700 dollars per pt per year times 600 pts equals 420000 dollars per year. What the overhead? If 50% or less, sign me up and get me out of this lousy job!

Dr Ory-
Your approach provides insight into how and why we are in the current mess. Qliance may or may not work, but it straightforrwardly states what it is and what it does, and you criticize it because “it does not solve the problems of society, lack of insurance for the uninsured, equity, etc.” It doesn’t rejuvenate wilted lettuce or hit the 3-pointer either. Do you really mean to imply that it’s not a concept worth trying because of these alleged deficiencies?
In medicine we have gone so far away from the concept of one person solving one problem at a time that we have painted ourselves into a corner where whatever we come up with has to solve every problem every time in every circumstance. That’s how we get thousand page health care bills in Congress that nobody has read, but everybody feels strongly about. I don’t know what specialty you practice, but in my field (surgery) I could see easily 50% more patients and do 50% more procedures if I did not have to comply with the hundreds of governments and insurance and JCAHO policies, rules, and regulations that affect what I do in literally every patients encounter. My office staff could be cut in half. My colleagues in primary care specialties agree, except that with their higher volume of patients their percentage is higher, sometimes up to 70%. Our compliance with these regulations is so ingrained that we would have to force ourselves to not comply- we would somehow feel a bit naughty if we did not hit all the bullets on the ROS when dealing with a straightforward problem, but after a while we would learn that sometimes simple problems can be resolved with one or 3 lines in the chart, and without recounting every items discussed in detail in the note.
Once, just once, I would be delighted to have someone propose a solution that requires fewer regulations, contains fewer requirements and mandates, and has more freedom of action for the doctor and patient. Qliance seems to be a move in that direction- note that it is a start-up, not a government or “not-for-profit” project. I wish them the best. I would be delighted to serve as one of their surgical consultants on the same terms- minimal documentation, cash up front, what I do dictated by the needs of the patient, not the insurance co or govt functionary. If only…

I like this model a lot, with my only reservations being about how to adapt it for a solo practice. I suppose if enough practices adopted it nation-wide, it could form a functional network “off the grid”.

My only quibble is that eschewing insurances won’t really cut documentation costs all that much. Even though you don’t have to document to be paid, you still have to document against liability. Just because you don’t take insurance doesn’t mean you won’t get sued.

Regarding the hassle factor: you may get out from under the thumb of third parties for payment, but they’ll still get you for all the prescription stuff (formularies and step therapy), plus precert for studies and imaging.

Still, I agree this is the direction we should be heading.

Most practices charge for FMLA and disability forms. Why not start charging for prior authorization forms for meds and procedures, telephone calls from patients, and other work? The answer is most insurance companies and Medicare bundle these paperwork and telephone codes into the office visit code. Even blood draws and simple urinalysis are being bundled into E&M codes with no increased reimbursement by about half the insurance companies for the average $55 office visit for an established patient.

A large city exists about 25 minutes from my practice. Some primary care city doctors charge each patient a retainer fee of $50-$70 a month just to be part of the practice, since there is a nationwide shortage of primary care doctors. Office visits for new patients are an hour and cost $200 minimum, and 20 minute established visits are an additional $100 per visit. A receipt is given with the billing codes so that the patient can file a claim with the insurance company and deal with denial hassles. The Monthly fee gives the person 24 hour access to the doctor, but after hours fees for called in meds are added. Most services are a-la-cart. This does select out a wealthier patient population. Currently the after hours care by phone and paperwork prior authorizations are done for free on insured and Medicare patients. Until doctors learn the value of their services and that doctors can exist without insurance companies but insurance companies cannot exist without doctors, the fees for insured patients will continue to be sub par and insurance companies will continue to reap the high premiums while throwing a few old bones to each doctor.

[...] Retainer medicine can fix all the problems.  While we may not yet have the best definition of retainer medicine, the Qliance model is a worthy staring point. Direct primary care – an interview [...]