The state of physical medicine: Benefits of working without health insurance hassles

Operating as a true solo practice without insurance contracts can dramatically reduce overhead and eliminated the time-consuming burdens of seeking prior authorizations, chasing reimbursements and justifying clinical decisions to insurance reviewers who may not fully understand the care they are approving or denying. John C. Cianca, M.D., FAAPMR, president of the American Academy of Physical Medicine and Rehabilitation believes his cash-pay model ultimately delivers a better product for patients because it removes the delays, denials and mandated step-therapy protocols that insurance-driven practices must navigate.

Medical Economics: I don't want to assume that courses of treatment go smoother because you don't have insurance working as a middleman. But could you describe what that's like to not have that burden?

John C. Cianca, M.D., FAAPMR: Yes, I can. Well, so first, a factual statement. My overhead’s way lower, right? I work alone. I have a true solo practice. There's no front desk people, there's no MAs, there's no PAs. It's just me. I greet them at the door, I treat them, I check them out, I reschedule them, I answer the phone. I don't have to deal with paying people. I don't have to deal with chasing down approvals ahead of time, I don't have to deal with chasing money later. So I'm much more efficient. But the issue of what to do, when you're in a cash practice or in a paying practice, you have to deal with all those things which makes practice more complex. So I have rid myself of that, and it allows me to function at a more efficient level.

Does it make things easier or harder, not having to deal with insurance? It makes it much easier, because I don't have to justify what I believe is clinically correct and reasonable. I don't have to deal with people who don't understand what they're approving or not approving, and that is very common that my colleagues have to talk to people that are going to say yay or nay, they don't really understand necessarily what they're they're overseeing, and that's frustrating for my colleagues. I don't have that issue, so I can deliver care in a timely fashion for somebody without all the delay or denial, which is, of course, even worse because then you can't even deliver the care. So in my view, I think my product is better. And I say that because people get what they need without all the obstacles put in their way and the delay that is entrenched with it and there's less compromise, there's less having to work around an issue. So I think ultimately I can get to the root of the problem in an efficient manner. Let's take a for instance: Somebody comes in with arthritic knee, and in order to really treat them, well, we might want to do something more advanced, but we have to do step one, two and three first before the insurance will even think about recognizing the other more efficient, more long-lasting treatment. And for the I'm not sure what the rationale is, I guess saving money, but ultimately you got to do those first three steps, which all cost money. I'm not sure that's a savings. It's just a delay. That's my take on it. That may not be entirely accurate, but I think it's pretty close.