Re: Another reason to rethink insurance contracts WAS Most Favored Nation - Insurance Contracts

[Guest guest]

Hi guys,

Thanks for the support.

Lou, to answer your questions regarding what my patients can expect for paying my access fee,

I am a little different from other physicians offering this type of Direct Practice in what I feel needs to be in writing for an official contract for my practice. I feel very strongly that my access fee is just that---and ACCESS fee . What you get is a guarantee that you have a primary care physician that you can access who will have her patients at the top of her agenda. I am not going to promise foot rubs, nail clipping, hand holding through MRI testing, etc. I am going to promise the annual exam and access to the benefits of primary care.

What is different for me here in Durango is that I am not trying to lure patients into my practice with promises. I am overwhelmed. All the primary care docs are overwhelmed here. Access to a physician is a REALLY BIG DEAL here in Durango. There is NO ACCESS AT ALL to new Medicare patients who move to Durango. No one will take them. We have several local family physicians who are on the verge of retiring. This problem is only going to get worse.

If people want more promises, they will have to look elsewhere. Sounds blunt, but this is the way it is. There are care issues I can improve on dramatically once I have breathing room with not so many lives under my care, and I plan to do them. (Do How's your Health on all my patients, continue in Colorado Clinical Guidelines Collaborative, etc.)

For the past 3 years, I have been providing same day access, expert coordination with specialists, access to me via cell phone 24/7, sometimes even when I am on vacation. What I have learned through my recent back surgery, however, is life can throw curve balls at you when you least expect it. I was out of the office for almost 4 weeks during due to my back. I was not able to provide 24/7 access to me, or the same level of care that I usually provided while I was out. (There are no other IMP's in town, so no, I do not believe my patients were given the same level of care.) Now, working down the back log during my recovery (I still get very tired very easily at 8 weeks post op) has become almost impossible. I do not have the stamina that I did prior to my latest surgery. What I have learned is I am not going to make promises that I might not be able to keep.

I appreciate the input and questions. Keep them coming. I will give you all an update soon, but Tuesday went a lot better than Monday. Still have confused-angry-happy-scared patients. Doing my best to answer my patient's questions. Still do not have answers for them regarding the social and economical issues surrounding the broken health care system. Probably wont ever have these answers. But I can continue to strive to be the best family physician I can possibly be.

Durango, CO

You will be successful, I am sure of it!

I love your website.

Lonna

> ,Maybe we should turn this on its head and make up a " Most Favored Doctor " clause-- " Given this office works with multiple insurers, the negotiated rate for a service will become the highest reimbursement offered for the same

service by any legitimate insurance company whose patients are seen in this office. " After all, if the insurance company is doing a good job at managing its overhead, I would think it would want to reimburse at least as much as the

competing insurance company down the street. Also, having such a system will decrease confusion over fee schedules and therefore likely improve efficiencies within the system saving money. > From: " Locke's in Colorado " <lockekcomcast (DOT) net>

> Date: 2008/05/13 Tue AM 01:37:19 EDT> To: " Locke's in Colorado " <lockekcomcast (DOT) net>> Subject: [Practiceimprovemen t1] Most Favored Nation - Insurance Contracts

> >

-- Durango, CO

[Guest guest]

said

" I am not going to promise foot rubs, "

Well ,that's it I am not coming.Jean

-- If you are a patient please allow up to 4-8 hours for a reply by email/please note the new email address/e mail may not be entirely secure/ MD

ph fax

[Guest guest]

Okay for you I will offer hair care and foot rubs, but I am unable to guarantee any true quality!

I hope purple hair color goes well with your complexion!

said

" I am not going to promise foot rubs, "

Well ,that's it I am not coming.Jean

-- If you are a patient please allow up to 4-8 hours for a reply by email/please note the new email address/e mail may not be entirely secure/ MD

ph fax

[Guest guest]

Hi Dr. : Congratulations. Your website looks terrific. I love the idea of access plan and particularly two different ones for patients to choose from. I Might follow your path in a couple of years. I am interested in trying this in a small scale soon ( may be start with small businesses in my area...if they would like to enroll their employees for an access fee). My practice is 9 months old and don't have large enough patient base to quit insurances now. Maha Mahalakshmi Seshadri, MD 603-A Omni Dr Hillsborough, NJ 08844l_spikol wrote: Hey -You do have a very nice website which I took a good look at. So here's my question-perhaps this is in your agreement. Don't get me wrong, I'm all for paying an annual fee. However, for $900 I would want to know whether I'm getting a little bit more for my money besides a yearly well physical. Am I able to get ahold of you 24/7 as long as you're not on vacation? (although some of us would say that living in Durango would be a permanent vacation). I assume you have advanced access and I can be seen same day? if I'm working unusual hours are you flexible? will you coordinate my care with other specialty physicians? if you are away, can I expect the same level of service from whoever is covering for you?Thanks in advance for the answers and I

apologize if you've already addressed them. I am interested in this model and what the agreement needs to be between patients and physicians to make it work.> >> > >> > > > ,> > > Maybe we should turn this on its head and make up a "Most Favored> > > Doctor"> > > clause--"Given this office works with multiple insurers, the negotiated> > > rate> > > for a service will become the highest reimbursement offered for the same> > >> > > service by any legitimate insurance company whose patients are seen in> > > this> > > office."> > > After all, if the insurance company is doing a good

job at managing its> > > overhead, I would think it would want to reimburse at least as much as> > > the> > > competing insurance company down the street. Also, having such a system> > > will decrease confusion over fee schedules and therefore likely improve> > > efficiencies within the system saving money. > > > > > > > From: "Locke's in Colorado" <lockek@... <lockek%40comcast.net>> > > >> > > > Date: 2008/05/13 Tue AM 01:37:19 EDT> > > > To: "Locke's in Colorado" <lockek@... <lockek%40comcast.net>>> > > > Subject: Most Favored Nation - Insurance> > > Contracts> > > >> > > >> > >> > > > >> > > > -- > If you are a patient

please allow up to 4-8 hours for a reply by email/> please note the new email address/> e mail may not be entirely secure/> MD> > > ph fax >