Saturday, November 18, 2006

How do you value yourself?

Ah, the quandary is the meeting of medical care with financial reality. As a solo practitioner, you are forced to attach a value to what you do. I never thought of that before opening my own private practice. Valueing, i.e. assigning a price to what I do, was a foreign concept to me. After all, in residency we never dealt with billing. There was no business of medicine course. But wait! Medicine is a business. It's a BIG business! So big that year after year the major health insurance plans are reporting RECORD and GROWING profits, whereas physicians' reimbursements are dropping. But, I digress. The dilemma is assigning a $ value to what we do then charging for it. Medical school didn't teach us this. But this is a concept that the street is very familiar with. After all, we live in a world of assigned and perceived values for all types of goods, both tangible and intangible.

So when you're running your own practice, and you're starting up, what do you do when someone comes to you in a supposed "bind" because they don't have a job or no insurance and they want to get a freebee from you? It's hard, because the resident in you may want to reach out with your heart and help this poor soul, but the growing businessman or woman in you knows that you need income to exist and provide valuable medical services to all of your patients. After all, if you don't value yourself, your patients won't either. Where does it end? Next thing you know, you're running a free clinic and have no cash to put a roof over your head. The problem is that with the onslought of the insurance-run world, people have come to believe that medical care is their right. Perhaps it is, but it's then up to the government to come up with universal healthcare for anyone who can't afford their own. Every other service business charges fees for its services which are standard and accepted, and in many instances (like in the case of lawyers) way higher than any private medical office fees.

What prompted this post is a patient I have never met asking me for free medical care and a prescription, without being an established patient in my practice. This patient wanted to get a freebee because they did not currently have health insurance or a job. My belief is that one's health is an investment. And that the service I provide, which goes beyond the single-problem single-solution type of Western medicine, as I like to address the whole individual, has far greater value than any price tag I can attach to it. However, I do help people out with discounted rates if they are insurance-less and have low or no-income. I believe in being fair, but I do not believe in giving out free medical care in the setting of my private practice (unless it is an emergency in dire circumstances), because often I've seen these very same people that are asking for free medical care going for facials, botox, hair-coloring, or carrying the latest ipod. I believe that if they can allocate finances for non-essentials, they can pay for a visit and in so doing show appreciation for the energy-exchange that has occurred to benefit their health. Even if it's only a small charge, if you give away your professional services, you're telling the world you don't value yourself, and in return you won't attract value to yourself. Perhaps my readers may have differing opinions? If so, do share.

Why do I think this way. Because I believe that if you do not value yourself, others won't value you, and you are bringing scarcity into your universe. The world has decided to operate with money. It is an energy interchange for services rendered. This was the way medical care was provided in the middle of the last century -- fee-for-service. I'm not saying everyone should have to pay for the their medical care, but having a person be directly involved (financially) in their medical care is a greater incentive for them to follow recommendations and improve their health. This is the reason that insurance plans came up with the concept of a copay, so that individuals would have a vested interest in their own care and their access to care. If along with a discounted rate, you can give the patient a bunch of samples, right there you've saved them a tremendous amount of money.

What people haven't realized is that physicians aren't necessarily the costliest part of medical care. It's prescription medications, monthly health plan premiums, and the waiting until a problem is too big to deal as an outpatient that the person has to undergo a costly hospitalization. In some ways those expensive monthly premiums are not insurance -- they are PRE-PAYMENT for health services. Perhaps if we started focusing on PREVENTIVE and PROACTIVE health care, the overall cost of providing care would go down.

Again, I believe one's health is an INVESTMENT. Exchanging something of value ($ or in the case of my country doctor grandfather in the middle of the last century, it may have been a chicken) for care is merely how the world works. Don't ask me for a freebee. It shows me that you do not value yourself nor me. Otherwise, when I don't have to worry about supporting my family and paying a mortgage and costly business expenses created by the medical-legal-insurance complex (i.e. malpractice insurance and a biller to chase after all of those forgotten, underpayed or incorrectly denied claims), along with the rising cost of living, I'll go do charity work in Africa or volunteer at a free clinic downtown. In the meantime, please value yourselves!


Blogger Dia DiCristino said...

I agree with you. You shouldn't give out "freebees" to poor sick people who would rather save up for an ipod, then pay out of pocket for health insurance that they shouldn't have to pay for in the first place.

The thing is, we do have the right to health care. It is just pathetic that America has turned into this money grabbing country that only cares about making a profit.

Another thing to think about. Sometimes, like in my case four years ago, a patient is willing to fork out hundreds of dollars a month for health insurance, but gets DENIED insurance because of a pre-existing condition! Then suddenly this same person becomes very ill and has no way to cover the 100,000 dollar a surgery bills.

Everyone has a story doctor. Not every person wants to cheat you out of money for free medical advice. Next time, tell your patient to look their symptoms up on Google and see what they come up with. HAH!

2:43 PM EST  
Blogger Medicine Man said...

Like I said I would never deny healthcare in an emergency under any circumstances (i.e. insuranceless), otherwise, I have to assign value to what I do for non-life or death situations. Wouldn't you also like that restaurant down the street to give you a free meal because you happen to be short on cash? It's not about being money hungry, it's the way the world turns (unfortunately).

1:24 AM EST  
Anonymous Bonnie said...

As a struggling acupuncturist, I used to do freebies. They were the worst patients. I'd end up spending my time showing up only to have them no show. Now, I discount my services after a lot of patient negotiation. I'll drop to a $10.00 or $15.00 service (average co pay in my area) but I won't do it for free.

The whole fee thing gets me. I guess I do care about my patients a lot more than the money, but I also have to eat. Nice blog.

9:20 PM EST  
Blogger Dia DiCristino said...

You obviously did not grasp the point I was trying to make which was: sometimes people have money to pay for insurance but still are not allowed to get it.

As for your comment about having a free meal at a restaurant--not everyone would want that. I for one wouldn't even trust the food was edible if it was free. I like quality over quantity. I think many people are the same.

7:54 AM EST  
Blogger Medicine Man said...

With regard to having money to afford insurance see
Good News for HMOs
. O/w I understand what you are saying, and I don't believe it is right. For example, I have a patient with Hepatitis C who can't switch insurance because no other insurance carrier will offer them reasonable rates with a pre-existing condition. Unfortunately, this patient has also been enrolled so long with the same insurance to see the trend of decreasing payments and unwillingness to pay for services that they once paid for 10 years ago. It's not right.

Like I said in another
, I am angry at how insurance is limiting access to care by refusing to pay or limiting the number of visits. Refusal to cover a pre-existing condition is yet another example of how they are distorting access to care. That same person in the US might be able to get on disability and qualify for Medicare/Medicaid, but that's not necessarily the best solution.

10:42 AM EST  

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