Do the math: running a clinic without accepting health insurance

i've been wanting to post for a few weeks now about a number of crazy and amazing things happening here in albuquerque. here goes...

the clinic is finally up and running. we had a few snags like our water gave out and was just replumbed today so the toilet flushes. that's always a good thing in a health clinic! :> we've had a steady, small stream of patients, about 4-6 a day, with no advertising. i've been torn on the advertising piece because we have the capacity to see more, probably 10-15 a day, and the need is there, but there is something really sweet about growing a clinic practice by word of mouth. it takes longer, but it really requires you to do good work, to build a reputation, to put alot of care into each visit. if the community likes you, they send friends and family your way.

on the financial end, alot of people have asked how this place could function without taking health insurance. let me put out a few notes of eath based reality on this. poor people pay their bills, and usually with less grumbling than los ricos when they are treated with respect and charged fair prices. i've had a 90% repayment rate so far. i charge $25 for a visit with a $10 charge for a brief follow up visit. it's roughly on par with what the other federally qualified poverty clinics charge as copays and below most insurance co-pays. so how do we do it?

low overhead.

i've been blessed to live in a country with a vast amount of excess so most of my medical equipment has been donated. that saved me probably $25-35,000.00 in startup costs. my startup costs were roughly $6,000.00 for disability access and paiting and odds/ends. by not taking insurance i don't need any other employees but myself. i don't pay for malpractice coverage, which would be $8-20,000.00 per year, depending on whether they considered my practice a doctors office or an urgent care. my rent and utilities are low.

so let's do some math.

at $25/visit working 6 hours a day (2-8pm, i'm dedicated and lazy at the same time), i can see 12 patients on average. that's $300 per day of work. i charge a bit more for supplies, labs and meds used which makes those items cost neutral to the business.

in the "real" world of medical practice, moonlighting for other doctors, i can get paid $50 per hour.

in my world, i have some overhead costs which bring down the overall income but i also have total control over my practice, no paperwork headache, as much or as little followup as i think is necessary, a profound amount of satisfaction, the ability to barter some care for folks, etc...

unless my calculator isn't working right, at four days a week for 50 weeks a year, that's $60,000.00. i choose to work a short week, do the math for what you want your work week to be.

on another level, i was thinking today about why docs work for insurance companies. and i don't get it. i'm working with really poor people, not homeless, but usually within a paycheck or two. imagine if you chose to work with the uninsured middle class. charge $50 or so per visit. work four days a week, see 10 patients a day for 48 weeks a year and you are pulling in $96,000.00 a year. subtract off overhead and fees and liscences and CME and such and you'll be down to perhaps $80,000.00 before taxes... and that's being lazy like me.

let's do one more math experiment.
at $50 per visit, 20 patients a day, 5 days a week and 50 weeks a year = $250,000!!! someone please check my math. okay, but there is a limit, once you start getting busy you need a secretary or medical assistant to order your supplies and answer the phone, so at some point you have to pay someone $30-40,000.00 a year to help out.

with 43Million uninsured patients and many more underinsured and even with well insured patients blocked from timely access to see their doctors, you will be full in this market. do the math for the type of work week you want to have.

aziwa