One of the most frequently asked questions I hear is, “when are you going to franchise?”  This is such a great compliment, and I have been so humbled by this remark, that I haven’t really given much thought to how to answer.  My initial answer was something like, “you are too kind.”  Then I went another direction, saying, “..as long as patients are willing to travel to see us, it doesn’t make sense to replicate what we have done, not that my staff (the true strength of our facility) could be easily duplicated.”

I now realize that while nothing is really wrong with the answers above, the real truth lies elsewhere.  The real answer is that we don’t have enough profit built into our pricing to franchise.  


I have said for some time “..don’t you think seeing all of the hospital expansion and building, that they’ve overdone the cost-shifting thing just a bit?”  The capital needed to metastasize (as the hospitals have done) has its origins in the overcharging, the price-gouging that is so commonplace in these institutions.  The new buildings and satellite clinics you see everywhere with the expensive hospital logos are the smoking gun of the high cost of health care, virtually all of which oozes from the institutional, hospital charges.

To the question, “why don’t you franchise,” I will now say this:

We have decided to charge patients for their care based on our cost plus a margin, a margin that does not include a percentage necessary to build an empire.  There is nothing keeping other facilities already in existence (all over the country) and operation from revealing their prices and doing so upfront.  In order to stay competitive with what we predict will be a large number of price-transparent and free market competitors, we are not going to build into our price the disadvantage of expansion.

G. Keith Smith, M.D.