Thinking about this concept...

[epidural man]

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Okay, stay with me for a moment the back story - it's short.

I sometimes do anesthesia for this guy who does Invitro fertilization. He makes a killing. I mean....we all should have done IVF for a living. But anyway, we were talking about how insurance may start to cover IVF and this physician was saying that would be very bad for business.

Now thinking about pain and what we do...I think that is super interesting. We (and not really we....more like YOU...because I don't have insurance to deal with) all worry about procedures LOOSING insurance coverage and thus loosing revenue. But if we look at other things (boob job, nose job, IVF) - it is the LACK of insurance that makes those thing pay really well. So why are we so worried about insurance coverage? It seems to me - that loss of insurance coverage could actually be a huge thing for getting paid more (and it seems like making someone pain free for 5-7 months is worth a lot of money).

What I have learned doing anesthesia for plastic surgeons, and this IVF doc - people have money to BURN.

So, what am I missing? Wouldn't doing epidurals for cash pay be a very good thing?

 

[Ligament]

My understanding is that IVF makes a lot of money IF and only if the lab facilities are owned by the OB/GYN.

 

[epidural man]

My understanding is that IVF makes a lot of money IF and only if the lab facilities are owned by the OB/GYN.

Well that's interesting.

The guy I work for goes to China every year and most of his patients don't speak English. He has found a nice corner of the market.

 

[hyperalgesia]

So, what am I missing? Wouldn't doing epidurals for cash pay be a very good thing?

I think generally docs hate asking patients for cash. It's easier to send a claim to a faceless entity. But it shouldn't be that way. We should welcome the exit of insurance.

 

[VA Hopeful Dr]

Having done IVF personally, it's not quite the same.

It's not a chronic problem. At a certain point, you either have enough kids or you give up trying and adopt, but either way this isn't something anyone does for more than 5-10 years. Since most chronic pain isn't fixable, you'll have patients who will be needing your services for probably decades. Same with cosmetic surgery: for most people a boob job is a one time expense.

A better example might be Botox.

That said, if you went cash only, what would you charge for epidurals? Because that would make a big difference as well. I did cash only primary care for a few years, and price matters a lot.

Also success rate: if you charge someone $500 cash for a procedure you need to make sure they're satisfied with the results.

 

[geauxg8rs]

Having done IVF personally, it's not quite the same.

It's not a chronic problem. At a certain point, you either have enough kids or you give up trying and adopt, but either way this isn't something anyone does for more than 5-10 years. Since most chronic pain isn't fixable, you'll have patients who will be needing your services for probably decades. Same with cosmetic surgery: for most people a boob job is a one time expense.

A better example might be Botox.

That said, if you went cash only, what would you charge for epidurals? Because that would make a big difference as well. I did cash only primary care for a few years, and price matters a lot.

Also success rate: if you charge someone $500 cash for a procedure you need to make sure they're satisfied with the results.

 

[geauxg8rs]

Agree that your procedure has to work. People with managed Medicare complain all the time about having to pay $45 copay for the specialist.
“Are you telling me I might have to pay $45 every six months for this nerve burn?” Forget it, I am going to ask my PCP to send me somewhere to “fix me permanently.”

 

[Ducttape]

people need to have babies. at least from their psychological standpoint
people need to have cosmetic surgery to improve their self esteem, and look like Kim Kardashian.

people don't need interventional spine injections. not when a prescription for vicovalium "works" even better (their perspective)

and fwiw, most of our pain procedures don't work long term. a boob job lasts until, well... one of the more disturbing sites ive seen was an inpatient with lung cancer in the late 80s that had implants done 20 years or so previously.

 

[swamprat]

people need to have babies. at least from their psychological standpoint
people need to have cosmetic surgery to improve their self esteem, and look like Kim Kardashian.

people don't need interventional spine injections. not when a prescription for vicovalium "works" even better (their perspective)

and fwiw, most of our pain procedures don't work long term. a boob job lasts until, well... one of the more disturbing sites ive seen was an inpatient with lung cancer in the late 80s that had implants done 20 years or so previously.

Yeah but there are people that love them - and our practice charges 450 for a new patient visit self pay and 325 for follow ups. We don't go outside CDC guidelines and there has to be a clinical indication for the medication (ok don't start with no indication for COT) .. if everyone was cash pay at this we would be doing quiet well - especially since managed medicare pays like 75$ for a follow up visit

 

[hyperalgesia]

People pay for chiro and other voodoo all day long. If we were all in it for the sale, we could do well with an all cash practice.

 

[lonelobo]

from just a number standpoint how many Docs perform IVF vs pain procedures.... I would say ratio at least 100(pain) to 1

 

[epidural man]

Having done IVF personally, it's not quite the same.

It's not a chronic problem. At a certain point, you either have enough kids or you give up trying and adopt, but either way this isn't something anyone does for more than 5-10 years. Since most chronic pain isn't fixable, you'll have patients who will be needing your services for probably decades. Same with cosmetic surgery: for most people a boob job is a one time expense.

A better example might be Botox.

That said, if you went cash only, what would you charge for epidurals? Because that would make a big difference as well. I did cash only primary care for a few years, and price matters a lot.

Also success rate: if you charge someone $500 cash for a procedure you need to make sure they're satisfied with the results.

You are right. It bette work. Isn’t that a good thing? It would make us more selective on who we inject.
Although as someone mention, chiro doesn’t work- lots of chiros are doing very well.

 

[hyperalgesia]

from just a number standpoint how many Docs perform IVF vs pain procedures.... I would say ratio at least 100(pain) to 1

probably closer to 1000:1

 

[VA Hopeful Dr]

You are right. It bette work. Isn’t that a good thing? It would make us more selective on who we inject.
Although as someone mention, chiro doesn’t work- lots of chiros are doing very well.

Potentially, but again price matters. Even if it works great, not many patients can afford to pay $500 4 times a year (admittedly pulling numbers out of my rear on this).

Chiropractors are cheap. Guy near me runs a special: new patient eval including xrays and first treatment run $80. If you could do your injections for $150, you'd have no shortage of patients I suspect.

 

[clubdeac]

You spelled lose wrong twice.....

 

[Ferrismonk]

In addition to the above statements, in medicine, people will pay cash for things they really want, not for things they only kinda want.

I also think that once insurance covers something, people are no longer willing to pay for it by themselves. If the guy down the street will do your IVF through your insurance for a $1000 and you do it for $10K, they'll go down the street.

I've seen people that try to do RegenMed only run into the same thing. Patients are okay paying for the procedure, but they don't want to pay for the office visit "when I have insurance for that". They have no understanding how much extra stuff must be done just to satisfy insurance.

That said, if you went cash only, what would you charge for epidurals? Because that would make a big difference as well. I did cash only primary care for a few years, and price matters a lot.

Also success rate: if you charge someone $500 cash for a procedure you need to make sure they're satisfied with the results.

How was your experience with cash-only primary care?

 

[10KHertz]

Dentists And orthodontists have a good mix of cash and commercial pay. That’s our goal, I think.

 

[VA Hopeful Dr]

How was your experience with cash-only primary care?

Mostly good, though I did learn that I don't enjoy running a business.

 

[Dr. Ice]

Out of network docs in my area charge 7k to Medicare for an interlaminar lumbar epidural. Not sure how much they actually get paid although most of them see 12 patients a day max and live a lot better than I do

 

[dmk5n]

Isn't this what is giving Regenerative medicine traction? Cash?

 

[epidural man]

What about this idea?

first epidural is free.

If it works, they will pay for it again.