http://www.medrants.com/archives/4751 Internal medicine, American health care, and especially medical education Sat, 11 Feb 2012 15:15:48 +0000 hourly 1 http://wordpress.org/?v=3.3.1 http://www.medrants.com/archives/4751/comment-page-1#comment-529185 qliance | Latest News | Hot News | Recent News Mon, 07 Sep 2009 04:11:35 +0000 http://www.medrants.com/?p=4751#comment-529185 [...] Are retainer practices the model for PCMH? [...] [...] Are retainer practices the model for PCMH? [...]

]]> http://www.medrants.com/archives/4751/comment-page-1#comment-528947 Dr. Mintz Sun, 09 Aug 2009 21:52:38 +0000 http://www.medrants.com/?p=4751#comment-528947 What's interesting about Qliance is that it is not really a retainer practice. Most concierge or retainer practices charge a year fee (sometimes quite hefty) which usually includes a physical, but the fee is generally just for access, not care. Most retainer/concierge physicians charge their patients for services rendered and also do not accept insurance. The Qliance model basically says that for about $600-$950 a year paid in monthy installments, all your primary care needs can be covered AND you can have pretty good access. This model, and not the traditional retainer model, might be a good PCMH model that most can afford. What’s interesting about Qliance is that it is not really a retainer practice. Most concierge or retainer practices charge a year fee (sometimes quite hefty) which usually includes a physical, but the fee is generally just for access, not care. Most retainer/concierge physicians charge their patients for services rendered and also do not accept insurance.
The Qliance model basically says that for about $600-$950 a year paid in monthy installments, all your primary care needs can be covered AND you can have pretty good access. This model, and not the traditional retainer model, might be a good PCMH model that most can afford.

]]> http://www.medrants.com/archives/4751/comment-page-1#comment-528946 solo dr Sun, 09 Aug 2009 20:44:51 +0000 http://www.medrants.com/?p=4751#comment-528946 Currently most patients with chronic diseases are seen around four times a year for between $40-$90 an office visit with the average around $55. Insurance companies and Medicare collect thousands of premiums from patients, employers, and taxpayers. The primary care providers get a very small piece of the pie. Most my my HMO/PPO contracts have clauses that state I have to be availabe to my patients 24/7 or have arrangements for coverage 24/7. I had to weed out the patients the first few years in practice who called me for pap smear results or other routine results at 7 PM at night or who called me at 3 AM for 5 days of a dry cough. Under the current system most care is free and work outside of office visits cannot be billed to the insurance companies or the patients. Part of the problem with our current payment system is the AMA and their magic CPT codes. The CPT codes that are payable for office visits do not cover paperwork, phone calls, etc. Other CPT codes exist for phone calls and paperwork, but Medicare and most private insurance plans refused to reimburse for them. Regarding visit times, extended visit codes exist, but most private plans only add $20 extra for an extra 15 minutes with the patient, when that same 15 minutes would be another $55 with an established patient. A comparison is my accountant, who charged me $90 for an email asking how much taxes I should pay on a retirement contribution. A final thought is that retainer practices usually entail younger or wealthier patients, as most Medicare and Medicaid patients cannot afford retainer practices. Currently most patients with chronic diseases are seen around four times a year for between $40-$90 an office visit with the average around $55. Insurance companies and Medicare collect thousands of premiums from patients, employers, and taxpayers. The primary care providers get a very small piece of the pie. Most my my HMO/PPO contracts have clauses that state I have to be availabe to my patients 24/7 or have arrangements for coverage 24/7. I had to weed out the patients the first few years in practice who called me for pap smear results or other routine results at 7 PM at night or who called me at 3 AM for 5 days of a dry cough. Under the current system most care is free and work outside of office visits cannot be billed to the insurance companies or the patients.
Part of the problem with our current payment system is the AMA and their magic CPT codes. The CPT codes that are payable for office visits do not cover paperwork, phone calls, etc. Other CPT codes exist for phone calls and paperwork, but Medicare and most private insurance plans refused to reimburse for them. Regarding visit times, extended visit codes exist, but most private plans only add $20 extra for an extra 15 minutes with the patient, when that same 15 minutes would be another $55 with an established patient. A comparison is my accountant, who charged me $90 for an email asking how much taxes I should pay on a retirement contribution. A final thought is that retainer practices usually entail younger or wealthier patients, as most Medicare and Medicaid patients cannot afford retainer practices.

]]> http://www.medrants.com/archives/4751/comment-page-1#comment-528943 NPs Save Lives Sat, 08 Aug 2009 21:20:12 +0000 http://www.medrants.com/?p=4751#comment-528943 I would love to be able to work in that type of environment where one doesn't have to answer to the insurance conglomerates. I do have some of those features in the rural health office that I work in. We have onsite lab, pharmacy, and X-ray capabilities. I tend to take longer with my patients and they appreciate it. Because I've become much busier, it's taking much more speed than I like to in order to get them in and out in a reasonable period of time. This forces me to take charts home to work on after hours and it's eating into family time. I'm glad that I love being a nurse practitioner so much and that I love taking care of my patients or I would be burning out right now. I would love to be able to work in that type of environment where one doesn’t have to answer to the insurance conglomerates. I do have some of those features in the rural health office that I work in. We have onsite lab, pharmacy, and X-ray capabilities. I tend to take longer with my patients and they appreciate it. Because I’ve become much busier, it’s taking much more speed than I like to in order to get them in and out in a reasonable period of time. This forces me to take charts home to work on after hours and it’s eating into family time. I’m glad that I love being a nurse practitioner so much and that I love taking care of my patients or I would be burning out right now.

]]> http://www.medrants.com/archives/4751/comment-page-1#comment-528940 Stefan Fri, 07 Aug 2009 19:10:04 +0000 http://www.medrants.com/?p=4751#comment-528940 In the last year or so I have seen several other reports, sometimes from small local newspapers, of similar practice arrangements. It looks promising In the last year or so I have seen several other reports, sometimes from small local newspapers, of similar practice arrangements. It looks promising

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