ROCKVILLE, Md. -- It began as a kind of experiment, says Alan Kravitz, a board-certified general surgeon with offices in Rockville and nearby Germantown, just outside Washington, D.C.
About five years ago, as the national economic recession was kicking in, Dr. Kravitz's solo practice started seeing fewer patients but more of those patients had no health insurance.
He noticed something else, too: While the insured patients enjoyed steep discounts negotiated through their insurer, the uninsured -- those least likely to be able to afford it -- got charged full freight. His thought: "It's completely upside down."
So Dr. Kravitz set about constructing an Internet-based practice catering to uninsured patients with hernias. Where someone typically might pay $6,000 to $9,000 at a hospital to repair a hernia, he charges a flat $1,900 fee.
His approach is simple, yet it has a revolutionary feel -- after getting a local surgical center and anesthesiologist to buy in on the set-fee idea, he has squeezed every efficiency he can into a procedure that takes about one hour to complete and rarely has complications.
"He's the Henry Ford of medicine," said Brian Friday, an uninsured Monroeville-area handyman who had Dr. Kravitz repair his double hernia last year. "He has an assembly line organization -- a place for everything and everything in its place. And he makes it affordable for everybody who needs it."
The process is simple: Anyone Googling search terms such as "cheap hernia surgery" will bring up ads from different physicians, including Dr. Kravitz. What stands out is his fixed, all-inclusive fee.
Physicians traditionally don't post a price list, he noted, and there's a certain financial risk involved. If the operation takes longer than expected, due to scarring from previous surgeries or some other complication, the price remains the same. But he thought the expected increase in patients would lessen that risk.
"The experiment was to offer heavily discounted hernia surgeries that made money through increased volume."
Once patients contact the office, they get a return call from Dr. Kravitz. Because most of the patients come from out of state, he wants to make sure they actually have a hernia and that there aren't any other medical issues, such as a heart condition or breathing or clotting problems, that would preclude surgery.
Patients typically can get in within two to three weeks and may head home that day.
Today, Dr. Kravitz, 54, can perform eight hernia procedures in a day at a local surgical center. More remarkable has been his reach -- in one 24-hour period last week, his office fielded inquiries from Eastern Pennsylvania, Tennessee, California, Texas, Arizona, Florida and Indiana. After someone called from North Dakota about a month ago, he says, the office has now seen patients from all 50 states.
"I knew that if you get the [patient] volume up, it would be both good business and good for the patient," he said. The practice buys supplies in bulk now, lowering the cost, and a local hotel has started offering discounts for his patients. "It actually kind of feeds on itself."
More importantly, he added, he and his team have honed their skills as the number of patients they treat grows, using smaller incisions, and moving more quickly and efficiently.
"When you do the same thing over and over again, you get more efficient with time, and so does the surgery center and the anesthesiologist," Dr. Kravitz said. "If you have the same team set up, doing the same thing, you get better."
While the Internet hernia business represents about 60 percent of his work week, Dr. Kravitz also maintains a private practice for other surgeries on the thyroid and breast, as well as gall bladder removal. Those and similar procedures also could be routinized, he believes. "There's no reason you couldn't have a transparent marketplace for all kinds of procedures."
Hernias, because they can be caused by pressure on the abdominal wall from heavy lifting or other manual labor, often occur more in people whose jobs do not include health insurance, so many see Dr. Kravitz's approach a godsend, both because of the cost and the care.
"He's attentive and he cares about helping people," said Mr. Friday, who endured nearly 18 months of pain from his hernia because he didn't think he could afford to get it fixed before finding Dr. Kravitz.
While few of his Internet hernia patients have health insurance, Dr. Kravitz estimated "90 percent are working and pay taxes. They are not mooching off of anybody. They just happen to have landed in jobs that don't provide health insurance."
The patients typically come from smaller towns, he said, and include the expected farmers, landscapers, pizza delivery drivers, the self-employed and substitute teachers who don't have health benefits. But there have been dentists and doctors, airline pilots and one former National Basketball Association player as well.
They also include people trying to enlist in the military or who are in line for a new job but can't get accepted or hired until their hernia is fixed. "They want to get in the system, but the system won't let them."
Across that wide spectrum of backgrounds, though, his patients share one trait, Dr. Kravitz said -- they are shrewd health care consumers. Unlike those with insurance, they are keenly aware of what they're buying and how much it costs.
"In a way, it's more rewarding to me when you're providing care for people who can't get it," Dr. Kravitz said. "That's a great feeling. It has a value that's greater than the reimbursement I get."
Steve Twedt: email@example.com or 412-263-1963. First Published July 7, 2013 4:00 AM