Dear Editor: I want to bring to your attention a growing national movement for self pay in medical care. Two family doctors, Vern Cherewatenko, M.D., M.Ed., and Dave McDonald, D.O., in Seattle, Washington, have developed a concept they call SimpleCare, as well as a non-profit organization –the American Association of Patients and Providers. To learn more than I can explain in one letter, you may want to visit their web site: www.simplecare.com I have been talking with these men for the past few months, have joined AAPP, got a chance to be interviewed on their talk radio show, and hope to work with them in training physicians how to make the transition from an insurance dependent practice to a SimpleCare practice. Their approach is highly compatible with approaches favored by those of us in the mental health community practicing outside of insurance. History: Cheretawenko and McDonald had been running a number of family practice clinics in Seattle; in fact they had the largest IPA in Washington state. They worked hard to practice within the guidelines of managed care. As a result they lost $80,000 per month, as follows: Their charge for a ten minute office visit was $79. Insurance companies were typically reimbursing $43. It cost them up to $20 to chase down that $43. That left $23 to pay their $30 worth of overhead. Thus they were short $7 a visit. Obviously they had to come up with an alternative or shortly be put out of business. They began offering patients their “best price” if the patient is willing to pay in full at the time of the visit. “Best price” is a key concept. Physicians typically have relatively high charges that they almost never collect from third party payers. The only people who wind up paying full fee to their doctors are the uninsured, who have no choice but to pay cash. (Isn’t that ironic?) Present: Cherewatenko and McDonald now charge $35 for a 10 minute visit, $65 for a 20 minute visit, and $95 for a 30 minute visit to those patients willing to pay in full at the time of visit. This also is their entire coding procedure, i.e., visits are coded as S, M, or L (short, medium, and long). The CPT book becomes unnecessary for these patients. The doctors are now making a reasonable profit and find that patients, including the uninsured population, are delighted. The doctors are not discounting their fees but rather are offering cash patients their “best price.” They have found that about 80% of the uninsured are not poor and can afford the “best price” pledge that provider members of AAPP make, i.e., the pledge is to charge cash paying patients their best price for the service. The amounts listed above are simply examples of what Cheretawenko and McDonald charge. AAPP members determine their own charges as they see fit. (AAPP has also come up with an approach for those who cannot afford the “best price,” which you can find on their web site.) SimpleCare puts patients and doctors back in charge of health care decisions and healthcare relationships, automatically (in my view) improving overall quality. It removes a great deal of unnecessary complexity and interference. If widely adopted, the national savings on outpatient medical care is likely to be substantial. The approach offers many advantages over our current “system” as well as a single payer system. The market for this approach includes the uninsured, as mentioned, and people who opt to have high deductible catastrophic coverage oriented policies, perhaps supplemented by a Medical Savings Account. SimpleCare has been getting a growing amount of national press. NBC Nightly News has filmed at their offices, and stories have been in such publications as Forbes and USA Today. Dana Ackley Editor’s Note: This originally appeared on the Division 42 Listserv and Dr. Ackley gave permission to print it as a letter to the Editor. SimpleCare’s web site address is: www.simplecare.com.