They didn't bring enough to cover their overhead, but most primary care physicians who for one day allowed uninsured patients to pick their price say they'd like to do it again at least once a year.

The concept of ‘pay-what-you-can days' grew out of a listserv discussion among physicians lamenting that primary care doctors were underappreciated and underreimbursed, reports The American Medical News.

In the ensuing experiment, a handful of doctors throughout the country each chose a different day to treat patients with no insurance (including Medicare) and asked them to pay only as much as they could. Laboratory tests were provided at cost, and patients who needed additional services were referred to various public resources. Practices also handed out lists of generic medications available for reduced prices at large, discount pharmacies. 

Although providing any payment at all was completely optional, most of the doctors said it was important to ask for something so that it would sink in with patients that there was a cost to the services they provided. "I would rather patients place their own value on the service than come right out and say it's free," said Gary Seto, MD, a family physician in South Pasadena, Calif.

Coincidentally, the pay-what-you-can model is also being tested by one nonprofit outlet of the Panera Bread restaurant chain, as the company's former CEO says he is "trying to find out what human nature is all about," notes The Wall Street Journal's health blog.

Although the practices' collections didn't match what the doctors would bring in with copays and insurance on a typical day, the physicians learned that, regardless of how payers or the government decide to reimburse them, that patients valued the care they received, even those with little to spare.

"I was very interested in what people paid. Some scraped up $20, some paid $60 to $80," said Jean Antonucci, MD, a family physician in Farmington, Maine. One patient, a waitress and college student, paid $80, mostly in singles. "I gave her $20 back. She couldn't afford it."

Beyond this vindication and the gratification of helping the uninsured, the physicians also enjoyed a day of freedom from awkward financial discussions and insurance paperwork. Participating practices also benefited from the positive media attention given to the event and the goodwill created with the patients they treated, who may one day return when they have insurance, and the community at large.

The pay-what-you-can day "definitely got recognized. We know we did the right thing," said Will Conner, MD, a family physician in Matthews, N.C. "It's not very practical to do every day, but it is good for the community, and good for patient care."

To learn more:
- read this article in The American Medical News  
- check out this post in The Wall Street Journal health blog

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