Doctors solution to health insurance

[Modelworks]

Some doctors are saying no to insurance , instead going to a pay as you go or retainer based service. I like this. It is very similar to the way doctors worked before health care and insurance companies caused the prices to become higher than they needed to be. You pay the doctor, not the insurance company , a monthly fee, for an individual could be as low as $50 a month and that gets you services from that doctor.

Actually paying a doctor directly for his services rather than paying the brokers at the insurance company . Cutting out the middle man.


http://money.cnn.com/2009/08/1...postversion=2009081714

NEW YORK (CNNMoney.com) -- Like a lot of their patients, doctors are sick of long waits in the waiting room and dealing with insurance companies.

That's why a growing number of primary care physicians are adopting a direct fee-for-service or "retainer-based" model of care that minimizes acceptance of insurance. Except for lab tests and other special services, your insurance plan is no good with them.

In a retainer practice, doctors charge patients an annual fee ranging from $1,500 to as high as over $10,000 for round-the-clock access to physicians, sometimes including house calls.

Other services included in the membership are annual physicals, preventive care programs and hospital visits.

Doctors argue that this model cuts down their patient load, allows them to spend more time per patient and help save the system money.

However, some industry groups caution that these emerging trends are a consequence of a health care system badly in need of reform.

"I had to change the model": Dr. John Kihm, 51, an internist based in Durham, N.C., converted his solo private practice to a retainer-based model in May.

Until then, his daily schedule was jam-packed. "I was seeing patients every 15 minutes," said Kihm.

He was seeing about 80 patients a week, "many were very sick with multiple systems and complications," he said. "After 20 years, I realized that this was not doable, not sustainable."

His goal is to continue medicine for another 20 years, "but I want to practice it the right way," Kihm said. That means spending more than 15 minutes per patients and doing house calls. "I had to change the model," he said, as he adopted the retainer-based structure.

He now spends 30 minutes on average per patient. He didn't disclose his annual fees but said his fees are "less that what it could cost to smoke a pack of cigarettes a day."

His fees covers annual exams, wellness programs and other types of preventative care typically not covered by insurance. If his patients do have insurance, it would pay for things like lab tests.

"My income is about the same as before, but I have less overhead costs from half as many patients and half the amount of supplies that I need," he said.

Michigan-based family doctor Dr. John Blanchard has been practicing the retainer-based care for eight years. He said his patients have "unfettered" access to him whenever they need him for a fee of between $50 to $150 a month.

The model has enabled Blanchard to "cut down on everything by about 25%," including his patient caseloads and time spent on filing insurance claims.

One industry report cited that processing claims is the second-biggest area of wasteful expenditure in the health care system, costing as much as $210 billion annually.

Prevention better than cure: MDVIP, based in Boca Raton, Fla., is one of the largest organizations of primary care physicians, numbering about 326 nationwide, that practice retainer-based medicine.

"We call it preventive, personalized health care," said Darin Engelhardt, president of MDVIP. "Our premise is if we reconstruct primary care, what would it look like?'"

According to the MDVIP formula, it means limiting its affiliated practices to no more than 600 patients.

 

[Genx87]

I think the idea of paying somebody directly would be a great thing for a good portion of our health care. Having an insurance or govt be a middle man for a regular checkup eliminates a mechanism for demand to be lowered. People dont know or care what they cost the system. To them it is just 15-20 bucks\visit.

Catastrophic care will still need a 3rd party imo. Because the costs are far too high for an avg person and the risk needs to mitigated over many many people.

 

[rudder]

So I pay my doctor $10,000 for round the clock access. What if my neighbor pays the same doctor for round the clock access. Since I paid first, is the doctor going to drop everything to come help me... for $10,000?

And what if I do pay $10,000 to the doctor and I need a neurologist? Do I have to fork over another $10,000 for more round the clock access since I need a specialist?

 

[KB]

I know some older people who are a part of this program with their doctor. Problem is they still have to have insurance for work their physician can't do, like heart surgery. So their costs have just risen by nearly 50% a year. Being older and wealthier they can afford it in the name of staying healthy, but this isn't a solution to the health care problem.

 

[QuantumPion]

Originally posted by: rudder
So I pay my doctor $10,000 for round the clock access. What if my neighbor pays the same doctor for round the clock access. Since I paid first, is the doctor going to drop everything to come help me... for $10,000?

And what if I do pay $10,000 to the doctor and I need a neurologist? Do I have to fork over another $10,000 for more round the clock access since I need a specialist?

1) A personal physician would cost a lot more than $10,000 a year.

2) If your personal physician didn't show up because he was working for someone else on the side, you could fire him. Or, if you had a contract, you could sue him.

3) If you have a personal physician and need more specialist care, you would have to pay for that in addition.

Really, I'm not sure what the point of bringing up Ted Kennedy-style elite/rich private medical care is to this discussion.

 

[alchemize]

PCP's are fine with this. Specialists/hospitals aren't. Specialists/hospitals dominate the system.

 

[Modelworks]

Originally posted by: rudder
So I pay my doctor $10,000 for round the clock access. What if my neighbor pays the same doctor for round the clock access. Since I paid first, is the doctor going to drop everything to come help me... for $10,000?

And what if I do pay $10,000 to the doctor and I need a neurologist? Do I have to fork over another $10,000 for more round the clock access since I need a specialist?

No the doctor does not take on more patients than he can manage. Right now the way it works the doctors have a lot of patients and little time is spent with each one. They want to change it so that they have less patients to see but are still payed the same because they don't have to deal with insurance companies.

Doctors now bill insurance companies one rate knowing the insurance company will only pay part of it. Why not cut out the insurance company and just pay the doctor what he actually request ?

That is the way it was years ago. You only paid the doctor because the rates were not inflated unnecessarily.

 

[Modelworks]

Originally posted by: KB
I know some older people who are a part of this program with their doctor. Problem is they still have to have insurance for work their physician can't do, like heart surgery. So their costs have just risen by nearly 50% a year. Being older and wealthier they can afford it in the name of staying healthy, but this isn't a solution to the health care problem.

How many times a year do you need heart surgery though ? The solution to health care is a non profit system, but there is too much corruption and greed for that to be put into practice .

 

[Nebor]

Originally posted by: Modelworks

Originally posted by: KB
I know some older people who are a part of this program with their doctor. Problem is they still have to have insurance for work their physician can't do, like heart surgery. So their costs have just risen by nearly 50% a year. Being older and wealthier they can afford it in the name of staying healthy, but this isn't a solution to the health care problem.

How many times a year do you need heart surgery though ? The solution to health care is a non profit system, but there is too much corruption and greed for that to be put into practice .

Non-profit = mediocrity. I don't want mediocre health care. I want a doctor that demands he's paid more because he's the best. And I want the best medical care because I can afford it, thus I deserve better care than someone who can't.

 

[her209]

Originally posted by: Nebor

Originally posted by: Modelworks

Originally posted by: KB
I know some older people who are a part of this program with their doctor. Problem is they still have to have insurance for work their physician can't do, like heart surgery. So their costs have just risen by nearly 50% a year. Being older and wealthier they can afford it in the name of staying healthy, but this isn't a solution to the health care problem.

How many times a year do you need heart surgery though ? The solution to health care is a non profit system, but there is too much corruption and greed for that to be put into practice.

Non-profit = mediocrity. I don't want mediocre health care. I want a doctor that demands he's paid more because he's the best. And I want the best medical care because I can afford it, thus I deserve better care than someone who can't.

Why would the doctor get paid less under a non-profit than a for-profit model?

 

[JohnOfSheffield]

Originally posted by: Nebor

Originally posted by: Modelworks

Originally posted by: KB
I know some older people who are a part of this program with their doctor. Problem is they still have to have insurance for work their physician can't do, like heart surgery. So their costs have just risen by nearly 50% a year. Being older and wealthier they can afford it in the name of staying healthy, but this isn't a solution to the health care problem.

How many times a year do you need heart surgery though ? The solution to health care is a non profit system, but there is too much corruption and greed for that to be put into practice .

Non-profit = mediocrity. I don't want mediocre health care. I want a doctor that demands he's paid more because he's the best. And I want the best medical care because I can afford it, thus I deserve better care than someone who can't.

Actually, the best research facilities in the world are non-profit facilities.

The overwhelming majority of healthcare personel don't give a flying fuck if their employer makes any kind of profit unless they get paid more because of it, which they never do.

If you want that doctor, then depending on what you are going to be treated for you have a choice of several doctors in several nations, none of them in the US.

 

[Thump553]

Originally posted by: Nebor

Non-profit = mediocrity. I don't want mediocre health care. I want a doctor that demands he's paid more because he's the best. And I want the best medical care because I can afford it, thus I deserve better care than someone who can't.

Think before you speak rather than projecting your political philosphy as absolute fact. The Mayo Clinic and St. Judes are nonprofit, and are generally recognized as the best of the best. In fact, according to Wikipedia, only 18% of the hospitals in the US are for-profit (as of 2003).

 

[ElFenix]

sounds a lot like the prepaid medical services that a group of doctors and hospitals in dallas offered in the 1930s.

Originally posted by: Modelworks

How many times a year do you need heart surgery though ? The solution to health care is a non profit system, but there is too much corruption and greed for that to be put into practice .

the medical insurance industry started out non-profit (the blues)

then along came the for-profit companies offering the same services at the blues at a reduced rate, partly by using experience rating rather than community rating.

then came along for-profit plans that, by restricting access to services (requiring people to get checked on the cheap to see if they have something before going to a specialist, for example), had an even further reduced rate.

and that's where we are right now.

 

[Carmen813]

Originally posted by: Nebor

Originally posted by: Modelworks

Originally posted by: KB
I know some older people who are a part of this program with their doctor. Problem is they still have to have insurance for work their physician can't do, like heart surgery. So their costs have just risen by nearly 50% a year. Being older and wealthier they can afford it in the name of staying healthy, but this isn't a solution to the health care problem.

How many times a year do you need heart surgery though ? The solution to health care is a non profit system, but there is too much corruption and greed for that to be put into practice .

Non-profit = mediocrity. I don't want mediocre health care. I want a doctor that demands he's paid more because he's the best. And I want the best medical care because I can afford it, thus I deserve better care than someone who can't.

Of course there is someone who can afford better care than you can. I'm not sure how you equate non-profit to mediocrity, could you elaborate? Non profit doesn't mean negative profit.

 

[sportage]

All that the insurance co is, is the middleman.
A middleman out for profits.
Since gov ran healthcare would not be a profit organization,
everyone would see cost reduction and personal savings.

A relative of mine is currently in Ireland on a summit.
Her dept group were asked where they wished to hold their summit.
"Ireland", they all voted to chose. So off they go, to Ireland, all company paid,
for their summit.

They are just one of hundreds+ of companies that depend on healthcare profiting for the existence of their business. Im not sure what she does or her company does, but she nor the company is a doctor, a hospital or a clinic.

They are just part of the huge parasites sucking up healthcare for profit dollars.

Even though she is a relative, and I wish her family well... THIS IS TOTALLY INSANE!!!

And THAT is just one reason your personal and employer healthcare costs have skyrocketed, and will continue to skyrocket.
Healthcare for profit is insane. Simply insane.

 

[WhipperSnapper]

We don't need to speculate about what national health care would be like nor whether it would make more economic sense than what we have now. We can just look to other nations.

United States: Currently spending about 17% of it's GDP on health care while leaving tens of millions of people uninsured or under-insured while hundreds of thousands file for medical-cost-induced bankruptcy every year and while the rest of the populace lives in terror of losing their jobs and insurance. Businesses are also heavily burdened with having to worry about pay for benefits.

Other First World Industrialized Nations: Currently spending far less than 17% of GDP while having 100% coverage and a more relaxed populace with zero medical bankrupticies and businesses and entrepreneurs that don't have to worry about medical benefits (at least not nearly to the extent they do in the U.S.). They either have single payer national health care or socialized medicine in the form of heavily-regulated insurance companies that bare no resemblance to U.S. insurance companies.

You don't need to be a rocket scientist to realize that people in other nations are paying less and getting more and that the U.S. should scrap its current inefficient system and adopt one of the outright socialized systems. However, you do have to be a townhall moron to support free market medicine.

 

[BoomerD]

Insurance companies negotiate lower prices for the medical procedures and visits for their members. This pushes the rest of the cost onto everyone else. For example, I had an MRI about 5 years ago and instead of sending the bill to the work comp insurance company, it got sent to me. Cost for the procedure (actually 2 MRI's of different areas) was just over $2200. The insurance company paid about $750 of that. The balance was "written off" as part of the negotiated price.

If the medical providers accept such low payments from insurance companies, shouldn't they be charging everyone the same price?

Time to end this practice and level the playing field instead of giving insurance companies preferential treatment.

 

[SammyJr]

Originally posted by: Nebor

Originally posted by: Modelworks

Originally posted by: KB
I know some older people who are a part of this program with their doctor. Problem is they still have to have insurance for work their physician can't do, like heart surgery. So their costs have just risen by nearly 50% a year. Being older and wealthier they can afford it in the name of staying healthy, but this isn't a solution to the health care problem.

How many times a year do you need heart surgery though ? The solution to health care is a non profit system, but there is too much corruption and greed for that to be put into practice .

Non-profit = mediocrity. I don't want mediocre health care. I want a doctor that demands he's paid more because he's the best. And I want the best medical care because I can afford it, thus I deserve better care than someone who can't.

I gots mine so fuck you! Yee-haw! Praise Palin and Jesus!

 

[zephyrprime]

Eliminating the conflict between the insurance companies and the providers is a key to health care reform in my opinion. Stuff like this is nice but it doesn't cover specialist of catastrophic problems which are the primary cost drivers. Maybe we should all go to HMOs.

 

[QuantumPion]

Originally posted by: sportage
All that the insurance co is, is the middleman.
A middleman out for profits.
Since gov ran healthcare would not be a profit organization,
everyone would see cost reduction and personal savings.

Your chain of reasoning is completely illogical.

First, you make the presupposition that the reason why health care is expensive is because insurance companies are trying to make a profit. This is wrong on so many levels, the least of which just being a gross oversimplification of the issue.

Then, you make the leap to saying that because the government is not for profit, costs would be reduced. Government programs have a proven history in every economic sector of simultaneously ballooning in expenses while providing far inferior service. For example: USPS, Medicare, Medicaid, Social Security, Public Education, AMTRAK, etc. What makes you think adding up the worst of the bunch into one giant combined program could possibly be successful?

 

[ElFenix]

Originally posted by: WhipperSnapper

We don't need to speculate about what national health care would be like nor whether it would make more economic sense than what we have now. We can just look to other nations.

United States: Currently spending about 17% of it's GDP on health care while leaving tens of millions of people uninsured or under-insured while hundreds of thousands file for medical-cost-induced bankruptcy every year and while the rest of the populace lives in terror of losing their jobs and insurance. Businesses are also heavily burdened with having to worry about pay for benefits.

Other First World Industrialized Nations: Currently spending far less than 17% of GDP while having 100% coverage and a more relaxed populace with zero medical bankrupticies and businesses and entrepreneurs that don't have to worry about medical benefits (at least not nearly to the extent they do in the U.S.). They either have single payer national health care or socialized medicine in the form of heavily-regulated insurance companies that bare no resemblance to U.S. insurance companies.

federal and state governments apparently already spend more per capita than most of the governments were the .gov supports a giant share of the population. so, basically, take all the funding for medicare/aid and schip, and use just that money to cover almost double the number of people. as george bush used to say, not gonna happen.

 

[piasabird]

It is pretty bad when a doctor has to hire 2 admins just to keep track of all the health insurance. The last time I had back problems I went to see a doctor who only accepts cash. It is like $45.00 a visit. No paperwork, No copay. He is a great guy from South Africa.

 

[Hayabusa Rider]

Originally posted by: BoomerD
Insurance companies negotiate lower prices for the medical procedures and visits for their members. This pushes the rest of the cost onto everyone else. For example, I had an MRI about 5 years ago and instead of sending the bill to the work comp insurance company, it got sent to me. Cost for the procedure (actually 2 MRI's of different areas) was just over $2200. The insurance company paid about $750 of that. The balance was "written off" as part of the negotiated price.

If the medical providers accept such low payments from insurance companies, shouldn't they be charging everyone the same price?

Time to end this practice and level the playing field instead of giving insurance companies preferential treatment.

So let's get this straight. Insurance companies pay what they want. It isn't a free market system. That forces others to pay when the reimbursement is less than cost.

Your answer? Make everything below cost! That makes no sense at all. What do you call someone who takes in less then they spend? Broke.

 

[classy]

I am not even going to go over all the ills of this proposal. Its the stupidest idea yet to surface in the whole healthcare debate.

 

[CPA]

I have been an advocate of a cash-based healthcare system for years. competition will push prices lower.