direct pay

Concierge and Direct Pay

by timryanmd

I’m occasionally asked, “Do you have a Concierge practice?”  My answer is, “Yes and no” because it depends on how you define “concierge”.  If you define “concierge” as the type of practice that provides individualized care, great service and the attention you deserve when you see a doctor then yes, I have a concierge practice.

But most people who ask about a “concierge” practice (now often called “Direct Pay”) are probably asking about a kind of practice where patients become members by paying a fee of usually about $1,500/year.

This membership fee promises service for patients beyond what they might otherwise receive.  Better service is possible because the Direct Pay doctor keeps his panel of patients very small, maybe 500, so he therefore has more time to spend with each patient.  This arrangement is very good for the doctor because he has few patients and a lucrative income.  It is pretty good for the patient because they get more time with the doctor and improved access if they can afford it.  I don’t have this new type of “Concierge Practice”.

The main reason I don’t have this type of practice is because I don’t think paying all that money provides nearly as much value for patients as a straight fee-for-service model like what I offer at my office.

It is also often the case that people who need the most medical care do not have the resources to pay for entry to a Concierge Practice.  Who is going to see them?  I think my system can do it best.  My prices are reasonable and a good value for everybody.

Concierge, or Direct Pay, is an interesting alternative style of practice and I’m confident it will grow.  I hope the future of medicine allows good doctors to establish their own unique practices so patients can find the individualized care that suits them best.

Private information hacked

by timryanmd

Community Health Systems owns or operates over 200 hospitals in the United States.  Almost half of their hospitals are recognized as “Top Performers in Quality Measures by the Joint Commission”.  They are also participants in a Patient Safety Organization (PSO). According to Community Health Systems,

“PSOs were authorized under the Patient Safety Act of 2005 and are designed to improve the quality and safety of U.S. healthcare delivery. By providing both privilege and confidentiality, PSOs create a secure environment where clinicians and health systems can collect, aggregate and analyze data, thereby improving quality by identifying and reducing the risks and hazards associated with patient care.”

Oops.  Bloomberg that tells us that their data is not secure. The data was hacked. The article points out how

“Medical records are extraordinarily valuable for identity theft, as they contain all manner of personal information needed to take out credit and receive services in victims’ names. They’re most valuable, ironically, for the non-medical information they contain.”

Doesn’t it seem inevitable that despite the efforts of HIPAA more data will be compromised?  Unfortunately, our current healthcare system is obsessed with collecting a lot of data on every patient and sending it to out to several entities like the large corporate headquarter of the hospital or to an insurance company or CMS.  The data includes not only your name, birthday, social security number, address, phone number and insurance number.  It may include your credit card number.  It certainly includes many diagnostic and procedural codes that now define you to the payers and planners. Many of the codes are inaccurate.

The collection of this data is dangerous not only because it is inaccurate and can be compromised.  It is also dangerous because it takes a lot of time and effort to collect it.  Filling out the Electronic Medical Record with these codes is a high priority to your doctor and hospital and it detracts from the real work of caring for patients.

 

No Insurance Here

by timryanmd

Years ago, the doctor was paid directly by his patient.  While not a perfect arrangement, it worked very well for doctors and patients.  If someone was ill and didn’t have the money to pay, the doctor would help them anyway and receive payment later or not at all.  Patients were grateful and if they couldn’t pay, they would probably send other patients who could.  Doctors’ incomes didn’t suffer too much and they had great satisfaction in helping their neighbor or a stranger in need.  This is still the way it works at my office.

Taking money from an insurance company to treat a patient never seemed right to me.   It seems simple and honest for me to receive payment directly from the patients I treat.

Some might object, “but I can’t afford to pay the doctor!”  You might be surprised.  Let me show you a few reasons why it is better to pay your doctor directly.

First of all, you should actually be a little uneasy when a doctor is paid by a third-party because that means his loyalties will be divided.  The cold fact is that the doctor needs to accommodate those who pay him lest he go out of business or find himself unemployed.  Therefore the doctor will ultimately do what the insurance company says, and the insurance company requires doctors to do all sorts of irrelevant and wasteful tasks that have nothing to do with your care.

Third parties can also complicate reasonable decisions.  Imagine the scenario where a patient might have a simple, straight-forward problem like a tension headache.  If they are paying their own bill, they will be relieved when I tell them, “this sounds like a simple tension headache.  Try these few things and just let me know how things go.  You do not need a lot of tests or an MRI….”

If they have insurance, they are more likely to ask about the “free” MRI “just to be sure”.  And the doctor is more likely to order it.  Most of the time tests like this are a waste of time and money.

In addition, imagine how much money your doctor actually spends on overhead to deal with insurance!  He must purchase computers, software, printers, phone lines and pay for office space and staff in order to manage the insurance company.  What a headache.  Those costs are passed on to the patient one way or another.

Not using insurance can also make your visit safer.  Insurance rules are burdensome and confusing. They can turn a simple encounter into a labyrinth of documentation, approvals, unnecessary testing and other distractions that can cause chaos at your doctor’s office and more mistakes are likely.

Your doctor’s visit should be private.  Despite all you hear about HIPAA and patient privacy, the ironic fact is that the records in almost all doctor’s offices and hospitals are anything but private.  If you have insurance, your name is attached to a lot of billing and diagnosis codes that can be seen by a lot of bureaucrats who work for your  insurance company and the government.  Your data is not private unless you come to my office or one like it.  I do not send any information about you anywhere unless you tell me to or I am ordered by the courts.

You will be surprised how much farther your dollar will go and how much better your medical care will be when you pay directly. Look here and here for examples.

Have any questions? Just call 770-382-1984 or visit.