Why The Doctor Takes Only Cash

Fixed-price clinics offer a glimpse at the post-Obamacare world

- Haley Sweetland Edwards

WHEN ART VILLLA FOUND OUT, AFTER ONE TOO many boating accidents, that he needed a total knee replacement, he began asking around to see how much it would cost. The hospital near his home in Helena, Mont., would charge $40,000 for the pro­cedure, he says. But that didn’t include the anesthesi­ologist’s fee, physical therapy or a stay at a rehabilita­tion center afterward. A 2015 Blue Cross Blue Shield study found that one hospital in Dallas billed $16,772 for a knee replacement while another in the same area charged $61,585.

It was in the midst of this confounding research that Villa, who’s 68, heard about the Surgery Center of Oklahoma, whose business model is different from that of most hospitals. There, the all­inclusive price for every operation is listed on the website. A rotator­ cuff repair for the shoulder costs $8,260. A surgical procedure for carpal tunnel syndrome is $2,750. Set­ ting and casting a basic broken leg: $1,925.

The catch is that the whole facility is cash­based. It doesn’t take insurance of any kind. Not Aetna. Not Cigna. Not Medicare or Medicaid. Patients or their employers pay whatever price is listed online, pe­riod. There are no negotiated rates, no third­party reimbursements and almost no paperwork. “We say, ‘Here’s the price. Here’s what you’re getting. Here’s your bill,’ ” says Keith Smith, who co­founded the Surgery Center in 1997 with fellow anesthesiologist Steven Lantier. “It’s as simple as that.”