Care for cash

Walk into Brian Forrest’s primary health care practice in Apex, and you’ll pay only $49 for a checkup.

Prices for most medical services are clearly displayed in his office, similar to a menu at a restaurant.

Forrest is one of a growing number of doctors around the country who operates on a cash-only basis.

His practice, Access Heathcare, does not accept insurance of any kind, although his privately insured patients are free to file on their own.

He said his business model is advantageous for both the insured as well as the uninsured.

“Sometimes you’ll look out in the waiting room, and you’ll have a homeless guy from Carrboro,” he said. “Sitting right next to him will be a millionaire.”

Since Forrest saves money by keeping administrative costs to a minimum, he can charge his patients lower fees and spend more time with them, he said.

Forrest said he noticed years ago that uninsured patients pay more for medical care, since they don’t have access to the discounted prices negotiated by insurance companies.

He founded his practice nine years ago to change that fact.

“It’s what everyone’s asking for in health care: reduced costs and better quality,” he said.

In the midst of a national health care debate and an approaching midterm election where Republican challengers are contesting the president’s health care reform act, Forrest said his model is the future of primary care.

While he said he supported some elements in the reform — such as banning insurance companies from discriminating against patients with pre-existing conditions — many of the reforms would make practicing medicine too expensive for physicians.

“We need health care reform badly,” he said. “We have for some years.”

But as the bureaucratic tape thickens, he said, more and more doctors are considering refusing government insurance, such as the Medicare and Medicaid programs.

Still others are closing their practices for good.

“Everyone may have health insurance in four years, but no one will have a doctor,” he said. “It potentially could be an access problem.”

B.J. Lawson, the Republican challenger to U.S. Rep. David Price, D-N.C., who represents the Triangle area, endorses Forrest’s ideas.

“Physicians are already frustrated with the direction medicine has gone — what (reform will) do to their ability to do the right thing for patients,” said Lawson, who graduated from Duke Medical School and opened a software company for medical administration.

Proponents of the federal health care law are skeptical of the viability of Forrest’s model.

“I think it’s of limited value,” said Adam Linker, a health policy analyst at the N.C. Justice Center.

He said avoiding insurance may work well in the primary care setting but could prove disastrous in the case of serious illness.

“It’s not realistic once you reach a certain level of complexity,” Linker said.

Price, who voted for the health reform bill, said he stands by his decision.

“I voted for reform because of the protections it gives Triangle families. Those both with and without insurance,” Price stated in an e-mail.

“If Republican candidates want to campaign on repealing reform … and let insurance companies drop coverage for adults when they get sick and need it most, they are welcome do so,” he said. “But why would anyone want to do that?”

Forrest said his model works for patients in need of specialists or hospitalization.

He said he’s been able to negotiate lower prices for his patients by convincing area specialists to also accept cash payments.

While this arrangement is not applicable to hospital stays, Forrest said he is able to keep his patients out of the hospital by providing more comprehensive care and giving them the time and attention they need.

“I wanted to be able to see one patient every 45 minutes to an hour,” he said.

But he encourages his patients to purchase high-deductible insurance for emergencies.

Forrest said he is launching a website to help physicians emulate his model for a fee, which he expects to be up by early July.

Contact the State & National Editor at stnt@unc.edu.