Do You Have A Chip On Your Shoulder About Cash-Only Medicine? Let Me Get You An MRI.

Originally posted on

In 2010, I started practicing Direct Care in Wichita, KS. I steadily built a full roster of subscribers who pay between $10 and $100 per month to see me whenever they need to, for as long as they need to, however they want to (at their home, in my office, or via the Internet), all with zero copay.

Recently, a patient of mine developed ongoing shoulder pain. He’s middle-aged, insured, in good health overall, and as expected, refused to get an MRI.

As a direct care practitioner, I act as my patients’ family doctor — routine checkups, consultation, etc. — and as their personal urgent care physician – lacerations, broken bones, earaches, and stomach flus — I can handle all of this at no extra cost.

I write and fill their prescriptions, some as low as pennies per pill. Patients do pay for their labs and panels, but our wholesale rates come out lower than the copay of most insurance plans.

I even have someone who helps them find super affordable wrap-around insurance plans in case of major trauma.

Just last week this same patient called me up first thing in the morning: He was in severe pain.

“Dr. Josh, I’m ready for that MRI.”

So I immediately made the call to a local lab technician, because I wasn’t fifteen minutes behind my third appointment scheduled for the first hour of my day like most doctors working within the traditional fee-for-service model.

Because of the relationship I’ve built with the lab, my patient owed only $400 for the MRI, instead of the out-of-pocket cost of $1,500 that’s billed standard.

Within 45 minutes, my ailing patient was leaving the lab. Within a few hours, I was reviewing the results [Josh, please tell me the results here > … ].

But critics are probably shaking their head, wondering why this man would want Direct Care when he’s currently insured.

Well, the thing about insurance is that in almost all cases, patients need to meet their deductible in order for insurance to cover things like MRIs. An Obamacare silver plan comes with a $3,000 deductible — twice the amount due! If they went to the same lab and used their insurance, they would owe $1,100 more out-of-pocket.

And they would still owe that monthly insurance premium that’s really only there in case of major trauma.

And they would risk having to go to an overpriced ER if they had any trouble late at night or on the weekend.

It’s worth remembering that insurance is a business and they sell their benefits like every other company. Major Medical will typically offer “free preventative care” in effect saying, “as long as you see an overworked doctor of our choosing, you pay nothing.”

Except you do pay. You pay by waiting 18 days to get an appointment. You pay when doctors talk to you for 7 minutes and have to look down at your chart to remember your name. You pay when these doctors refer you to the same lab for the same MRI and you’re indebted $1,500 because you haven’t met your deductible yet.

That’s why it baffles me when people have knee-jerk reactions to paying cash for medical services.

“Oh, cash-only medicine, that’s only for the rich,” said an associate of mine while we were in L.A years ago. She went on to manage Patient Experience for the prestigious USC Medical Center, a place even the insured might only dream of receiving care.

Then there are critics who say things like, “You doctors seeing fewer patients will reduce access to primary care.”

Or our favorite gripe, “You’re going to create two-tiered healthcare.”

As a Direct Care practitioner I take offense to these attacks because they lack perspective. Do critics of an affordable option that delivers real value want healthcare without any tiers? And what would this tier look like? Millions losing existing coverage, rising premiums for small businesses, cheap Obamacare plans sneaking in absurd drug costs…

To me, this sounds like a universal healthcare system that equally fails all people of all socioeconomic backgrounds.

Why would someone criticize me when I tell people, I’m happy doing what I’m doing, I’m happy to consult other doctors in doing similar work, and I’m happy to motivate students to choose family medicine instead of a specialty?

Critics see affordable cash-only doctors as the root of our doctor shortage. I see us as a viable long-term solution. When students begin to perceive the financial and emotional benefits of practicing family medicine – two things I can personally vouch for their attainability – then this doctor shortage might actually be addressed.

And when critics want to examine the chip on their shoulder, I’ll be glad to negotiate for them.

Direct Care Is So Good You Will Cry. Stream ATLAS MD PODCAST #15…

Direct Care Is So Good You Will Cry. Stream ATLAS MD PODCAST #15…

Thank you for Tweeting us your direct care questions. We went through and answered them one by one in our newest podcast. Someone asked about how many patients we’re seeing. Great question! We’re proud to say that we’re seeing about 1,500 patients in total now, and that Dr. Palomino is seeing ~415 patients after entering Atlas MD last May.

Read more

Student Discusses Atlas MD, Capitalism And The Free Market In Research Paper

We’re blessed to have been the thesis of Sam Jordan’s academic paper, “Medicine Shrugged.” Originally from Salina, Kansas, she’s now a freshman at George Mason University in Fairfax, Virginia and is majoring in Economics. She included email correspondences with Dr. Josh as part of her sources to build a case for free market medicine. Texts from Ayn Rand, Alan Greenspan and other intellectuals were cited alongside our personal experience.

Thanks to Sam, for letting us share her work with our supporters. We have to admit, we blushed when she compared us to Aluminum Company of America. ALCOA is known for its shining example of profit-maximization and price-minimization in Greenspan’s paper, “Trust.” It serves as a concise way of understanding our mission to cut the red tape. And yes, it’s true: we’re motivated to offer the best healthcare while making the most money possible. Sam had no hesitation in addressing that.

We’ve included the complete work below. Take a look. And if you’re interested in a digital copy of Sam’s paper, send us a line at hello[at] …

Read more

Posted by: AtlasMD

September 29, 2013

1 Comment

Dr. Josh Talks About Practicing Medicine in Kansas

Special thanks to Physicians Practice, who conducted an interview with Dr. Josh. You can stream it on their site here. He talks about why Kansas is a state that lets doctors truly practice family medicine.

While of course we want to see direct care spread EVERYWHERE in America, there are some advantages to Atlas MD’s location in Wichita. Josh explains how great it is to be able to experiment, and offer a wide range of services – colonoscopies, obstetrics, and more. This has given the practice the power to challenge the status quo and reinvent the patient-doctor relationship to the benefit of all parties, insurance companies included.


Atlas MD On Expanding Your Direct Services

It’s Dr. Josh here. We had a doctor write us in response to our Atlas MD price listing recently. The doc asked,

What about X-rays, MRI, and emergency visits like broken bones?

Thank you for the question. We’ll gladly expand on how we negotiate for discounted services.

Read more

MUST FOLLOW_The Self Pay Patient Blog

Sean Parnell reached out to us recently, expressing support of our cash-for-service model of primary care. We’re glad he did. Turns out he runs a blog called The Self Pay Patient and it’s a helpful resource for “tens of millions of Americans who are either uninsured, have high-deductible health insurance, or just want to escape from bureaucratic medicine…”

His blog entries are the basis of a book he’s currently writing that will be “a ‘users guide’ to self-pay medicine, explaining in detail how to find doctors, hospitals, pharmacies, and other providers of health care goods and services…”

He recently wrote about a patient who needed knee surgery and benefitted indirectly from cash-only medicine. The first hospital he visited wanted an out of pocket payment (he had a “good” insurance plan) that was MORE than the cost of the whole operation at the Surgery Center of Oklahoma, a cash-only facility. In the end, the patient used price transparency to negotiate and save about $3,000 on his procedure.


Once more we see the power of the market, and price transparency, in making healthcare more readily available. We believe it’s worth writing down — every direct primary care practice and every cash-only hospital that offers competitive, cost-saving procedures, treatments, prescriptions, etc. puts pressure on the insurance companies to treat clientele more fairly. Cheers to Mr. Parnell’s blog for keeping a record of these establishments and spreading awareness of their benefits.

This Week in Concierge Medicine

Here are five thought-provoking posts on concierge medicine circulating the Web this week. Follow the links to read the complete articles.

Concierge Medicine Can Ease Escalating EHR Requirements
Wayne Lipton addresses growing concerns over new EMR guidelines and highlights some advantages of the concierge business model.

New Doctor in Town Offers Alternative to Traditional Fee Model: Concierge Medicine for the Masses
Dr. Samir Qamar see Las Vegas as the perfect market for concierge medicine. His model is slightly different than AtlasMD’s, with a subscription and a $10 fee per visit. However, he’s made it very attractive for employers who typically don’t offer insurance, like the billion-dollar service industry.

Read more

Just Another Day at the Concierge Medical Office

I feel like you might be tired of hearing another concierge medical success story. But then again, there’s still plenty of opposition to the model. Which brings up a post about how a concierge doctor saved a woman’s life. (Original link no longer available.)

The post from The DO, a blog for osteopathic physicians, features two doctors who successfully transitioned to the model.

One of the men, Dr. Schneiderman, a Monterey, California-based concierge medical doctor, was ready to leave his home state to practice medicine elsewhere. He was frustrated that he didn’t have actual time to spend with his patients. He tried everything. Working for the prison system, working for the Veterans Affairs system, and none of it made a difference.

Read more

Rising Deductibles Make Concierge Medicine Look Even More Desirable

Doctors considering transitioning to a concierge business model, take note: deductibles are on the rise. Here are the grim findings from a study conducted by Athenehealth between 2009 and 2011:

Deductibles as a percentage of contracted rate have risen by 47% in the Northeast and by 20% in the rest of the country.

Read more

Improve Patient-Doctor Relationships With Shorter Emails

Improve Patient-Doctor Relationships With Shorter Emails

Life Hacker offers help for abbreviating those long emails that no one’s reading. You might be a master of the inbox, but if you’re finding yourself writing novels, take a look at the pointers below.

Read more