By Debra Wood, RN, contributor
Troubled by the number of uninsured people disabled with chronic, uncontrolled health conditions, a nurse practitioner in Alexandria, Virginia, took it upon herself to open a cash-only, moderately priced clinic. She now views the treatment center as a model that could help solve the country’s health care access problem.
Nurse practitioner, Anne Boston Parish, has published a book outlining how to open a cash-only clinic that successfully serves people without health insurance.
“This model is successful and doesn’t cost taxpayers a dime,” said family nurse practitioner Anne Boston Parish, MSN, RN, CS, FNP-C, owner of the Queen Street Clinic.
Parish had previously worked in a nursing home and cared for many middle-aged patients facing life with debilitating conditions and limited options.
“The common thread on the [history and physical] was that they never had primary care. They were not eligible or couldn’t afford it or chose not to go,” Parish said. “When they actually got sick, they ended up in the emergency room.”
Armed with that knowledge, Parish decided to open a clinic and provide primary care for uninsured and underinsured men and women. She conducted a market study and found that 24,000 people in Alexandria lacked health insurance. She figured that if she could capture even 10 percent of those people as patients, she could keep the doors open.
“I was 48, and thought if I don’t do it now, I will never do it,” Parish recalled. “I’ve never had a challenge I couldn’t overcome.”
Parish knew enough about the area and its available community services to take the risk. She borrowed $75,000 against her townhouse to buy a rundown building and renovate the storefront. She quit her job and opened the Queen Street Clinic seven years ago. In the beginning, she worked six days a week, nearly 12 hours per day, to pay off the note.
Now she has cut back the clinic hours, offering services from 7:30 a.m. until 3 p.m. or 4 p.m. She answers her own phone and completes all of the back office tasks herself. She charges $60 cash for an office visit and offers lab work at discount prices.
“We don’t have to give away health care. People are willing to pay,” Parish said.
Some folks, however, expect free care. After having a few people leave without paying, Parish started asking all patients to pay for services up front, and she does not offer refunds. She accepts no insurance plans, recognizing that the cost of billing and collecting would drive up her overhead.
Many of her patients are working people who are temporarily unemployed, college students or young adults who have chosen to forego health insurance to save money. She serves an average of 120 to 150 patients per month, and has treated more than 20,000 patients since opening her doors.
The success of her clinic, which continues to operate in the black, prompted Parish to write a book, Confronting America’s Health Care Crisis: Establishing a Clinic for the Medically Uninsured, published by AuthorHouse. In it she proposes that the concept of cash-based clinics across the country could improve access to care.
“I hoped the book would reach someone of influence,” Parish said.
Parish recommends two or three nurse practitioners come together to open a clinic, allowing breaks for vacation while still providing coverage during office hours. She hopes benefactors will come forward with upfront funding, which the clinic could pay back.
“I would love to have a huge corporation buy my concept and take it all across the United States,” Parish said. “It would save taxpayers money in the long run.”
That hasn’t happened yet, but Parish maintains a positive, upbeat attitude. She gets up every morning convinced it will be a good day--a day when she can help others who are less fortunate and spread the word about the success that is possible with cash-only clinics.
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