got a bill for $175, Tomsett says. “That means we saved him $141. He was inunsured, and that was his bill without insurance.”
Tomsett’s clinic is not alone in posting its prices. He says there is a doctor in North Carolina who has a direct-pay practice: it’s Brian Forrest, at Forrest Direct Pay. The idea has attracted a lot of interest from many people in the field, including Dave Chase, a Microsoft alum who is working on a healthcare startup called Avado. Chase wrote this piece about Dr. Forrest on KevinMD.com.
Then there’s ZoomCare in Portland, Ore. Their price list is here. It’s probably no accident that their Web site has one page titled “zelp,” because they seem to have something similar to the ethos on Yelp, the online crowd-rating site. We know people in Portland who like ZoomCare because of the way they do business: same-day or next-day appointments, online scheduling, published prices. One friend goes to ZoomCare even though they don’t take his insurance because he likes the vibe.
Zoomcare, Forrest Direct, GracePointe. Transparency in prices. What an interesting idea.
Do you know of a clinic that posts its prices? Let us know. Email: info [at] clearhealthcosts [dot] com.