Skip to comments.CASH ONLY, PLEASE
Posted on 07/23/2006 2:42:46 AM PDT by Hostage
Nearly five years ago, my husband and I left a university clinic practice to explore ways to spend more time with our patients. Denied the right to provide services to my patients because the patients' insurer did not deem it necessary, we felt we were losing personal control of the practice of medicine.
Much of my practice was women's care, and the idea of providing comprehensive women's care in 12-minute visits was absurd. Furthermore, to maintain an "efficient" patient flow, my schedule was typically filled weeks in advance with physicals and Pap smears, so that acute care was frequently shunted to one of my colleagues; any possibility of continutity of care was totally lost. Believe me, when a patient is acutely ill, frightened, or in pain, there is nothing "kind" about forcing her to see a total stranger for her care.
We moved to a completely new area and started a retainer-fee practice from scratch. Unlike many retainer practices which cover "extra" sevices while charging insurance and/or Medicare for the usual covered services, our fees cover the entire cost of the medical care.
We are not on contract with Medicare, Medicaid, or any insurance company, although many of our patients still retain traditional insurance coverage for secondary services, hospitalization, medication, etc. However, they pay us out of pocket for the personalized care we provide them.
Ironically, our monthly care fees are considerable lower than the "access fees" that insurance e-based retainer practices charge for the "extra" services.
The bottom line is that we are very affordable.
Two years ago, our state insurance commissioner decided that he did not approve of the concept of "concierge" medicine and announced that he would shut us down. We pointed out that, far from serving only the wealthy, we in fact provide care for many groups of people who could not otherwise afford care of any kind, or might otherwise abuse emergency rooms for outpatient care. Even our maximum monthly charge (which is for housebound adults who require in-home care) is only $100 a month, regardless of utilization.
So, yes -- retainer-based medical care can be kind. But perhaps you can see why we take exception to the term "concierge".
United Healthcare's CEO has a salary well in excess of $200 million per year and is presently under SEC investigation for $1.9 billion (B-I-L-L-I-O-N) in backdated stock options.
Is United Healthcare the group who is providing the care for a fee, or is that the Washington State Health commissioner's group? The newspaper link did not work.
Medicine is now at the point where insurance companies are dictating to doctors how they should practice medicine while demanding huge premiums. They are also constantly bitching to keep costs down at the expense of patient health. I find this all rather disgusting to say the least when CEO's of the HMO's are making millions per year.
Malpractice insurance isn't getting any cheaper either. I agree with you. Charging patients what they can pay works. Not dealing with insurance billings also keeps the overhead down. Working out of your home keeps costs down also.
(Go Israel, Go! Slap 'Em, Down Hezbullies.)
(Go Israel, Go! Slap 'Em, Down Hezbullies.)
United Healthcare is a publicly traded corporation. I added a comment about their CEO to provide a contrast, otherwise the author made no mention of United Healthcare specifically.
But United Healthcare is known to fight doctors at every turn for patient coverage. In other words thay don't pay unless you spend countless hours on the phone badgering them.
United makes money by not paying doctors for service meaning not allowing doctors to provide medical services to patients that have United as their health insurer. Or put it this way, the doctors can provide care for free unless they charge a so-called "concierge" fee.
I have no qualms with CEOs making a gazillion dollars for inventing a better mousetrap. But making money by denying patients their health benefits rubs me the wrong way.
I know a primary care physician who takes fresh fish and other food items if patients can't pay in cash. He can't cook and they bring him food. Pretty good arrangement. It's not extremely lucrative, but this physician isn't in it for the money.
"Just try getting your insurance company to pay for your attorney's services."
Check out a company called Pre-Paid Legal Services (PPD). There apparently is a market for what they do. I don't use their services, and have managed to stay out of court and not really needed it. On the other hand, I've been lucky enough to remain basically healthy and have not really needed the medical services that I have paid for through my health insurance plan, either. Looking back, I would have been better off paying out of pocket for the few times I have needed medical care over the years and saving on the ongoing premiums, the same as with my legal needs. But I didn't know that going forward and it seemed the better course to have the health insurance. However, I can't see the principled difference between that and the legal insurance I passed up. In both cases, I would have been happy to have the coverage if things had gone wrong in various ways that they did not.
I posted similar info a while back about some cash - only health providers that would let you have a REAL doctors visit for like 25 bux out of pocket. You basically had only to pay them cash and sign some statement saying you would not sue them for malpractice.
The post was attacked by somebody who said it couldn't possibly be true, as no hospital would admit someone from a doctor who didn't have up to date malpractice insurance.
Back before insurance companies went whole-hog at the trough and the government got involved in health care, you could actually AFFORD to go have a regular doctors visit, or even have one come to you.
Your link doesn't work and when I went to the website I couldn't find this article. In which issue of the journal was this article published?
There was an OB-GYN who recently passed away on the Island of Maui. He was eighty years old and had practiced on the Islands for well over 50 years.
He often accepted a lettuce or sack of onions or other produce in return for services. Don't ever remember hearing of any trouble with the IRS but he did have trouble with his wife. He would often make house calls while she would wait for him to return to the office. But he would take sometimes hours for a one-hour call and return with a pineapple instead of a check or cash.
He used to spend countless hours talking and catching up on the latest gossip and local politics with his patients while getting a lettuce in return. Drove his wife nuts.
Needless to say he was a favorite doc in Maui. And he did have a grand lifestyle there regardless of how people compensated him.
Sorry to say it is an editorial and is not listed under the website's articles.
I just tried this link and it worked. Don't know why it isn't working otherwise for you.
Your link is misspelled in your post: you spelled it ww.physicianspratice.com. Please ask the mods to fix your spelling.
Thanks for pointing that out. How do I ask the mods?
Just post a reply to Admin Moderator and they should fix it fairly soon.
This is the cure for Medicare and Medicaid too. Instead of CMS rules and regulations, just give poor seniors and those with clear disabilities a $50,000-per-year healthcare account in the form of a debit card. Of course there'll be monthly premiums to keep costs down - but no more deductibles, co-pays, and other BS. Unused monies won't carry over - whatever the existing balance is will be added to the X amount to bring it back to the $50,000 level. They can use the account to buy prescription drugs (NO MORE "DOUGHNUT HOLE" NONSENSE), dental, medical, vision, nursing home care, etc without the BS. Some FReepers will scream that this is socialism but it's not. This immediately reduces 90% of paperwork and saves billions in bureaucratic costs. The program phases itself out on it's own.
Please fix the link to the source. Thie original was misspelled. It should be:
Sounds like he loved what he did. Which is really the true definition of success.
Sounds like he had a glorious time and helped many people along the way. He loved his work and liked to have the kind of relationship with his patients that creates a very rewarding experience all the way around! His poor wife though....I bet some of his house calls lasted 3 hours! LOL!
I don't want to keep bugging you, but I cannot find the editorial section or any articles by this name at this website. How do you navigate to this editorial?
You can't. I also tried to find so that I could cut and paste it but editorials aren't on the website. So I typed it in by hand.
I have the editorial in front of me. It's on page 14 of the current July/August issue. If you like I could scan it and maybe display it but it would take time for me to remember how to do that on FR. Or otherwise I can email it to you.
So sorry otherwise.
We don't mind if you type it in by hand, that's fine. But this article as posted doesn't appear to be the complete editorial. Is that the entire editorial? She never explains why the insurance commissioner tried to shut down her practice, or what happened after that. You can take your time posting it, but I think you want to post the entire editorial (unless that is the whole thing.)
This is what the Soviets used to say, I kid you not.
And don't get me wrong, I am not a communist sympathizer. Far from it, I am a hardcore Reaganite for life.
But whether we have the best is debatable. Many will say that other societies are far more advanced in healthcare. One example that is touted is Iceland.
Or put it this way, if you are rich you will have access to the best. And it was the same under the Soviet system, if you were affiliated with a high ranking party member, you had the best.
I agree that's not socialism and anything that cuts down on bureaucratic costs cannot be deemed socialist. The only thing is that procedures like by-pass surgery, which is being done now with regularity even on very elderly patients, ends up costing over 100,000-150,000 when you add in all costs. America is getting "Grey"....baby boomers are going to become retirees and health costs are going to sky-rocket. The government, if it does adopt a socialized health care system, will have to become "Rationed Healthcare". Life extending procedures for those over a certain age or health status could get clipped in favor of funding "curable conditions".
No, it's the entire letter that she wrote or that was published. She may have written more but that is all that was published.
I just did a Google search of:
washington state concierge medicine
and it came up with alot of sites that discuss the politics behind her editorial letter.
Thanks for being concerned.
I tend to think it's the governments involvement that screwed things up from the start.
If it is the governments responsibility to make sure everyone is taken care of, then the providers and the insurance companies can AND WILL charge whatever they damn well please, because they know the government can just print whatever dollars or checks it takes to get the job done.
This is not "free market economics" in any sense of the phrase.
I think that's going to be the case no matter what system is used. That's the way of the world. It applies to justice too.
I agree with you. Fat government "Hogs" are hard to feed.
And what people don't realize is that during the "Clinton" era, many health procedures covered by medicare were cut, yet premiums increased.
I seriously considered medical school some time ago but decided against it because I had seen, as a R.N., that it would be the insurance companies that would be deciding the care for the patients, not me.
Where I live there is one organization that CONTROLS the health care. You are either with them, or you you dont work.
Talk about bloated! We have a prime example of it here.
And there is another factor to be considered:
Even though FR has tons of naysayers, even they have to admit that the bulk of the SS baby boomer money has yet to be printed.
We're talking about HUNDREDS OF BILLIONS, if not TRILLIONS of dollars that will hit the streets.
And when you have way, way more dollars chasing the same amount of goods and services, the result is ALWAYS the same.
On a massive scale.
Oh, it's printed all right - but it's sitting in the "Social Security Trust Fund" in the form of huge government bonds which by law can't be let out to the public. It constitutes an IOU the government has written to itself - and it has the same effect as an IOU for a billion dollars would have if you wrote to yourself.
There is however a hole card - the tax liability of the baby boomers' IRAs and 401(k)s. A baby boomer who retires and draws Social Security will use a nontrivial fraction of that money to pay the income tax on his IRA distributions. So it isn't quite as bad as face value would have it - given a good stock market.
The idea which the Democrats boast of having defeated - "privatizing social security" by investing payroll tax money in stocks and bonds - would not cost the government any money. It would recognize costs that already exist and are kept off the books now, but that is not the same as actually costing the government money. To the extent that it improved the stock market it would actually help bail the government (read, our grandchildren as taxpayers) out of this ghastly problem.
I have had United Health Care for years and have only one or two disagreements with them about care.
They have paid tens of thousands of dollars for my chronic health problems and I have been very happy with them.
I thought someone should know that they are not always bad.
It's not printed. If there is such a thing as the "Trust Fund", it's in the form of bonds and T-bills. It has yet to become physical greenbacks.
Let me get this straight. Even if I am somewhat charitable and conjecture that the government did not force folks to give their money to Social Security (at gunpoint), you are actually saying it's a good thing that they are now forced to pay taxes on their donations to get it back?
What a freakin racket...
not only will their money end up buying far less than a couple decades ago, they have to pay taxes on it!!!
There was, up until a few years ago, a pediatrician, north of Atlanta, who practiced well into her 90's.
She saw patients on a first come, first served basis, and charged around $10 per visit...and she spent as much time as she needed with the patient (sometimes 45 minutes.) She didn't have to maintain an office, but practiced out of an outbuilding on her own property. She didn't use staff, so she really had no overhead.
I had many friends that used her as a doctor for their kids for years and years, and she was always "right on" in her diagnosis'. We saw her once when we were visiting our friends and my son became ill. She was (and if I'm not mistaken she's still living and well past her 100th birthday) a breath of fresh air!
Congress will be impotent, controlled by an unstoppable AARP.
There is a minor factor that you are not considering in that formulation: What is "the best," when? The difference in the state of the art in medicine now and a century ago is the difference between life and death for a lot of seniors, myself included. I went to the hospital a hurting puppy a couple of years ago, and the Dr. diagnosed it and readily treated it.And it was the same under the Soviet system, if you were affiliated with a high ranking party member, you had the best.
He remarked that the procedure - with which I happened to be intimately familiar, but not as a patient 'til then - was invented 100 years ago. Before that, if you got that problem, you just died of it. Whether or not you were royalty, never mind merely being "rich." The temporal improvement in the SOtA in medicine - and much else - has been such that an American secretary today wouldn't be better off trading circumstances with Queen Victoria.
And of all the fraudulent claims of socialism, being "progressive" is one of the most egregious. Equality by diktat is easy, but unattractive. Bait the boobs with equality with the rich, but give them the only equality possible - making the rich equal to everyone else. But having done so, you have eliminated the incentive to rapidly improve the SOtA in medicine or anything else. And over any length of time at all, that translates into significantly poorer medicine for everyone.
Sure - the best in the USSR. But since they would always be in the process of learning from the West rather than innovating, even with all special provisions for the nomenklatura they couldn't actually have care equal to the best in the West without going to the West.
I refuse to take insurance from my patients anymore. It's pay as they go mostly. Some situations require allowing them time to pay. Others require a lower fee. I have time to talk to all, answer phone calls from them and even emails.
My sister has been an RN since 1980. She complains that 90% of the "job" is now paperwork to legally protect the hospital. There isn't much real patient care going on. She works in OB-GYN. Last week she was dealing with illegal alien Mexicans arriving for "emergency" care to deliver yet another anchor baby. They were rude and demanding. When they act like that, they get the absolute MINIMUM legally required level of care. She is getting very tired of working in that line of business.
Another of my colleagues does Oracle database admin and teaches Oracle at a local community college. He is a very accomplished emergency room MD and OB-GYN. He just can't afford the medical malpractice premiums to continue to work in the field. Oracle work pays the bills just fine...especially when he doesn't have to shoulder the big malpractice insurance premiums.
My own experience with $204 extracted for every 2 week pay period and $1500 per year per person minimum co-pay is likewise unsatisfactory. We pay cash for my oldest son's ongoing cardiac care. He's off the insurance as of age 23. The PT tests run $40 every 3 weeks. A bottle of Coumedin costs $70 for a 1 month supply. Annual checks of the pacemaker run $240. If he was still on my insurance, the annual minimums would require the same expenses we currently incur as they don't exceed $1500 for him. The Coumedin would only cost $35 instead of $70. As a family, we rarely use any medical services, so those premiums are feeding a big pool to cover lots of other people. A cash only approach would be much less expensive for me...unless something really bad happened.
Do you know which town?
I'm up in Bellingham and my doctor is a 79 year old. He's terrific, and we pay cash.
For the last 25 years he's had a sign in the waiting room that reads, "Warning the doctor plans to retire within 10 years."
He quit taking new patients a few years ago. And someday I'll probably have to find a new doctor.
I'd love it if more doctors would accept cash. They look at you crosseyed if you say you don't have health insurance.
$50,000 per year? Where is this money going to come from? Getting rid of co-pays is the wrong idea, because without the patient paying a portion of the cost, he has no incentive to shop for the most effective services, and no incentive not to overuse medical services. Rather, we should move in the direction of a more market-based solution, with services that help the poor afford it--not programs that give it away for free.
Where are you in Nebraska? Grew up about 40 miles north of Omaha.
Insurance companies always pay for their clients' legal representation for a claim or potential claim.
That's a bizarre comparison.
Iceland has less than 300,000 people. We have 300 million. You cannot compare the two.
We have the best healthcare system by far. If not - then why do people come from all over the world to use it?
Of course it's not perfect - but we shouldn't throw the baby out with the bathwater.
My husband has United Healthcare Ins. and last year he was in the hospital ICU for 2 weeks. A couple of weeks ago (this is 1 year later) he received a letter in the mail from United Healthcare saying they were paying $0.00 and that the patient (my husband) owed $200,000 to the hospital. Needless to say we are appealing this, but I think it is outrageous and unthinkable that they make people jump through hoops all the time.