another way to approach the problem of low reimbursement is to keep your costs ultra low

expenses generally come from employees,( after figuring in costs of employee health insurance, workmens comp, paid holidays, paid vacations, paid sick days)

we end up working half the day just to pay for staff

second comes costs of rent/utilities/property maintenances

( many employees means large volume of patients needed, which means more rooms, bigger parking lot, bigger waiting room, bigger electrivc bills, etc….

third comes from malpractice insurance/licenscing fees/memberships/CME etc.

this practice model at first seems not feasible but I have learned recently that it is becoming widespread

http://www.aafp.org/fpm/20020200/29goin.html

it is possible to run a practice with no employees or just a part time one, very small ofice space (500 sq feet)

infact this style of practice is blossoming and there is a an active internet group on yahoo groups called family practice improvement which now has @ 300 memebers, many are doing these low cost practices

the limits of this practice certainly are many
small pt panel
limits on income ( but not too much less then a typical
2-3 employee practice)

the benfit is smaller patient panel where the doc really gets to know their patients, less stress and most of these practices limit the number of insurers they deal with so billing becomes easier.

these practice do not charge ” BOUTIQUE ” fees

Just over a year ago I had a great deal of tightening in my lower abdomen area, lower than my stomach.

Regular doctors wouldn’t see me because I didn’t have money due to the privy pit over which part of my condo had been built (causing hydrogen sulfide to be in my home, among other things) so I had to go to the emergency room. Only that was an initial wait of 5 hours, by which time I decided they didn’t think I was really sick. So, maybe I wasn’t, I faultily reasoned. (I genuinely have a bit of brain damage from low B12 and the hydrogen sulfide, as well as a fall caused by the hydrogen sulfide.)

When I managed to get a doctor to see me at her office, a light touch on my stomach caused contractions in my back muscles that were screaming painful, so the doctor called the ambulance and wrote down that I had an appendix problem. (She didn’t ask if I still had my appendix, which I don’t.)

Because of my brain damage and the pain – I was screaming – I failed to tell the ER docs that there were three things I wondered about… bad eggs that I’d eaten, the needle jab I got in my toe after gardening, and the cold in my house because I was afraid to turn up the heat.

Instead of giving the doctors a choice, I said I was afraid I had tetanus.

Now, there was no swelling on my foot or toe. There were some minimal red/taupe lines under my toe nail. There was no fever. And the muscle seizures didn’t happen if I held myself perfectly still, which of course I did since I was terrified of them happening again.

The ER doctor called down someone from the psych ward and I was duly diagnosed with paranoia.

Luckily they decided to give me some antibiotic to “humor” me.

When I went back about a month later because the muscle contractions where I have peripheral neuropathy were extremely painful, they said well for sure I didn’t have tetanus because if I did, I would have died. So, no more antibiotic.

Between the time of the jab and February when I was diagnosed with tetanus, I ate many bottles of vitamin C which had the effect of reducing the red lines under my toe nail… so long as I also used Epsom salts.

In March I went to a doctor with less of a homeopathic persuasion and was prescribed Metronidazol in pretty stiff doses, over a pretty long time. And that made a complete and huge difference.

But, I am still without the strength I used to have, and it takes very little stress to cause the weird cement feeling of tightness in my lower abdomen (way beneath where my stomach is.)

So, it seems to me that a boutique via the internet with some kind of access to proper prescriptions, as opposed to homeopathics, could be arranged to provide healthcare to the impoverished (like me last year) for a monthly subscription rate that would be little more than what I paid for Pre-Paid Legal.

Today, now that I’ve sold one of my rentals, I am not eager to return to doctors who refused to see me when I was poor.

The upshot, therefore, is that I can see the need for doctors to make a living, but there really needs to be some more efficient way for poor people to get proper healthcare.