Comments on: Direct primary care – an interview

By: donald stevens, md

donald stevens, md — Mon, 04 Oct 2010 18:22:16 +0000

consider the cost of a traditional full coverage health insurance plan, family of 4, $500 annual deductible with premiums of ~1400/month. Exchange this for a $5,000 deductible HSA linked plan with premiums of $750/month. Annual savings: $7800/year.
Join Qliance or a similar program for 60 x 4 family members or $480/month or $5760/year. Net savings on insurance $2040/year which can be contributed tax deferred (or tax free if used for medical expensees) to the HSA.
At year 3 you own an HSA funded at over $6,000, have full access to great primary care, and are fully insured for catastrophic care

By: Around the Mediverse: May 7, 2010 « The Notwithstanding Blog

Around the Mediverse: May 7, 2010 « The Notwithstanding Blog — Sat, 08 May 2010 04:21:48 +0000

[...] in society. I present to you PartnerMD and Qliance. Much more has been written on Qliance here, here, and [...]

By: DB's Medical Rants » Blog Archive » I disagree with @DrVal – retainer medicine is the answer

Thu, 17 Dec 2009 13:41:45 +0000

[...] 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 [...]

By: Qliance – a new, affordable approach to quality health care | The Filutowski Law Firm, PLLC

Sun, 13 Sep 2009 16:39:42 +0000

[...] and discounted MRIs. Specialty practices are not included in the practice. While their are skeptics of the approach, overall the patients are pleased with the affordability and quality of care [...]

By: solo dr

solo dr — Mon, 24 Aug 2009 01:13:44 +0000

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.

By: jb

jb — Sun, 23 Aug 2009 14:58:51 +0000

Dino-
I do not see why this could not be used for primary care solo practices. Make it clear to all (as Qliance does) exactly what the practice does and does not do, what the policies are (not just financial but with respect to appointments, refills, how/when to get in touch with the doctor or nurse, etc.).
I think that the documentation issue will actually help with fending off liability- the doc can concentrate on documenting clinically relevant information, not on worrying about “do I have the HEENT bullet covered” when trying to goose an ankle sprain visit up to the 99213 level. It’s also a short leap from no insurance to going bare (no malpractice insurance) in many states. Just make sure patients are notified (sign in waiting room and/or registration process) that if they of a mind to sue if things go south, they should take their business elsewhere, as this doc has no resources to go after. (Protecting assets is a must for all docs anywhere in any state anyway- see your attorney). That will weed out the litigious from the get-go. The malpractice premiums not paid go right to the practice bottom line, allowing lower prices for office visits and more take home for the doc.
For the hassle factor- charge for it. Most of your patients will be uninsured anyway, but for those who want/need to submit forms, charge $5-10 per page of forms to fill out. As you get busier, you may need to hire a person to do this, but she will be a profit center, not a dead loss of revenue as it is now. Remember, you are not the one who signed the contract with the insurance company. If the company requires a form to be filed out, it’s not your responsibility to provide that.

By: #1 Dinosaur

#1 Dinosaur — Sat, 22 Aug 2009 16:29:00 +0000

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.

By: rbalboajrmd

rbalboajrmd — Sat, 22 Aug 2009 14:58:48 +0000

Qliance is a forward-thinking, brave bunch. This model is the ONLY way primary can make a comeback.
The medical-industrial complex does not value our services. They view primary care as a cog for referral to expensive, profitable ancillary services/ procedures/ specialists. All driven by the specialty-dominated RUC powered by the corporate-run, AMA-owned CPT codes. We are their villains.
Our value is our vast general knowledge base, superior communication skills, and TIME spent directly with patients.
We are a threat to their bottom line, which is order more, do more, scope more, cut more.
We have allowed ourselves (via extremely poor leadeship) into an ugly corner of high patient volume, the equivalent of sending a surgeon into the o.r. without a scalpel or anesthesia, a gastroenterologist into their surgicenter without scopes… you get my drift.
In addition to the excellent Qliance leadership, other true leaders such as Gordon Moore’s Ideal Medical Practice movement, Jay Parkinson’s HelloHealth/MYCA startup, SIMPD, and Dan Palestrant’s SERMO are moving forward from a bottom-up disruptive approach.
We are still in the early adoption phase. If we are smart and unified we will reach critical mass and then the tipping point…
Transforming the current non-transparent, profit-driven, medical-industrial non-system requires action and leadership amongst frontline, grassroots PRACTICING physicians.
Politicians, lobbyists, policymakers, the AMA, CEOs, managers, administrators, etc are guaranteed to FAIL any meaningful healthcare reform.
Transforming healthcare delivery will be the biggest public health breakthrough this century. This will only happen from a patient-centered, current-practicing-direct-patient-care-physician-led bottom-up approach.

By: jb

jb — Sat, 22 Aug 2009 13:18:28 +0000

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…

By: Bohdan A. Oryshkevich, MD, MPH

Bohdan A. Oryshkevich, MD, MPH — Fri, 21 Aug 2009 23:16:12 +0000

I am wondering what license, state insurance, and what malpractice implications such a practice has. Clearly such a plan does not cover prescriptions.

This concept also shows how much the insurance companies cost in terms of paper work, bureaucracy, and middlemanship, etc.

This does make sense with reference to a high deductible plan since by being a sound adviser to the patient you seem to save the patient money. This depends whether or not the patient trusts you to make the cost-effective decisions and is willing to forgo the tests you might avoid.

For the patient who needs hospitalization it may be a gamble that results in exorbitant costs. Just think of a patient with a $10,000 or $20,000 deductible.

On the other hand it does not solve the problems of society, lack of insurance for the uninsured, equity, etc.

It shows how we cannot solve health access from the point of society so we find individual solutions. Other societies are able to come up with societal solutions that are good and the top up additions (private care) are marginal to the system. Here it is only individualistic solutions that work. Since they do not work societally, they solve fewer problems.

Bohdan A. Oryshkevich, MD, MPH