Richard Samuel, M.D., imagines a system where patients walk into a doctor's office, are seen quickly and pay their bill before leaving.
The doctor has less paperwork and no delinquent accounts. The patient does not have to worry about insurance claims and future bills, and may even see lower costs, said Samuel, a board-certified family physician who is opening such a practice in Hayden, Idaho.
"I want to be part of the solution as much as I can," he said. "We are heading into so many problems in health care, insurance costs are going up, and I know employers who are worrying they can't afford insurance for their employees."
Patients would pay during their visit. The office would be accessible to the area's uninsured or underinsured, those with some coverage but a high co-payment or a limited plan. He said both groups represent more than 25% of Idaho?s Kootenai County, or more than 26,000 people.
But he also does not want to turn away anyone who is already insured. Instead, he will tell them how to contact their own insurance companies to submit the bill, or put them in touch with Skills Connection, a local program that handles billing for $3 a transaction.
Without insurance to deal with, Samuel said he can charge lower fees.
The Idaho Medical Association said Samuel's approach is new for the area, but not nationally. It also shows a growing trend among doctors frustrated with the health care system.
"So many doctors are getting so fed up," said Bob Seehusen, association CEO. "You can see how people are thinking about trying something else."
He said most doctors went into the business of medicine to take care of people, not to battle insurance companies. But increasingly, doctor's offices are hiring higher numbers of office help just to handle insurance and regulations.
Samuel's staff will consist of a registered nurse and one other employee. He will try to prescribe generic medications and will not offer after-hours care.
"This way I can focus more on seeing patients at the office," Samuel said. "I'll also try to take same-day appointments or walk-ins."
He can see people who are on Medicare or Medicaid, but will make them sign a waiver that they cannot later bill the government for the service.
"If a patient of Medicare age wants to see me, that doesn't mean they waive all of their other benefits," he said.
Seehusen said the only possible downside he could see to Samuel's model is for patients who want to recoup some of their costs with their own insurance companies.