Re: Why Only Non-Health Care Business Can Save America From The Health Care Industry

[Guest guest]

Cool site! But I think I disagree (to an extent) with that author's thesis. I'd prefer to think that through leading by example, people like those of us on this list-serve have the power to totally revitalize primary care. The amount of actual value that health insurance offers has shrunken so dramatically over the years that the entire health-care 'industry' is primed for destabilization. The insurance industry has been trying (and largely succeeding) to rewrite the rules of the game so that doctors are forced to assume much of that administrative burden that they have imposed on us. By opting out of insurance-based models, primary care physicians can change the rules of that game. (Remember the golden rule: (S)he who has the gold, makes the rules.) Direct pay ideal micropractices are an ideal vehicle for doing just that. We can take back medicine from the clutches of the insurance industry (and alleviate a great deal of CMS's looming drain on the federal budget) by positioning ourselves as providers of medical care that's actually worth paying for. If we succeed (and things have now become so bad/inefficient in the mainstream healthcare 'industry' that it's almost hard to imagine that we won't), then there's going to be a *major* shift of power to leaner and meaner (or maybe i should say wiser and nicer) primary care providers in the near future. KenSent from my iPad

This is a beautiful and concise writing regarding our situation in the US today.

http://careandcost.com/2012/01/26/why-only-non-health-care-business-can-save-america-from-the-health-care-industry/#comments

[Guest guest]

Hi ! Thanks for the post.

And Amen to Ken.Sharon

Sharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA  92617PH: (949)387-5504   Fax: (949)281-2197  Toll free phone/fax: 

www.SharonMD.com

 

Cool site!   But I think I disagree (to an extent) with that author's thesis.  I'd prefer to think that through leading by example, people like those of us on this list-serve have the power to totally revitalize primary care.  The amount of actual value that health insurance offers has shrunken so dramatically over the years that the entire health-care 'industry' is primed for destabilization. The insurance industry has been trying (and largely succeeding) to rewrite the rules of the game so that doctors are forced to assume much of that administrative burden that they have imposed on us.  By opting out of insurance-based models, primary care physicians can change the rules of that game. (Remember the golden rule: (S)he who has the gold, makes the rules.) Direct pay ideal micropractices are an ideal vehicle for doing just that.  We can take back medicine from the clutches of the insurance industry (and alleviate a great deal of CMS's looming drain on the federal budget) by positioning ourselves as providers of medical care that's actually worth paying for. 

If we succeed (and things have now become so bad/inefficient in the mainstream healthcare 'industry' that it's almost hard to imagine that we won't), then there's going to be a *major* shift of power to leaner and meaner (or maybe i should say wiser and nicer) primary care providers in the near future. 

KenSent from my iPad

 

This is a beautiful and concise writing regarding our situation in the US today.

http://careandcost.com/2012/01/26/why-only-non-health-care-business-can-save-america-from-the-health-care-industry/#comments

[Guest guest]

Ken,

We have just lost several United patients as we are out of network. The patients loved us and our IMP style. United just rewrote policy with their employer and will not cover any test or medication not ordered by in network MD. So much for the gold!

This is a beautiful and concise writing regarding our situation in the US today. http://careandcost.com/2012/01/26/why-only-non-health-care-business-can-save-america-from-the-health-care-industry/#comments

[Guest guest]

, I suspect , where I practice is like yours with the 25% lower reimbursement compared to LA. Worse there's high HMO penetration and fragmentation. I still dont know more than 20% of the specialists in the area. They are all locked away in several different IPAs. I am guessing its the same with patients. So effectively we are all practicing in several small towns , despite it nominally being a metro area.

I dont ever see myself swinging a NCBF fee. But keeping costs low,there's our forte. I think overhead is much much lower  than several traditional and larger practices ( personnel management and the mistakes those personnel make.. ooof that costs a lot).On the other hand, I am getting burnt out by being the NO sayer of the practice. I do have a recpetionist, but its not quite as strong a buffer as a full fledged office. adn thats where the ncbf would make a difference, allowing you say NO or YES more confidently ( and not being conflicted about it )

Sangeetha

 

The question is: how many IMP's are there in " dead zones, " and if so, are any of you charging NCBF or not contracted with insurance?  We are definitely in an overserved area. Patients come and go every year based on what insurance their employer is offering. I would love to share with patients the small $ amount checks that they are paying their insurance co to send to us instead of simply paying us and asking their insurance to reimburse them (the patient) instead. 

Have been thinking a lot about payment models and at what point we could stand to give up patients in lieu of NCBF.  Once I convince myself, I have to convince Steve! Pratt

 

Cool site!   But I think I disagree (to an extent) with that author's thesis.  I'd prefer to think that through leading by example, people like those of us on this list-serve have the power to totally revitalize primary care.  The amount of actual value that health insurance offers has shrunken so dramatically over the years that the entire health-care 'industry' is primed for destabilization. The insurance industry has been trying (and largely succeeding) to rewrite the rules of the game so that doctors are forced to assume much of that administrative burden that they have imposed on us.  By opting out of insurance-based models, primary care physicians can change the rules of that game. (Remember the golden rule: (S)he who has the gold, makes the rules.) Direct pay ideal micropractices are an ideal vehicle for doing just that.  We can take back medicine from the clutches of the insurance industry (and alleviate a great deal of CMS's looming drain on the federal budget) by positioning ourselves as providers of medical care that's actually worth paying for. 

If we succeed (and things have now become so bad/inefficient in the mainstream healthcare 'industry' that it's almost hard to imagine that we won't), then there's going to be a *major* shift of power to leaner and meaner (or maybe i should say wiser and nicer) primary care providers in the near future. 

KenSent from my iPad

 

This is a beautiful and concise writing regarding our situation in the US today.

http://careandcost.com/2012/01/26/why-only-non-health-care-business-can-save-america-from-the-health-care-industry/#comments

[Guest guest]

Sorry to say it, but if you're losing a crappy payor and your patients are losing a great doctor, then you're not the one who is going to be suffering by sticking with that insurer. One of the harder lessons I've had to learn in residency is that no matter how much I may cringe when I have to do something to a patient that hurts them, their pain is not my pain. ("Doc! Is this gonna hurt?" "Nope. I won't feel a thing."). So it is in cases like these. Help others as much as you reasonably can without doing yourself harm. Putting up with an abusive insurer is doing yourself harm and you're really better off without being in abusive relationship.If you want the last laugh, though, then fight back. Go have a word with their employer and find out if you can persuade them to drop United in the future in favor of switching to a high-deductible catastrophic coverage health plan, possibly in conjunction with hiring you to look out for their employees' primary care needs for a reasonable price. They'll be able to save money, their employees will get IMP-level primary care, and United will lose. Make it work, then publicize your coup and make United *really* lose.KenSent from my iPad

Ken,

We have just lost several United patients as we are out of network. The patients loved us and our IMP style. United just rewrote policy with their employer and will not cover any test or medication not ordered by in network MD. So much for the gold!

This is a beautiful and concise writing regarding our situation in the US today. http://careandcost.com/2012/01/26/why-only-non-health-care-business-can-save-america-from-the-health-care-industry/#comments

[Guest guest]

I am in a dead zone here in LA. I do charge a NCBF of $250 pp or $400 per family. I dont charge medicare pt as MC pays 30% more than the privates. My dilemma now is BX and BS cut their acupuncture reimbursement by 50% this year. This really hurt me as 50% of my practice is AP. I am thinking of writing to BC and asking if I can stay in network but out of network for acupuncture because currently I lose $10 per visit! The blue cross pts that I have now are a great group of people and pay the NCBF, so I want to stay in network for them ( I think the insurance co count on our kindness and take advantage of us. I know it is not a good business decision). Now if BC says no, what are my choices except go out of network. I could charge the MC rate and drop my NCBF or charge the network rate and cont to charge NCBF. Anyone have experience with being partially in network? any advice? Ultimately  a few years down the road, I hope to be AP only and cash only. I just have to be prepared not to have any income for a while

 

The question is: how many IMP's are there in " dead zones, " and if so, are any of you charging NCBF or not contracted with insurance?  We are definitely in an overserved area. Patients come and go every year based on what insurance their employer is offering. I would love to share with patients the small $ amount checks that they are paying their insurance co to send to us instead of simply paying us and asking their insurance to reimburse them (the patient) instead. 

Have been thinking a lot about payment models and at what point we could stand to give up patients in lieu of NCBF.  Once I convince myself, I have to convince Steve! Pratt

 

Cool site!   But I think I disagree (to an extent) with that author's thesis.  I'd prefer to think that through leading by example, people like those of us on this list-serve have the power to totally revitalize primary care.  The amount of actual value that health insurance offers has shrunken so dramatically over the years that the entire health-care 'industry' is primed for destabilization. The insurance industry has been trying (and largely succeeding) to rewrite the rules of the game so that doctors are forced to assume much of that administrative burden that they have imposed on us.  By opting out of insurance-based models, primary care physicians can change the rules of that game. (Remember the golden rule: (S)he who has the gold, makes the rules.) Direct pay ideal micropractices are an ideal vehicle for doing just that.  We can take back medicine from the clutches of the insurance industry (and alleviate a great deal of CMS's looming drain on the federal budget) by positioning ourselves as providers of medical care that's actually worth paying for. 

If we succeed (and things have now become so bad/inefficient in the mainstream healthcare 'industry' that it's almost hard to imagine that we won't), then there's going to be a *major* shift of power to leaner and meaner (or maybe i should say wiser and nicer) primary care providers in the near future. 

KenSent from my iPad

 

This is a beautiful and concise writing regarding our situation in the US today.

http://careandcost.com/2012/01/26/why-only-non-health-care-business-can-save-america-from-the-health-care-industry/#comments

-- M.D.www.elainemd.comOffice: Go in the directions of your dreams and live the life you've imagined.

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[Guest guest]

Did not get the link to work, but just had a minute to go to the website.  Certainly looks like a group of folks who share IMP values in many ways.  It looks like they only have 268 subscibers, so perhaps we can give them a boost!

Annie

 

This is a beautiful and concise writing regarding our situation in the US today. http://careandcost.com/2012/01/26/why-only-non-health-care-business-can-save-america-from-the-health-care-industry/#comments

-- Annie Skaggssville, KY

[Guest guest]

try this:http://careandcost.com/2012/01/27/why-only-non-health-care-business-can-save-america-from-the-health-care-industry/

or just Google why only non health care business can save america

Also attached PDF.

Sharon

 

Did not get the link to work, but just had a minute to go to the website.  Certainly looks like a group of folks who share IMP values in many ways.  It looks like they only have 268 subscibers, so perhaps we can give them a boost!

Annie

 

This is a beautiful and concise writing regarding our situation in the US today. http://careandcost.com/2012/01/26/why-only-non-health-care-business-can-save-america-from-the-health-care-industry/#comments

-- Annie Skaggssville, KY

1 of 1 File(s)

2012.2.Why Only Non-Health Care Business Can Save America From The Health Care Industry _ Care And Cost.pdf