Monday, February 12, 2007

Is there a solution to the medical practice woes?

A fellow blogger, conciergedoc is giving us a fresh perspective on starting a concierge practice. Wherein I wrote in January about the micropractice, a low-cost alternative to the healthcare conundrum = rising costs/ falling reimbursements, the Concierge Practice offers another solution to this mess. The polls say doctors are depressed and unhappy (see Physician morale on shaky terms), but honestly, it doesn't matter what the polls say, no Internist or PCP I've spoken to across the entire country is happy with the system. No doctor has ever reported to me, "I love this. It's great!" How can you, when you're being skr@$ed every day by the insurance giants. Perhaps those in concierge medicine would sing a different tune. Personally, I've thought of all possible solutions, including a concierge conversion.

Currently, one of my doc friends on the West coast is converting his practice to concierge. It isn't easy, and no matter how great it is and how wonderful the promises, as conciergedoc points out, people are not yet running in droves to sign up for concierge care. It may not even be overly expensive, but the population mass has been educated to believe that healthcare should only be about copays, forgetting the fact that they may be paying several thousands per year for their substandard healthcare. It's all been a marketing victory for the insurance companies with their ever-expanding financial base. To be fair, they have created access. But again, like I've said in previous posts, Access =/ (does not necessarily equal) quality.

In this case, concierge doc's have created a system to make medicine more palatable for both parties. This is the same way for the micropractice, except that the micropractice physician still agrees to work within the system, by cutting operations to bare bones (Is it right the system has forced this upon us?), so as to become profitable on diminished returns. It's like a damaged airplane dumping fuel to increase the chances of a safe emergency landing. Ok, perhaps that is overly dramatic, but it may not be the best solution in the long-term.

For now, the micropractice may be able to somehow function within the quagmire of insurance codes, but what happens when they tighten the reigns, will the micropractice run into jeopardy at some point? Will the insurance companies never-ending ploys to NOT PAY, require the inevitable addition of a billing specialist to the practice payroll, thus reducing the functionability of the micropractice? Or will it be inevitable for the micropractice to join their concierge colleagues in providing essentially the same-promise of a Norman Rockwell-style medicine independent of the concerns of insurance payments.

Is there an in-between solution? Well, many doctors don't convert to concierge, but decide to go Out-of-network on certain insurance plans -- usually the ones that pay poorly. By going out-of-network, the patient has to pay until they meet their deductible (which may very well be in 1 -2 visits), then they only pay an agreed upon percentage of the total fee (say 20-25%). The kicker is that the insurance contract forces the insurance company to cover the other 75-80% of the billed amount. There is no such thing as "allowed" amounts! The insurance company has to pay what is billed, and that's that. So why aren't more docs going out-of-network? Probably because they fear their patients will leave them for the doctor next door still accepting the plan. This brings us back to what we can learn from concierge practices. You have to provide another level of service and commitment. This promise and the ever-important old fashion doctor-patient relationship is what will keep patients coming back.

Which one is the right solution?
1) Micropractice
2) Concierge practice
3) Cash practice/ Out-of-network

I'm not sure. Each has its own hurdles and potential set-backs. But I imagine that the happiest doctors are in 2) or 3). Let's face it, getting paid 6 months after you performed a service just doesn't cut it. Medicine is in crisis in this country, and the federal government may not be the one to solve it. Perhaps the way to bridge the problem of the lower half, the uninsured, while providing the greatest physician satisfaction (something law makers don't seem to be very concerned about) is to follow the Dr. Vic Wood's model. Would this solve the nation's health problems? How about low-cost primary care clinics throughout the country, with universal healthcare providing catastrophic coverage for hospitalizations and more complex issues, but the simple stuff left to the doctors, who can then benefit from providing good care.

How I ended up here, I'm not sure, but I'm just trying to find a solution for my medical practice woes. Perhaps the solution that can help the rest of the country is the one that makes BOTH doctors and patients happy. As it is now, the system is BROKEN. And unless I find some solution for my own woes, I may be tempted to leave medicine all together.

3 Comments:

Blogger The Independent Urologist said...

I read both your post and the article on Vic Wood's model. I'm not sure that you would be able to even make overhead with an annual capitation rate of $120 per family. Certainly not in NY. I do applaud your valiant efforts. It certainly is difficult and probably not what you had been led to believe it would be like when in med school or college. Good post and good luck.

9:25 AM EST  
Blogger Medicine Man said...

Well, prices have to be adjusted for cost of living. However, that rate is monthly, which equals $1440/year. For an individual, the rate was $83/mo or $996/year. It's a numbers game. The concierge practice is charging more, building on smaller numbers. Dr. Wood's practice is providing service for a larger group, lower cost, but making up for it by higher volume (is what it seems). Either way, the model does not have to wait to get paid by insurance, thus eliminating the need for a costly billing specialist or even an outsourced billing company taking a bite out of the profit.

2:02 PM EST  
Anonymous Anonymous said...

Yes! Don't wait for the federal govt to do anything! Any time they get their grubby little hands into anything, they screw it up. Let the physicians form a union - and convert to cash only practices.

11:56 AM EDT  

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