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Scott Shreeve, MD

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I'm the CEO of Crossover Health, a patient-centered, membership-based medical group that is redesigning the practice, delivery, and experience of health care. We offer urgent, primary, and online care to our members who can access our technology platform, practice model, and provider network from anywhere and anytime to optimize their health. Email Me



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Sermo makes the connection: Health Reform leads to Cash-based Practices

Connection (kə-nĕk‘shən) n.

  1. The act of connecting.
  2. The state of being connected
  3. An association or relationship
Sermo finally makes the connection between all the health insurance reform conversations and the inevitable consequence of pushing a large percentage of providers toward a cash based practice. I have highlighted the rise of direct practice multiple times, and believe enough in the model that I am currently creating a direct practice network for Southern California. There are multiple emerging tools that will make this much easier and I believe the inevitable financial reimbursement fallout will result in a dramatic rise in the number of physicians moving to this model.

The comments below are only available once you log into Sermo:

The past two weeks have seen polls come out that would appear to portray physicians with diametrically opposite positions in the current healthcare debate. A September 14th poll of 5,157 physicians in New England Journal of Med… indicates that:

  • 63% of physicians support a combined public/private approach to coverage (i.e. the healthcare reform approach currently proposed)

A poll two days later by IBD/TIPP of 1,376, also randomly selected physicians, indicated that [LINK]:

  • 65% say they oppose the proposed healthcare plan
  • 45% of the respondents stated that they would consider leaving medicine if the reforms were in fact enacted

In parallel, there has been a dramatic acceleration in the number of discussions around cash-on… While fee-for-service or “cash only” practices have long been a popular topic on Sermo, there appears to be increasing interest in this as the healthcare debate has progressed.  Given the growing impact of this trend, the media is asking the Sermo physician community to help asses this trend and the possible impact on the physician-patient relationship.


Daniel Palestrant, MD
CEO & Founder, Sermo

P.S. Get your colleagues involved. And help us make a big statement to the media. Cut and paste this link into your outgoing email:

3 comments on “Sermo makes the connection: Health Reform leads to Cash-based Practices

  1. Dierdre says:

    Huh? Switching to a cash-only practice will mean that these docs lose the vast majority of their patients and treat only the rich. News flash: that’s about 2% of the population. Good luck scrapping for that business.

    1. Dierde,

      Thanks for your comments.

      You have a common misperception about “cash based practices” (perhaps the name is inappropriate). In the “Direct Practice” model, the physician has a direct financial, clinical, and administrative relationship with the patients. In the setting of increasing amount of copays, coinsurance, and deductible – the patient is already coming out of pocket for the “first dollar” medical expenses. It is up to $2,500 per person right now, and quickly going to $5,000. So, if you are paying the first $2500-$5,000, it might make sense to take $500-1,500 of it to have a private physician advisor at your disposal for 24/7 hours per day. That’s it.

      And, if you read the article, the number of physicians who are dropping off of insurance panels (particularly Medicare) is going to rapidly increase over the coming yeasr. It may be 2% now, but will be 5% within the year, and moving to 20-25% over the coming years.

  2. Health Care in America, is like a Russian Bread Line.

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