Some Doctors Offer Flat-Fee Medicine

Florida Doctor Offering Care For $75 Per Month

More than 43 million Americans are uninsured, according to the Centers for Disease Control and Prevention. A recent Harvard study showed 45,000 Americans die every year partly because they lack health insurance. As this country prepares for health care reform, some doctors are taking your health into their own hands by offering an alternative.

"About three years ago, I found out there was an increase in missed appointments and when I talked to the patients, I found out many of them had lost their insurance," said Dr. H. Lee Adkins, a family physician in Fort Myers, Fla.

Instead of turning his back, Adkins set up a flat-fee system where patients pay $75 a month for a year.

"It's a very easy way to perform in the office," said Adkins.

Patients get 15 visits a year and access to all services, including blood tests, EKGs and pap smears. Adkins said 30 percent of his patients are on the self-pay system.

"Last month, we were up 30 percent over last year," said Adkins.

While it's difficult to track, an estimate from the Kaiser Family Foundation revealed "several hundred" primary care physicians have begun to offer prepaid plans for their patients. Critics said some doctors who use flat-fee services are operating like insurance companies -- without proper licensing. Adkins said he's just offering a service that benefits patients.

"If the doctors don't get active and do something, we'll have less qualified people making our decisions for us," said Adkins.

Mike Scott lost his insurance when he lost his job. Suffering from diabetes, he chose the prepaid method.

"It offered an opportunity to recheck for my diabetes, to keep it in control, and that's what I wanted to be able to do," said Scott.

Like so many Americans, Kim Turano used to have insurance. When she lost it, her health took a back seat.

"What this program allows is for me to get the care that I had been ignoring in the past," said Turano.

Adkins said the flat-fee approach saves him money by eliminating administrative costs that come from dealing with insurance companies. He also offers an a la carte system for patients who don't want to or can't pay $75 a month. A la carte patients pay per visit, per blood test or per service needed. Those services range in price from $10 for a blood test to check for colon cancer to $103 to test for HPV (human papillomavirus).

BACKGROUND: More than 43 million Americans are uninsured, according to the Centers for Disease Control and Prevention. Many of these people avoid simple medical care because it's often too expensive. They just don't have the money to pay for yearly check-ups, blood work or other screening tests. Now, some doctors around the country are offering an alternative that has patients back in their offices again.

FLAT-FEE MEDICINE: Patients at Fort Myers Family Medicine in Fort Myers, Fla., have a new option for medical care. Adkins offers his patients a "flat-fee" program. Patients pay $75 a month, with a $10 co-pay per visit, and get 15 visits a year. They get access to services including blood tests, EKGs and pap smears. The practice started the plan to encourage patients to continue to get preventative services.

"Patients know that when they go into an emergency room that it will cost them between $800 and $1,200. If they walk into my office, it will cost them between $85 and $135, with a follow-up visit cost of $65 to $110, depending on the complexity," said Adkins

He still advises patients to obtain a hospitalization insurance policy, which is more affordable than a full-coverage policy in case of catastrophic circumstances. His plan does not cover hospital care.

GOOD FOR PATIENTS AND DOCTORS?: Adkins said the flat-fee program has helped his bottom line. One month, his revenues had gone up about 30 percent since the previous year. He said the approach saves him money by eliminating administrative costs that come with dealing with insurance companies.

A LA CARTE SYSTEM: If patients don't want to or can't pay the $75 a month, Adkins also offers an a la carte system where patients come in and pay per visit or service needed.

A CRITICAL VIEW: In March 2009, insurance regulators told one New York City doctor who offered a flat-fee program to his patients that he had to shut it down. This doctor was not charging his patients a co-pay for follow-up visits and was not limiting the number of follow-up visits allowed. The regulators said that the doctor was operating like an insurance company without the proper licensing. However, Adkins said his membership plan has been tailored to avoid the legal definition of an insurance plan as described in the Florida statues.