Please read this op-ed from the WSJ (kudos to Kevin for the link.)Finding a Medical Home May Be Just What the Doctor Ordered
But it makes sense to me that there be fair payment for primary care services that require a lot of what is now largely uncompensated work beyond an office visit. The cost would be peanuts, and the benefits of improved care could be enormous. What’s missing in the debate over our nation’s health-care crisis is that primary care is cheap. Cheaper than your cellphone bill. Cheaper than a tank of gas. Cheaper than dinner and a movie. It’s so cheap the average person doesn’t value it properly. I could have covered my salary for 2007 and the costs of all my staff and overhead for less than $20 per patient per month, including maternity and hospital care. My practice covers 80% to 90% of what the average person would ever need a doctor for. Compare that to what you or your employer is paying for health coverage, and you’ll find that the high costs are due largely to catastrophic illnesses, hospital charges and money going to middlemen.
Even though I’d like to, I can’t offer comprehensive primary care on a subscription basis for $20 per month. The Illinois Department of Insurance would send me to the slammer for running an unlicensed insurance company.
But most Americans could afford a package that combined $20-per-month primary care, $4 generic pharmacy prescriptions and some catastrophic coverage. If the combination was tax-deductible for the individual, then I think it would be a slam dunk. Netflix can rent you 4 movies a month for $23.99, but I’m not allowed to rent you a medical home for less than you’d spend to watch a movie each week. Before we’re saddled with an unaffordable national health plan, we should consider renting an affordable medical home.
Amen!
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{ 8 comments… read them below or add one }
A doctor in West Virginia tried a subscription service in a low income area and was ordered to stop by the state insurance board. Those complaining were the hospitals and insurance companies. The chief complaint was that they were loosing government reimbursement which was at a higher rate than the doctor was charging for office visits. It seems better to take financial advantage of the poor than to service their needs.
The result was after a long battle the doctor was allowed to proceed due to a special bill signed by the governor making this a test situation. We can only hope this test will be allowed to continue.
Steve Lucas
I don’t know how this could be (i.e. primary care is cheaper than all the things that the person listed). Where I live on the East Coast, an office visit averages $150-200 for primary care.
Pulling from conversations and things I am not suppose to know: here in the rust belt a doctor is reimbursed $40-60 for an office visit. In order to receive their money they will need a full time coder, with salary and benefits, along with a computer system, plus they will buy from the same people supplying the insurance industry the coding software. Upgrades become mandatory. The doctor still has the rest of his/her overhead to pay, rent, staff, office supplies, phone, copier, etc. There is also the issue of working capitol as insurance companies use denial of claims as a means to increase their profit. Essentially a doctor is working for everyone but themselves.
There are two ways to get money: 1 make it, 2 keep it. When a doctor opens an office taking insurance and with other contractual commitments they are in fact subscribing to the make it model. They will hire a staff and employ extenders in order to do the volume needed to cover expenses and still make a profit.
Concierge or pay for service doctors tend to work on the keep it model. Office space can be smaller since they have no need for coders and associated equipment. Service extenders can be limited since this is not a volume business. Working capitol can be smaller since cash is rendered at the time of service or in advance.
While this is a gross oversimplification the concepts remain valid. It is possible to lower price/cost to the patient while the doctor has a higher profit/income due to the elimination of overhead, not to mention lower stress since you are not responsible for all those people and overhead expenses.
Steve Lucas
I saw an endocrinologist for awhile who had a deal where you could pay a certain amount of money a year to schedule a certain number of visits outside of office hours. It was something like $150 for 4 visits and $200 for six visits. Of course, you still paid the cost of the visit, but you could schedule it at a time that didn’t require missing work.
I have to say I would pay my PCP a fair amount a month (or year) to be able to see her without missing work and it would make up for some of the time she spends on the phone with me when I can’t come in.
As a general model, subscription services to doctors seem like a great idea, particularly things like that endocrinologist’s deal. I’d take it in a heartbeat and it seems like it would be good for the PCP in most cases.
steve,
just to clarify, the 40-60 dollars per visit you talk about is the “doctor’s work” part of the total reimbursement per visit. There is another amount paid per visit, often about the same as the doctor’s work part for primary care, that is supposed to cover the pracitce expenses and malpractice. (at least in theory)
pcb:
thanks for the information.
steve lucas
Don’t expect private insurers to adopt the “medical home” model soon. This isn’t about patient care: it’s about profits. Primary care docs are a commodity and the goal is to play docs off against each other until physicians become salaried or leave the field.
As for projected cost savings because of decreased utilization that doesn’t matter to insurers either. They know that churn rates are so high, they won’t benefit from those later cost savings anyway?
I run a large medical marketing firm in Chicago and was in TV news for many years. Trust me, the MBA’s will keep the pressure on MD’s, even if patients pay the price as well.
PCB, The doctor’s fee/facility fee mostly just happens in the ER or similar places where there are 2 different entities billing the patient. In the clinic, we just get one fee. For an average established visit (99213) we get paid anywhere from $36 (Medicaid) or $49 (Medicare) up to $73 for our best paying insurance company. Our overhead is about $35 – $45 per patient in the clinic, that’s why nobody wants to see Medicaid or Medicare.