Retention is a second factor. One of the perceived benefits of a cash practice is that the doctor doesn’t have to prove medical necessity formally. That does not mean that he/she can be cavalier about the design and execution of the treatment plan. Patients are not fools and if what the doctor does isn’t making sense, the patients will stop coming. Moreover, the doctor must understand that the time saved by avoiding the notes and reports processes will likely be consumed by more comprehensive discussions with the patients.