MJB - happy to help
Labs - took about 5 minutes to sign up with a local lab. the big national companies will do the same but our local lab gave the best rates. $2 cbc, $4.50 cmp, $3 tsh, $2 crp, etc All with no negotiation. It was just their physician discount.
Medicines - all but 4 states allow pretty unrestricted access for physicians to dispense to their patients from their office. The savings can be tremendous, one RA medicine is a $11 for us/mo, but $120 for generic and $940 namebrand at the pharmacy. I know what our pts prefer.
Routine labs - as noted above, for pennies on the dollar
Routine screening - if we can do it in the office, its free, including things like dexa, ekg, holter, spiro, home sleep apnea screening, audiometry, UA, STREP, etc
Mammo - $75-200 screening at local centers for cash
Colonoscopy/EGD $700-900 cash. Not cheap, but cheaper than ins. and i definitely see that being an area that REALLY comes down in cost b/c of ease of procedure and volume of pts needing screened.
Hospitalizations - we work with the hospitalist but you could admit your own pts under this model if you wanted to. Its another huge value to the patient for the type of admissions you'd be comfortable doing etc.
Referrals - drastically decrease the NEED for referrals when you have plenty of time to manage the patient. Curbsides - i can do more talking with my specialist for 2 minutes on the phone than can be done in weeks of waiting to see the specialist. That ensures they don't waste their time with inappropriate referrals. If the pt doesn't have ins, they pay cash, if they have a major medical (more common) they still pay cash. So referrals aren't too different right now. But i think you'll see innovative solutions to this in time too.
http://www.pointofcaredispensing.net/dispensing-faq/
hope i didn't miss anything
thanks
josh