Cash Only Doctors: Challenges and Prospects of Autonomy and Access

Jeffrey B. Hammond, Faulkner University

Abstract

With the passage of the Patient Protection and Affordable Care Act of 2010, the American healthcare system is poised to fundamentally change. However, the Affordable Care Act’s passage has made many physicians queasy at the prospect of more bureaucratic control over their professional lives. Hence, a form of ambulatory medicine not seen since before the advent of health insurance, “cash only” medicine, or healthcare encounters fully paid in (usually) the primary care doctor’s office, is beginning to gain more attention among doctors and in the popular press. This Article argues that cash only medicine is a salutary development in the American healthcare system because it allows for more thorough treatment and better patient satisfaction for patients who remain with their doctors once they transition to a cash only model. Further, the Article locates the roots of the current cash only trend in the formula-based system derived by Congress to pay physicians contracted with the Medicare program, and its modifier, the Sustainable Growth Rate, which perennially threatens to precipitously cut already weak Medicare physician reimbursement. The Article also argues that cash only medicine should be welcomed as a means of patient access over against the insurance-dominated system mandated by the Affordable Care Act. These doctors provide access that would be lost entirely should they leave the practice of medicine altogether if unsatisfied with the changes wrought by healthcare reform. Finally, the Article acknowledges that, qua trend, cash only medicine could work to alienate some patients, like economically disadvantaged chronically diseased patients, who do not have the financial wherewithal to purchase with cash all of the healthcare they need nor purchase insurance before the 2014 effective date of the individual insurance mandate.