Unsung Hero: An Oklahoma doctor brings the market back to medicine

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Posted: Nov 18, 2016 8:23 PM
Part 5 of 8 in the series Unsung Heroes

Dr. Keith Smith admits he’s a throwback.

“Whenever I give a talk or lecture, typically the first thing I tell people is that I shouldn’t be here.”

The Oklahoma City anesthesiologist was running his practice full-time in the early 1990s when he decided it was time to change the equation.

So he and a colleague created the Surgery Center of Oklahoma, a facility that accepts only cash payment instead of billing insurance companies or the government.

While that might sound like a drastic step, the decision to abandon the modern medical morass really wasn’t that hard.

“We thought, ‘let’s just open our own place and get away from these lunatics and not deal with the federal government,’” Dr. Smith said, as he recounted the discussions prior to the center’s opening. “We decided we were going to be honest and fair with our pricing and not deal with the feds. And that was our mission.”

Dr. Smith’s dedication to free markets is why the Surgery Center of Oklahoma has been a success, with patients including members of the Oklahoma City Thunder, University of Oklahoma Sooners and Oklahoma State Cowboys.

But it’s not just athletes who go to the Surgery Center to get treatment. Dr. Smith has had patients from all across the United States and Canada fly into Oklahoma for treatment. He said it’s because people know what they’re getting.

“You know with our facility, the reason that the prices are so comparatively low is that we’re not trying to hit a grand slam on the facility charge,” he said.

Dr. Smith also pointed out the Surgery Center doesn’t try to gouge patients on administrative costs because he’d have to justify the charges. He sees his job as not just being a medical advocate for patients, but a financial advocate, too.

Dr. Smith’s transparency has won praise from patients.

“Dealing with them was the easiest thing in the world,” patient Michelle Ray said. “I called to verify that the price listed on the website was inclusive and accurate. I made an appointment and they told me everything I would need before, during, and after surgery.”

Free-market advocates call it a viable alternative to dealing with government and insurance companies.

“It’s funny it’s being called innovation. It’s really not,” Oklahoma Council of Public Affairs President Jonathan Small said. “All Dr. Smith wants is for the purchase of health care to operate like the purchase of anything else you need. For years, the struggle of patients was just trying to get a price for routine procedures. Dr. Smith and his partners were able to do that. Now you see that all over the country.”

The practice has grown from two to about 40 doctors since it was founded. In its first year they saw about 1,000 patients. Dr. Smith said they have averaged about 7,000 a year since they began posting prices online in 2008.

But Dr. Smith’s “everything old is new again” concept was not an easy sell to the powers that be.

Dr. Smith said the state legislature attempted to get the Surgery Center of Oklahoma shut down in 2000.

He blames the Oklahoma Hospital Association for pushing legislation to require a tax on every physician or facility that did not generate 30 percent of their revenue from Medicaid, Medicare or charity care.

That would have forced Surgery Center of Oklahoma to accept government funds, something Dr. Smith wasn’t going to let happen.

“We had to work hard at the legislature to make sure to make that go away, and it backfired. We were attacked by our own health department,” he said, but “we ended up winning that.”

The legislature hasn’t tried to go after Dr. Smith and his colleagues since, and even adopted a market-oriented policy last year that allows state employees to use their self-funded plans at cash-only facilities.

Now Dr. Smith’s ideas are spreading beyond Oklahoma.

In 2014 he helped launch the Free Market Medical Association, which hooks up patients with like-minded doctors. FMMA holds conferences to show doctors how to make a cash-only system work.

Dr. Smith said the movement has benefited from widespread disenchantment with the 2010 health care law. And he expects it to grow.

“I’m optimistic about the practice of medicine in the United States than I’ve ever been before,” Dr. Smith said. “In the federal government’s attempt to take it over, it actually very paradoxically created a consumer market and it’s going well. It’s very exciting.”

Dr. Smith’s efforts to re-instill a philosophy that goes back to his great uncle’s work as a physician during the Great Depression — medical and financial accountability to patients — make him an Unsung Hero.