Visitors to the Karas Urgent Care website will see something they won’t encounter at a lot of other physicians’ sites: a price list, so they can know how much their care will cost them.
A visit for a sore throat, for example, costs $70, an x-ray is $50 and removing an ingrown toenail is $120.
That’s important for the patients to know because Dr. Robert Karas, who has offices in Fayetteville and Lowell, doesn’t mess with insurance. He treats, and the patients pay as they walk out the door. Those who have insurance are handed an itemized invoice they can mail to their insurer so they can be reimbursed directly.
Karas, who originally went to college to study business and then for a time wanted to be a medical missionary, says his approach creates incentives for cost-effective care that don’t exist elsewhere in the medical profession. Patients are responsible for paying for their health care upfront, so even if they are reimbursed by their insurance companies, they are aware of costs. Because he relies on cash payments, he can’t provide unneeded tests and treatments knowing the insurance company or government eventually will pay. Cost-conscious by nature, he has researched drug prices at nearby pharmacies so he can point his patients in the right direction, and he has negotiated prices with local radiologists that save his patients significant dollars on CT scans and MRIs.
Meanwhile, having the insurance companies reimburse the patients rather than him gives those companies an incentive to pay promptly. If they don’t reimburse quickly, they may lose their customer.
“They can slow-play me and slow-pay me as much as they want, and that’s kind of their goal,” he said. “There’s not a buyer-seller relationship. With the patient and insurance company, there is.”
He says he’s cheaper, too, because he has less overhead. Nobody in his office is paid to input codes, fill out forms in triplicate and haggle with insurance companies. Because he’s cheaper, those insurance companies want him in their network.
The seeds of the idea were planted during the 10 years Karas worked as the medical director of a busy hospital emergency room in Indiana. Traveling radiologists seemed to be making a good living reading scans for the hospital at a rate of $50 each scan. Karas wondered if a doctor could charge the same way.
When he moved to Arkansas to be closer to his wife’s parents, he went back to work at a local emergency room. However, he soon found himself burned out by the long hours spent away from his family and began transitioning to a private practice. He’s been on his own full-time for about a year.
In Fayetteville, he guesses that 70 percent of his patients have insurance. Lowell, which has a large Hispanic population, is the opposite. There about 30 percent-40 percent of his patients are covered.
So far, he hasn’t had a problem getting paid. He estimates that 80 percent to 90 percent of his patients pay in full as they walk out the door. The rest set up a payment plan. Unencumbered by a hospital bureaucracy or insurance middlemen, he has the freedom to develop a small business relationship with his clientele.
“I’ve gotten paid in chickens, produce, massage, beer,” he said.
One patient paid with pickings grown at a community garden. In tears, he told one of Karas’ fellow church members how much he appreciated being allowed to pay that way.
There are plenty of reasons for a doctor not to operate this kind of practice. Karas can’t accept patients on Medicare or Medicaid – which, the way we are headed, will soon be a whole lot of us. He spends more time doing administrative work than if he were working in a big hospital. He’s making less money, at least for now.
But he’s his own man, he’s offering a needed service and he says he’s having fun.
Would this kind of health care reform work systemwide?
Obviously, patients can’t pay for cancer treatments with chickens. Still, it’s a worthy idea. There’s a lot of talk these days about strengthening the doctor-patient relationship as the basis of health care.
That’s hard to do when a third party is paying. Three’s a crowd in any relationship.
Steve Brawner is an independent journalist in Arkansas. His blog — Independent Arkansas — is linked at arkansasnews.com. His e-mail address is email@example.com