Re: Interesting idea/organization

[Guest guest]

I LOVE this idea, and actually tossed it around with a Selectman 5-6 yrs ago.

Nantucket, as an isolated, rural island, is the PERFECT lab for such health care

reform experimentation.

Alas, Romneycare has probably ruined this. Now that Mass has a universal,

indivudual, insurance mandate, there is less reason to brainstorm on alternative

plans.

And now, myself, as an individual... I'm just not sure I have the energy to

think it through.

But I LOVE the idea.

>

> A happy discovery made by my wonderful wife as she was exploring the streets

of Portland, OR today: http://www.patientphysiciancoop.com

>

> They have 3 sites/communities established so far (in NC, OR,and TX) with a

faith-based umbrella organization that really seems to have the right idea.

This looks tailor-made (heaven-sent?) to fit in with IMP and Direct-Pay models,

and I would *love* for this idea to keep growing, heathen though I may happen to

be. Maybe their next site should be organized somewhere in the Northeast,

perhaps on Nantucket?

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> Ken

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[Guest guest]

With a quick look at this (there is a lot of disconnected info on these

websites):

What looks good: sufficient primary care capitation negotiated directly with

patients.

But: They're promoting >$500 per year for primary care as " affordable " . Most of

my uninsured patients wouldn't agree.

And: They say you're getting access to a provider who has 1500-2000 patients.

Not exactly concierge-level care for this price....

If there is a commitment to IMP-ish principles, it's not coming through to me...

Haresch

>

> A happy discovery made by my wonderful wife as she was exploring the streets

of Portland, OR today: http://www.patientphysiciancoop.com

>

> They have 3 sites/communities established so far (in NC, OR,and TX) with a

faith-based umbrella organization that really seems to have the right idea.

This looks tailor-made (heaven-sent?) to fit in with IMP and Direct-Pay models,

and I would *love* for this idea to keep growing, heathen though I may happen to

be. Maybe their next site should be organized somewhere in the Northeast,

perhaps on Nantucket?

>

> Ken

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[Guest guest]

Criticisms noted; I didn't take the time to look too closely at this group, but to some patients, a deal like this is actually pretty cheap. As to that 1500-2000 patient panel, that's what this one guy is doing. By contrast, the Portland website ( http://www.ppcpdxcoop.org ) lists a fair number of providers (albeit mostly NDs and NPs so far), and I've no reason to believe they're all as busy as the guy you saw seems to be. Similarly, there's no reason in principle why you couldn't be part of such an organization and set your own fees and panel size to be whatever you think is appropriate. I think the concept is sound and has the potential to (a) generate a lot of buzz, and ( be a game-changer re: people's interactions with the insurance companies. Finally, I think there a goodly number of people who can and do soak up $500 worth of primary care per year. Is it that you're not providing that level of service (admittedly, not possible to do well with 1500+ patients), not charging what you might be worth, or is it that somebody besides the patient is subsidizing the bills?KenSent from my iPad

With a quick look at this (there is a lot of disconnected info on these websites):

What looks good: sufficient primary care capitation negotiated directly with patients.

But: They're promoting >$500 per year for primary care as "affordable". Most of my uninsured patients wouldn't agree.

And: They say you're getting access to a provider who has 1500-2000 patients. Not exactly concierge-level care for this price....

If there is a commitment to IMP-ish principles, it's not coming through to me...

Haresch

>

> A happy discovery made by my wonderful wife as she was exploring the streets of Portland, OR today: http://www.patientphysiciancoop.com

>

> They have 3 sites/communities established so far (in NC, OR,and TX) with a faith-based umbrella organization that really seems to have the right idea. This looks tailor-made (heaven-sent?) to fit in with IMP and Direct-Pay models, and I would *love* for this idea to keep growing, heathen though I may happen to be. Maybe their next site should be organized somewhere in the Northeast, perhaps on Nantucket?

>

> Ken

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[Guest guest]

Yes, if something like this could create a broad patient-driven movement to

separate primary care payment from insurance while keeping it accessible to

everyone, that would be terrific.

(Incidentally, the 1500-2000 patient number is in the " Tomorrow's Bread Today "

sponsor's information, so it seems to be a guiding principle for the group.)

(Also, their repeated assertions that this plan is not insurance might not stand

up to state regulators. I think that unlimited services for a prepaid fee quacks

a lot like insurance in the eyes of most states. What if your practice goes

belly-up -- or to Mexico -- the day after you're paid for a year? How does the

patient then get their primary care?)

Yes, there are plenty of folks who use >$500 worth of primary care in a year.

But most people I know right now aren't going to pony that up, for various

reasons: they don't have it, they're already giving a lot to an insurance

company that is supposed to cover this stuff, they believe (possibly correctly)

that they won't use $500 of primary care, they believe that someone else should

pay all of this, etc.

So how do we get this $500/person/year out of the hands of insurance companies,

back into the hands of patients, to spend on primary care as they see fit, be it

an annual charge or FFS? Wouldn't it be a great societal benefit if every person

had their own account that is guaranteed to be funded with $500 every year that

they spend on primary care at their own discretion? I see increased preventive

care, improved health, and lower costs (particularly administrative costs) from

such a plan.

Haresch

> > >

> > > A happy discovery made by my wonderful wife as she was exploring the

streets of Portland, OR today: http://www.patientphysiciancoop.com

> > >

> > > They have 3 sites/communities established so far (in NC, OR,and TX) with a

faith-based umbrella organization that really seems to have the right idea. This

looks tailor-made (heaven-sent?) to fit in with IMP and Direct-Pay models, and I

would *love* for this idea to keep growing, heathen though I may happen to be.

Maybe their next site should be organized somewhere in the Northeast, perhaps on

Nantucket?

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> > > Ken

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[Guest guest]

My (admittedly murky) understanding is that the magic ingredient of a retainer agreement required (in some states) to not fall afoul of regulations (besides asserting in the agreement that the agreement does not constitute insurance) is that the provider must demonstrate financial solvency/ability sufficient to guarantee continued access even if the patient were to make effectively unlimited claims on the offered service. In practice, this means that the billed amount (including any copay) for a visit must at least cover the physician's costs for providing the visit.KenSent from my iPad

Yes, if something like this could create a broad patient-driven movement to separate primary care payment from insurance while keeping it accessible to everyone, that would be terrific.

(Incidentally, the 1500-2000 patient number is in the "Tomorrow's Bread Today" sponsor's information, so it seems to be a guiding principle for the group.)

(Also, their repeated assertions that this plan is not insurance might not stand up to state regulators. I think that unlimited services for a prepaid fee quacks a lot like insurance in the eyes of most states. What if your practice goes belly-up -- or to Mexico -- the day after you're paid for a year? How does the patient then get their primary care?)

Yes, there are plenty of folks who use >$500 worth of primary care in a year. But most people I know right now aren't going to pony that up, for various reasons: they don't have it, they're already giving a lot to an insurance company that is supposed to cover this stuff, they believe (possibly correctly) that they won't use $500 of primary care, they believe that someone else should pay all of this, etc.

So how do we get this $500/person/year out of the hands of insurance companies, back into the hands of patients, to spend on primary care as they see fit, be it an annual charge or FFS? Wouldn't it be a great societal benefit if every person had their own account that is guaranteed to be funded with $500 every year that they spend on primary care at their own discretion? I see increased preventive care, improved health, and lower costs (particularly administrative costs) from such a plan.

Haresch

> > >

> > > A happy discovery made by my wonderful wife as she was exploring the streets of Portland, OR today: http://www.patientphysiciancoop.com

> > >

> > > They have 3 sites/communities established so far (in NC, OR,and TX) with a faith-based umbrella organization that really seems to have the right idea. This looks tailor-made (heaven-sent?) to fit in with IMP and Direct-Pay models, and I would *love* for this idea to keep growing, heathen though I may happen to be. Maybe their next site should be organized somewhere in the Northeast, perhaps on Nantucket?

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> > > Ken

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[Guest guest]

We don't need an organization to provide this type of primary care. We need docs

to just start doing it, and making it mainstream thought, as opposed to the

third party scheme present today.

I have been doing it in my practice since 2008. I have all socioeconomic classes

participating. At your rate, it equates to just over $40/month. I get more from

adults, less for college age and kids.

All but the lowest incomes can choose to afford it.

The key word is " choose " .

But why would a patient choose if they believe they can get it a cheaper way.

But it is only cheaper as a copay, not if you factor in the increased premiums

and overhead.

Primary care needs to dismantle itself from the third party scheme.

Let insurance be just that, insurance, and not prepayment for everything.

Steve

stown, NJ

> > > >

> > > > A happy discovery made by my wonderful wife as she was exploring the

streets of Portland, OR today: http://www.patientphysiciancoop.com

> > > >

> > > > They have 3 sites/communities established so far (in NC, OR,and TX) with

a faith-based umbrella organization that really seems to have the right idea.

This looks tailor-made (heaven-sent?) to fit in with IMP and Direct-Pay models,

and I would *love* for this idea to keep growing, heathen though I may happen to

be. Maybe their next site should be organized somewhere in the Northeast,

perhaps on Nantucket?

> > > >

> > > > Ken

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[Guest guest]

I totally agree that we don't _need_ this kind of organization to provide this kind of primary care, but I still think such organizations can have very useful roles to play: (1) They increase patient involvement and can act as effective community healthcare advocacy organizations.(2) They raise awareness that retainer medicine and concierge medicine are different animals and that the former can be afforded by most people if (as you say) they choose to afford it. (3) They provide a non-insurance-based/non-HMO-based umbrella under which specialists can be networked to each other and primary-care providers.(4) For those of us who have not yet built up our patient panels, they can serve as a potentially important sense of referrals(5) They are naturally better nuclei for healthcare/insurance reform movements to coalesce around than individual practitioners. Ken

We don't need an organization to provide this type of primary care. We need docs to just start doing it, and making it mainstream thought, as opposed to the third party scheme present today.

I have been doing it in my practice since 2008. I have all socioeconomic classes participating. At your rate, it equates to just over $40/month. I get more from adults, less for college age and kids)

All but the lowest incomes can choose to afford it.

The key word is "choose".

But why would a patient choose if they believe they can get it a cheaper way. But it is only cheaper as a copay, not if you factor in the increased premiums and overhead.

Primary care needs to dismantle itself from the third party scheme.

Let insurance be just that, insurance, and not prepayment for everything.

Steve

stown, NJ

> > > >

> > > > A happy discovery made by my wonderful wife as she was exploring the streets of Portland, OR today: http://www.patientphysiciancoop.com

> > > >

> > > > They have 3 sites/communities established so far (in NC, OR,and TX) with a faith-based umbrella organization that really seems to have the right idea. This looks tailor-made (heaven-sent?) to fit in with IMP and Direct-Pay models, and I would *love* for this idea to keep growing, heathen though I may happen to be. Maybe their next site should be organized somewhere in the Northeast, perhaps on Nantucket?

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> > > > Ken

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[Guest guest]

curious   It isn;t insuracne becasue it only guarantees prices for both patietns and docs Near as I could tellThere a re not unlimited services for fees that I see just guaranteed  pricings. for paying  the membership fee I could not see that is guarantees anythign else Nor is any phsycain accountable for any particular access or quality

 I would guess docs are doing it for guaranteed payment at 99213 being paid 52.00 is awful low but maybe  folks were  never collecting at all and this  gives teeth to get paid something? sorta good concept leaves alot out

 Starfileds ideas about policy iniatives to have a publicly accountable entity and low copays makes more sense  to me...(IMP call see the website archives June 2011)Jean

 

Yes, if something like this could create a broad patient-driven movement to separate primary care payment from insurance while keeping it accessible to everyone, that would be terrific.

(Incidentally, the 1500-2000 patient number is in the " Tomorrow's Bread Today " sponsor's information, so it seems to be a guiding principle for the group.)

(Also, their repeated assertions that this plan is not insurance might not stand up to state regulators. I think that unlimited services for a prepaid fee quacks a lot like insurance in the eyes of most states. What if your practice goes belly-up -- or to Mexico -- the day after you're paid for a year? How does the patient then get their primary care?)

Yes, there are plenty of folks who use >$500 worth of primary care in a year. But most people I know right now aren't going to pony that up, for various reasons: they don't have it, they're already giving a lot to an insurance company that is supposed to cover this stuff, they believe (possibly correctly) that they won't use $500 of primary care, they believe that someone else should pay all of this, etc.

So how do we get this $500/person/year out of the hands of insurance companies, back into the hands of patients, to spend on primary care as they see fit, be it an annual charge or FFS? Wouldn't it be a great societal benefit if every person had their own account that is guaranteed to be funded with $500 every year that they spend on primary care at their own discretion? I see increased preventive care, improved health, and lower costs (particularly administrative costs) from such a plan.

Haresch

> > >

> > > A happy discovery made by my wonderful wife as she was exploring the streets of Portland, OR today: http://www.patientphysiciancoop.com

> > >

> > > They have 3 sites/communities established so far (in NC, OR,and TX) with a faith-based umbrella organization that really seems to have the right idea. This looks tailor-made (heaven-sent?) to fit in with IMP and Direct-Pay models, and I would *love* for this idea to keep growing, heathen though I may happen to be. Maybe their next site should be organized somewhere in the Northeast, perhaps on Nantucket?

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> > > Ken

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--      MD          ph    fax

[Guest guest]

RE deductibles.

Once deductibles get high enough for most, then $30-40/month retainer should make lots of sense.

Not sure legally though how to do this?

M

Re: Interesting idea/organization

We don't need an organization to provide this type of primary care. We need docs to just start doing it, and making it mainstream thought, as opposed to the third party scheme present today.I have been doing it in my practice since 2008. I have all socioeconomic classes participating. At your rate, it equates to just over $40/month. I get more from adults, less for college age and kids.All but the lowest incomes can choose to afford it. The key word is "choose".But why would a patient choose if they believe they can get it a cheaper way. But it is only cheaper as a copay, not if you factor in the increased premiums and overhead.Primary care needs to dismantle itself from the third party scheme.Let insurance be just that, insurance, and not prepayment for everything.Stevestown, NJ> > > >> > > > A happy discovery made by my wonderful wife as she was exploring the streets of Portland, OR today: http://www.patientphysiciancoop.com> > > > > > > > They have 3 sites/communities established so far (in NC, OR,and TX) with a faith-based umbrella organization that really seems to have the right idea. This looks tailor-made (heaven-sent?) to fit in with IMP and Direct-Pay models, and I would *love* for this idea to keep growing, heathen though I may happen to be. Maybe their next site should be organized somewhere in the Northeast, perhaps on Nantucket? > > > > > > > > Ken> > > > > > > > > > > > > > > > >> > > >> > > > > >> >>

[Guest guest]

Has anyone seen this idea?

http://www.goehealth.net/

They have set up a plan in Florida, charge $83/month, which includes visits,

certain labs, etc. They claim to be doing well though still in its infancy.

> > > > >

> > > > > A happy discovery made by my wonderful wife as she was exploring the

streets of Portland, OR today: http://www.patientphysiciancoop.com

> > > > >

> > > > > They have 3 sites/communities established so far (in NC, OR,and TX)

with a faith-based umbrella organization that really seems to have the right

idea. This looks tailor-made (heaven-sent?) to fit in with IMP and Direct-Pay

models, and I would *love* for this idea to keep growing, heathen though I may

happen to be. Maybe their next site should be organized somewhere in the

Northeast, perhaps on Nantucket?

> > > > >

> > > > > Ken

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[Guest guest]

M

High deductibles, hsa's and fsa's are very popular with my retainer patients.

Many see me because of history with them. But others would rather pay me their

deductible money or FDA/hsa money than an in network doctor they don't know or

like.

Easy answer to the healthcare dilemma is to have the govt guarantee high

deductible catastrophic coverage to all citizens, with deductibles being means

tested.

But, and here is the big but, deductible funds must be totally under control of

the patient, and no third party intermediary, other than perhaps for

catastrophic costs.

This is simple, would bring the market into play to reduce costs, increase

quality with competition, and remove the middleman from our exam rooms.

Govt can negotiate with private insurers to run the catastrophic coverage so the

govt can fix its costs.

It is really pretty simple but the main issue is that this would take away power

from the crooks, ummmm, the politicians and lobbyists presently in control.

Our best hope is for physicians to lead the way to this type of open patient

centered reform, instead of following all the power mongerers who have destroyed

the system.

Rant is now over.

Thanks for reading!

Steve

stown, NJ

> > > > >

> > > > > A happy discovery made by my wonderful wife as she was exploring the

streets of Portland, OR today: http://www.patientphysiciancoop.com

> > > > >

> > > > > They have 3 sites/communities established so far (in NC, OR,and TX)

with a faith-based umbrella organization that really seems to have the right

idea. This looks tailor-made (heaven-sent?) to fit in with IMP and Direct-Pay

models, and I would *love* for this idea to keep growing, heathen though I may

happen to be. Maybe their next site should be organized somewhere in the

Northeast, perhaps on Nantucket?

> > > > >

> > > > > Ken

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