WALLINGFORD, Vt. — The board in the waiting room tells patients what they'll be charged: $2 a minute for labor, $5 for an ear wash, $30 for a knee splint, $10 for a suture, $2 for a large bandage, $1 for a small one.
If it sounds like a mechanic's shop, that's what Dr. Lisa Grigg had in mind. While waiting at the garage for her car one day last year, she noticed a board listing charges and wondered why medicine couldn't be that simple.
Now she runs Simply Medicine, an acute care walk-in clinic where patients know what services they'll get and how much they'll pay. Grigg takes only cash as payment and doesn't accept insurance. The 36-year-old osteopath treats ear infections for as little as $8 and wraps simple sprains for $20. For a $40 flat rate, she'll make house calls.
"You put a board up and tell people what you're going to charge them and skip all the middle people. Just make it reasonable," Grigg said.
She said she doesn't need to make a lot of money and hopes to turn a profit next year.
About two-thirds of her patients have health insurance, and Grigg's services are no cheaper than the insurance co-payment they would make to see their regular doctor, she said. But for simple problems like a cold, most of her insured patients would rather walk in to Grigg's clinic than drive the often-congested seven miles into Rutland to see their doctors.
For more serious ailments, Grigg urges patients to see their own primary care physician.
Patients seldom have to wait long to see Grigg.
"This is just walk right in, look down your throat, $7. You're in and you're out," said Carol Martin, who works next door at the post office. She has health insurance and a regular doctor up the road, but she prefers the quick service Grigg offers.
"I went with a sore throat, and she gave me an antibiotic. I would have waited until it got worse" before seeing another doctor, she said.
Martin brought her daughter in, and it turned out the 16-year-old had mononucleosis. Grigg hand-delivered the lab results to the post office the next day, Martin said.
In the age of managed care, when patients don't always choose their doctors, this type of encounter is rare. The one-to-one doctor-patient relationship is an ideal to which Grigg wants to return.
"The other reward about doing this is helping to repair the doctor-patient relationship," the soft-spoken doctor said in her office, an old house converted into a clinic.
"I wanted a way to return some control to the patient, especially about time," she said. "A lot of people come in quite troubled, and you're supposed to be able to see them in between five and 10 minutes and you're always pushing people. I have a real distaste for doing that."
Now patients can talk to Grigg for as long as they're willing to pay. She keeps track with a stop clock in her office, which she punches only after she has introduced herself and had a minute to chat.
Grigg spent three years in family practice in Rutland before leaving the practice in July. Many of the patients were on Medicaid. She grew tired of writing and phoning insurance companies to fight for coverage.
"I was very frustrated by insurance," she said. "The demands don't stop."
Now her involvement with insurance is limited to giving patients receipts they can send to insurance companies.
Grigg is not the first to shun insurance. A group of doctors in Seattle set up a program called SimpleCare made up of 200 physicians around the country. The doctors offer patients who pay in cash their "best prices" on office visits. A husband and wife in Denver have set up a practice called HMNo. Drs. Heather Sowell and Jonathan Sheldon say they want to treat patients based on medicine and not insurance coverage.
Patients pay in cash. Sowell and Sheldon charge $80 for a 20-minute interview and $240 for a full hour. If a patient knows he or she has an ear infection, the appointment will be quick. The doctors even do house calls and take phone calls at home.
"It's odd that it becomes news when doctors simply rediscover our role as healers and passionate patient advocates," Sheldon said.
Skeptics say that though they appreciate the concept of doing away with insurance, it can only go so far.
"In concept, I think it's nice. Those of us that deal with the nightmare of insurance, government and regulation would love to be free of it," said Dr. Stephen Brittain, a neurologist at Rutland Regional Medical Center.
"I think it's very nice when patients are paying," he said. "They really will think about what they're paying for. Presumably the physician will also think about that. The problem is with all the higher-tech diagnostics."
Grigg concedes her approach would not work for more complicated cases, but for acute care--sinus infections, earaches, and sprains--the concept appears to be working.
Another doctor works at the clinic one day a week, and a registered nurse works part time, at half her emergency-room salary.
"Just because I believe in it so much, I'm willing to hang in there," nurse Jeanne Raiche said.
Patients cross the state line from New York and drive from Rutland to see Grigg. She figures she'll have to see nine to 11 patients an hour to make a profit; she hopes to reach that point next year.