Cash-Only Practices: Better for Patients or Just Better for Doctors?

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Kamal Menghrajani/KQED

Jayaledchumy Yogaratnam visits with Dr. Hisana Qamar at the MedLion practice in Monterey.


Some primary care doctors around the Bay Area are converting to cash-only practices, rather than taking insurance payments.  Doctors who choose this model are leaving some of their patients behind.
76-year-old Jayaledchumy Yogaratnam climbs onto the table at her doctor's office. She's been having a runny nose lately and her primary care doctor, Hisana Qamar, wants to check her out. 
Dr. Qamar used to get paid through Yagoaratnam's Medicare insurance. But not anymore, so Yogaratnum is paying $10 today, plus $39 a month to come here.  She says it's worth it if she can stick with her doctor.
Dr. Qamar and her husband, Dr. Samir Qamar say they came up with the idea of starting their own direct primary care clinic, called MedLion, after becoming concerned about the growing number of uninsured in their Monterey community.
This means they can afford to accept fewer patients and spend more time with them.  And they're marketing their model across the country.
Is this model competing with insurance companies? Dr. Samir Qamar says yes. "We don’t think primary care needs insurance.  I think it’s ridiculous to pay $500 a month to be treated for a sinus infection every spring. Insurance should be saved for the catastrophes," says Qamar.
Critics of this model argue when doctors do business this way, they only see half as many patients - exacerbating the doctor shortage.  
Dr. Sophia Chang is an internist at UCSF and an expert in health care delivery. She says niche solutions like this one ignore the bigger problem. 
"It’s clearly the answer to people who have means and essentially want a different tiered system. It’s clearly not the answer if we want to provide population health and if we want to provide good health care to Americans," says Chang.
Patients who do not pay the monthly fee have to find a doctor somewhere else.  But others, Yogaratnam,  appreciate that they can spend as much time with their doctor as they need.
"It's not like a doctor's office for me - it's just like going to visit someone, visit a friend like that," says Yogaratnam.
The Affordable Care Act allows for retainer-based practices to compete in health exchanges, when paired with high deductable insurance.  So we may see more of them if the law goes through. 
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