Comments on: In which I continue my debate with Dr Val

By: Alan Dappen

Alan Dappen — Sun, 20 Dec 2009 22:39:31 +0000

The fundamental problem of primary care is that 95% of patients are “owned” by the insurance companies. Woe to the doctor who drops their preferred provider status. Our experience at DocTalker (a pay-as-you-go practice.) shows that most people need 3 contact points a year. Two of the three are done through phones and emails and one at the office. The average time required of the physician is an hour. Total cost for a “concierge level service” is $300.00/ year for most people No one is getting rich, and we work 10-12 hour days to pay our bills. We feel our mission is to gain the respect and trust of our patients while at the same time explaining that patients need to be part of the solution for fixing health care and be aware that time is money too Primary care physicians as a whole have failed to take responsibility for re-inventing themselves into a “force for the good” and win back the consumers trust at a price that is much cheaper than going through insurance, Until then, most patients take comfort in the protection afforded to them through insurance companies over the perceived predatory pricing habits of doctors and health care system at large. . In the end doctors medical services can’t get around the business formula that time is money. We are trying to give our patients the best service at a price continues our mission. If someone prefers unlimited access for a fixed amount of money, the more power to them. Re-inventing primary care in the end is nothing more than what it takes to bring patients to use our service and to date, the insurance owned patient continues to have all other models beat 10 to 1 no matter how hard we have tried. No matter what method of payment we choose, try we must if primary care is to have a future separate from the insurance task masters who consistently profit off our work while charging the patient (or employers) excessive amounts of money for the service we provide.

By: PalMD

PalMD — Sun, 20 Dec 2009 04:46:14 +0000

Hmm…this "retainer" in a non-concierge setting, while appealing in some ways, sounds a lot like capitation.

By: pcb

pcb — Sun, 20 Dec 2009 04:13:04 +0000

you guys are splitting hairs.
The key is eliminating the 3rd party payer from the equation, then you and the patient decide what the value of your services is. See what volume you're comfortable with. See patients how you want to see them and how they want to be seen. All the things you can do when you don't have to follow insurance company and govt checklists and protocols to get paid.

By: Dr. Val

Dr. Val — Sun, 20 Dec 2009 03:13:10 +0000

Bob, I think we agree on the fundamentals (let's get primary care physicians off the treadmill and spend more time on medicine rather than paperwork). But I'd like to explain a little further why my model is better at covering more patients than concierge practices.
The ideal patient load depends on how many actually need to be seen in the office.
The reason why I can see so many patients is because I'm not bound by the reimbursement system designed by third party payers. My practice partners have found that about 66% of office visits (for patients well known to us) are unnecessary, and can be handled via phone, email, or webcam visit. This unburdens the waiting room, and is dramatically more convenient for all.
If there is a whif of concern, we ask the patient to come in to see us – or we can make a house call.
Let's keep the dialog going – because we all have the same ultimate goal – outstanding, affordable patient care that's convenient and enjoyable for both physician and patient!

By: Rocky Balboa, Jr, MD

Rocky Balboa, Jr, MD — Sun, 20 Dec 2009 01:39:10 +0000

Lets not lose sight of our goal: empowering primary care and making it a profession again.
It does not have to be a one size fits all model. Direct care, retainer, and hybrid models can peacefully coexist and still cover patient volume.
Individual physicians can customize what type of practice and payment model is best for their patients and themselves.