In the face of this ever-changing world of health care, patients as well as doctors have many options. To have insurance or not have insurance? HMO or PPO? For physicians, the decisions are not too far off from those of their patients. Private practice or employee? Accept insurance or do not accept insurance?
These questions and decisions can provoke a large amount of anxiety on even those savvy in “health care lingo”. Personally, I believe that the general public has absolutely no idea what they are getting into when they sign their insurance agreement. The vast majority of people assume (and you know what they say about assume) that because they have insurance, they have GOOD health care. Wrong. Way wrong. Listen up. Insurance companies are like any other company-they are there to make a profit. Period. If the public as a whole only knew what physicians know, I don’t think half of the companies would be in business. Hey, medicine is like anything else-you get what you pay for (especially in terms of insurance). The same will likely hold true for government insurance, unfortunately.
What I spent a good portion of my training doing. Terrible.
Let me give you an example. In Miami there are ACO’s everywhere. ACO’s are accountable care organizations. Read about them here. A very popular ACO here may quite possibly provide the worst coverage I have ever seen. Are the doctors good? Actually, the main doctor in the hospital is excellent. However, as an outpatient, getting any high-end medication approved is like have teeth pulled without an anesthetic. They pay for bottom-of-the-barrel medications. Getting a more effective blood pressure medication approved is like a 3 week process. Why? Because the less effective one is CHEAPER. Imagine you just had a heart attack. Your doctor wants to put you on the best medication to help your stent stay open but waiting 3 weeks for the approval is out of the question. So, instead of letting you suffer, waiting for it to be approved for the better medication, you’ll get the older, generic medication instead. The list goes on and on. This includes radiological tests and procedures too! Could your doctor call the company, yell, yell again….argue and finally get something approved? Sure. But you tell me what doctor that is seeing 40 patients a day has time for that. Exactly.
Oh wait! One better. There are capitation or “risk” contracts that doctor’s can be a part of. In layman’s terms, this is a contract where the doctor starts off with x number of dollars, and those dollars get deducted for tests or treatments ordered by the doctor. It pays a physician or group a set amount of money for each enrolled person assigned to them per certain period of time, whether or not a patient seeks care. So, basically, doctors are given an incentive to consider the cost of care. Or, the way I think of it…they are given an incentive to save the insurance company money- which puts more money in the doctor’s pocket. Luckily, all of the physicians I know are ethical, so they do all they can for their patients in terms of care.
Enter: me. Bluntly, I can’t stand the way people are manipulated in regards to their health care. Just because you walk into a pretty building and get pastries at the door (don’t even get me started on that) does NOT mean that you are getting quality healthcare. So, I decided to do something a little more….straightforward.
I do not want to see 40 patients a day. I saw someone post on facebook the other day..”What a great doctor! I was in and out in 5 minutes with a prescription in hand for my COLD”. What the heck? BUT, most doctors have to do this. And for some absurd reason it is perceived by the public as good care. We as practitioners are reimbursed so poorly nowadays from insurance companies that in order to make a good living (and pay off our ridiculous student loans) we are forced to see 30 patients a day. No thanks.
My husband and I have decided to go the concierge medicine route. Just hear me out and you may understand why. I like people. A lot. I also like to talk…a lot. In order for me to be able to spend a solid 45 minutes with a patient (which is what they deserve), I have to charge extra. If not, I’d be barely breaking even after billing the insurance company for the services rendered and then paying for the office, supplies and staff. I do not like to be rushed, and I do not think that a patient should ever feel rushed. I want to have the time to talk about nutrition, weight loss, prevention of disease, family medical history..etc etc. I can’t do that in 15 minutes. No one can do it in 15 minutes. I also believe that a patient should have access to their doctor 24/7. Cell phone and e-mail included. So, we decided to form a style of practice that is becoming more and more popular these days. We charge a flat annual fee (which comes out to a monthly payment equivalent to most people’s cell phone bills) to be able to provide a SERVICE. The service is 24/7 access, cell phone and e-mail access, same or next day appointments in the case of an illness or emergency, extended office hours (evenings and weekends) and extended office appointments- 45 minutes to an hour. We still bill the patient’s insurance company for services rendered (the office visit, labs, etc), but we have the TIME to actually call and get things approved, as mentioned above. So, basically, the patients pay a fee for a service, not the medical care.
Make sense? Well, I hope so. Thus far, we are doing well and we have patients that are so happy to walk into a nice, inviting office, free of a packed waiting room, people yelling or the smell of a “doctor’s office”. I am happy to be able to call my patients my friends…and I am even more happy that they are able to put their trust in me that I am ALWAYS 100% on their side…I am their advocate, no one else’s.