Cut The Red Tape: Dr. Ciampi — Portland, Maine

In South Portland, Maine, Dr. Michael Ciampi took a step last spring that Bangor Daily News said some physicians would describe as radical (not us, though). He reclaimed his practice from the Mercy health system because he found that patient care was too impersonal. Then he stopped accepting insurance and Medicaid so that he could work more directly with his patients. Earlier in 2013, Ciampi sent a letter to his patients informing them that he would no longer accept any kind of health coverage, both private and government-sponsored. Given that he was now asking patients to pay for his services out of pocket, he posted his prices on the practice’s website.

“It’s been almost unanimous that patients have expressed understanding at why I’m doing what I’m doing, although I’ve had many people leave the practice because they want to be covered by insurance, which is understandable,” Ciampi said.

Before the switch, Ciampi had about 2,000 patients. He says he lost several hundred, which is disappointing. But imagine if he’d left medicine entirely. That’s 2,000 patients that would have had to find a doctor, and 1,800 who wouldn’t be getting cash-only medicine from a doctor they trust.

The decision to do away with insurance allowed Ciampi to practice medicine the way he saw fit, he told the Bangor Daily News. Insurance companies could no longer dictate how much he charges. He could offer discounts to patients struggling with their medical bills. He could make house calls.

“I’m freed up to do what I think is right for the patients,” Ciampi said. “If I’m providing them a service that they value, they can pay me, and we cut the insurance out as the middleman and cut out a lot of the expense.” Ciampi, like us, expects more doctors to follow this path. That’s because even with the small loss of patients, Ciampi expected his practice to perform just as well financially, if not better, than before he ditched insurance.

“I’ve been able to cut my prices in half because my overhead will be so much less,” he said.

Before, Ciampi charged $160 for an office visit with an existing patient facing one or more complicated health problems. Now, he charges $10-$100 per month for a subscription. Patients with an earache or strep throat can spend $300 at their local hospital emergency room, or promptly get an appointment at his office and make no additional copay.

That time is crucial to Ciampi. When his patients come to his office, they see him, not a physician’s assistant or a nurse practitioner, he said.

“If more doctors were able to do this, that would be real health care reform,” he said. “That’s when we’d see the cost of medicine truly go down.”

Amen, Dr. Ciampi. And considering the fact that cash-only medicine improves satisfaction and income, perhaps more doctors will follow suit. How about that for addressing an ever-widening doctor shortage in the U.S.?