06/03/2026
WHY PI? HERE YOU GO!
Here is an article I read that only highlights even more the “Why PI”, and fitting directly into the need to treat patients as soon as they present versus the hurdles that modern medince has in place that delays or denies care, or causes patient abandonment.
This article is about cash pay because then you don’t have to mess with insurer pre-authorizations or denials or delays. So really if you think about it, PI really stops delayed care, and delaying the care patients want and that you believe will be a difference maker – oh …. and it pays at the highest rate too.
While cash-pay requires the patient to come out of pocket for the care they need, in PI, most of the time it is the PI lawsuit that covers that care. So when you really think about it, PI is not just a unique practice segment, but literally can be the lead segment in not just “net profit” but also “timely patient improved health outcomes.”
The cash-pay revolution
Monday, May 18th, 2026
As reimbursement challenges and administrative burdens continue to squeeze physicians, cash-only and direct primary care models are gaining ground.
Medical school debt, burdensome paperwork and declining reimbursements are the primary factors driving physician interest, and ASCs are increasingly exploring the same path as insurance reimbursement becomes harder to secure.
When insurance can’t keep up with medicine
Insurers’ inability to keep pace with rapid advances in biologics, diagnostics and AI-enabled care is pushing more physicians, and patients, toward cash-pay options. “Insurance companies lag behind the science and speed at which medicine advances,” said Joshua Siegel, MD, director of orthopedic sports medicine at Access Sports Medicine and Orthopaedics in Exeter, N.H., told Becker’s.
He pointed to the growth of functional medicine and advanced diagnostics, including programs such as Galleri, that have expanded while insurers “sort out if and how to respond or pay.”
The pattern is a familiar one: New services launch as cash-pay, build clinical momentum and patient demand, then eventually get evaluated for broader coverage. Dr. Siegel has watched this play out over the past decade with treatments like Class IV laser therapy and extracorporeal pulse activation technology.
AI is also reshaping how patients navigate these choices. “AI tools allow patients to be their own advocates and search for doctors who will provide what they want,” he said. “The days of providing a limited scope of services and not informing patients of their many choices are over.”
The regulatory patchwork
On the federal side, a significant barrier was recently removed. The One Big Beautiful Bill Act, which took effect Dec. 31, eliminated the disqualification issue for individuals contributing to an HSA while participating in a DPC arrangement. This means patients can now use pre-tax HSA funds to pay DPC membership fees. Previously, enrolling in a DPC practice could disqualify a patient from contributing to an HSA entirely, a meaningful deterrent for cost-conscious consumers.
Who gets left out
Cash-pay and DPC models have a well-documented equity problem: They work best for patients who can afford them.
The subscription structure, while often more affordable than traditional insurance premiums for healthy individuals, creates barriers for lower-income patients, the uninsured and those with complex or chronic conditions who require more than primary care. DPC practices are predominantly concentrated in urban and developed regions, leaving rural populations underserved, according to research from Straits.
https://www.beckersasc.com/asc-coding-billing-and-collections/the-cash-pay-revolution/?origin=ASCE&utm_source=ASCE&utm_medium=email&utm_conte
