Re: Re: Charging patients for 24x7 phone access

March 10, 2012

Stew, I think this is a great idea. $100 per month for expanded home care services is a steal.At $10 per month for primary care, you are way underpricing your value. MedLion in California gets $59 per month and $10 per visit for direct primary care by subscription.As a reference, in Illinois, McKesson corp has a program they sell to "manage" the high utilizers of previously uncoordinated Medicaid care and do case management for the state. They supposedly help the family doctor coordinate care for high utilizers. Incredible to me, but they receive $250-350 per month for this service and don't even see the patients! Even with this outrageous fee, the state is saving money compared to uncoordinated

care.Ben To: Sent: Friday, March 9, 2012 9:05 PM Subject: Re: Charging patients for 24x7 phone access

Thanks for your optimism. I'm worried that I haven't thought of the dark under-belly of this idea yet.

I know I will be refilling meds and filling out the FMLA forms even though I'm not the "PCP" but the key issue is that I cannot tell all my present patients that they now have to pay 10 times more and It would be wrong to have a stark two tiered system within my patient population as well. I won't do boutique medicine. It is hard enough to explain to someone that they have a chronic illness that can only be palliated - imagine adding to it that now that i have named them a "palliative care patient" they have to pay me 10 times more. Eeeech!

But in reality, the service is worth that much for the ill patient for the 6-18 months until they qualify for hospice. Once they go on hospice I will no longer bill them because the hospice team takes over.

Stew Mones MD

Eugene, OR

>

> THis sounds fantastic. (Sorry run out of cynicism just yesterday)

>

> I have done a lot of palliative care in my life and agree that it is a very

> needed services.

>

> The only thing I can think as a comment is that although you will not offer

> yourself as the PCP (in my experience) you will become their de facto PCP. I

> am not sure if you don't want to advertise as PCP or you don't want to be

> their PCP (two very different things in my opinion) but as I am sure you are

> aware, the second you show up providing this kind of care, is approximately

> the same time the PCP disappears (at least in my experience)

>

> Finally, if you have a group of people coming from the same insurance

> company, consider selling the program to the insurance people, the pitch of

> course being the money you will be saving them by doing this

>

> Izquierdo-Porrera MD PhD

>

> Executive Director & Co-founder

>

> Care for Your Health, Inc

>

> Phone

>

> Fax

>

> www.care4yourhealth.org

>

> "Don't ever let injustice go by unchallenged."

>

> From:

> [mailto: ] On Behalf Of Stew Mones

> Sent: Friday, March 09, 2012 9:43 PM

> To:

> Subject: Charging patients for 24x7 phone access

>

> I have become an inadvertent lurker but appreciate the group very much. I

> want your input and advice.

> For those who don't know me, I started my FP solo imp in 2009 with much

> inspiration and assistance from this list. I do 50% office FP work (low

> overhead/micro) and diversify my income with 50% of my time doing home

> visits for a medium sized hospice. I love the balance.

>

> I have been charging my FP patients $10/ month for 24x7 access and phone

> advice in lieu of office visits when it is the right thing to do. Patients

> can opt out and pay per phone visit but most gladly pay $100 in Jan or feb

> for the whole year with little hassle for me and my one assistant (this lump

> salary really helps with taxes)and it is a steal really for my patients and

> it has been good enough for me, I like that patients are really happy with

> it and insurance companies are happy with it too.

>

> Recently I have been struggling with some sick patients who have become over

> utilizers but as a hospice and palliative care doc, I pride myself in

> helping people get good care with fewer burdens then the typical office

> imposes on sick patients. Still I struggle with the fact that our choices

> are always stark - between either giving our services away or creating two

> tiered medicine. (I know some will say "or ridding ourselves of third

> parties" - thank you but that is a different debate)

>

> I have a new idea and want to share it with the group and get ideas about

> the potential pitfalls ( I'm inviting your cynicism and doom-saying).

>

> Today I thought of offering a service of palliative care 24x7 phone access

> to patients who need a palliative care doctor. These are high needs patients

> who are not hospice appropriate yet, but also are tired of making office

> visits or can't go to the ER or don't want to be admitted - they may have

> been kicked off hospice for "failure to die" and don't have an adequate

> medical support system to help them avoid that next hospitalization. I would

> NOT offer to be their PCP but only their palliative care specialist (thus

> differentiating them from my FP patients) and I would charge $100 a month

> for the phone access, willingness to make home visits, but would charge

> insurances if/ when I make a home visit. I could not handle very many of

> these, but might accept 20-40 patients total ($2000-$4000/month is not a bad

> compensation). I would also offer a sliding scale for those who don't have

> the finances. There is a huge need for this and nobody is willing to step in

> to help people in the chasm between home health and hospice for bed bound/

> home bound patients.

> So this is the kernel of an idea. Please tell me your impressions or if any

> docs are already doing this.

>

> Stew Mones MD

> Eugene, Oregon

>

March 10, 2012

Yes my palliative care colleague also told me $100 is too low and $200/ month (2 hours of my time per month at $100/hr) is prob the starting point.Stew