My last post looked at a new reimbursement model – well, maybe a “tweak” of the current model would be more accurate. In a recent New York Times item, Dr Thomas Gross suggests still another:
“The current medical reimbursement system pays by the job performed, not by the time spent…Your family doctor receives the same reimbursement for diagnosing a sinus infection in 6 minutes as he does if he takes 30 minutes…In our current system, there is no way to buy an hour of your doctor's time just to talk.”
First, in fairness, one most likely COULD purchase an hour of the doc’s time; it would just be VERY expensive, and not a covered expense under one’s medical plan. But I see Dr Gross’ real point, which is that medicine has become outcome-based, as opposed to health-based. And that this is at least partly a result of the current medical insurance system.
In previous posts, I discussed Consumer Driven Health Care (CDHC). The primary goal of CDHC is to empower patients/insureds in taking a more active role in their own health care. We talked about coupling catastrophic medical plans with tax-advantaged savings accounts.
But HDHP’s and HSA’s are not the only way to engage in CDHC (there, is THAT wonkish enough for you?). We’ll look at some alternatives next week.
A few docs in the Atlanta area have converted their practice to cash only, prepay businesses. No more insurance. No forms to fill out. No disputes over payment.
ReplyDeleteThey operate like a boutique. You prepay an annual fee, around $2000 and for that you get a comprehensive physical once yearly. No in and out, see ya next year, but a thorough exam that takes about 3 hours.
For your $2k you get ready access to your doc 24/7 with his/her private number and a promise of a call back within an hour. When you schedule an appointment you are guaranteed to be seen within 30 minutes.
Sounds like those oil change shops . . .
Each appointment gives you face time with the doc, as much as is needed.
It's an interesting concept to say the least but it is also a bit elitist. The docs that are doing this are mostly family practice or internists. I do know at least one GYN that does the same but at a lower price.
So you pay $2k and have your own personal doc. But you still have to pay for lab work separately and then file with your carrier direct for reimbursement.
Yes, you still need to keep health insurance in case something happens that your internist can handle.
So you are paying health insurance premiums AND the $2k. You might be able to get reimbursement from your carrier for a portion of your physical if your plan includes annual exams, but there is no guarantee of that happening. These docs do not bill carriers, nor do they generate an itemized statment (except for lab) so there really is no way to submit a bill to your carrier for a physical.
I suppose if I were older, and had some chronic problems this kind of care might be nice. But as a young 54 with no discernible health problems other than chest-in-drawers disease, I think I am going to pass on this for now.
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ReplyDeleteThe trend toward "boutique" medicine is relatively new, and (thus far) relatively rare, but...
Still, I googled [interesting that it's now a commonly-recognized verb, no?]
"boutique medicine" and found quite a few "hits."
The most interesting one basically compared a typical practice with, say, 2500 or so patients, versus a "limited practice" (which I suspect will become the preferred term -- you heard it here first!) of, say, 600.
2500 patients works out to roughly 50 or so patients a week. Given a 6 hour day (taking into account lunch, paperwork, etc), that means the practice has about 1200 hours a year to see and treat patients. That works out to less than 1/2 hour per patient.
Contrast that with 600 patients in a L-P, which would leave over 2 hours per patient.
You're right to point out that the patient will still need cat cover for the "big stuff." But I suspect that those who are drawn to L-P's probably wouldn't bat an eye at the $2k retainer plus, say another $2400 for an HDHP plan.
That's $4400/year, or about $350 per month. You'd have vitually unlimited access to your PCP, plus a safety net. I submit that high-income folks would consider that a bargain.
BTW, don't you mean an "immature 54?"