I have previously posted on the topic of doctors dropping out of Medicare and even private insurance and establishing cash-only medical practices. Here is another study of this phenomenon.
A few health insurers recognize the value of these services and reimburse enrollees for them, but concierge practices usually cater to cash-paying customers. Thus, they may be especially useful to patients who have a consumer-driven health account – such as a Health Savings Account (HSA), a Flexible Spending Account (FSA) or a Health Reimbursement Arrangement (HRA) – and to the uninsured.
A major consideration for the HSA patient is the fact that medical fees are grossly inflated by Medicare and insurance companies that draw up contracts with physicians including “discounts” from imaginary retail prices. When I retired from private practice, I had 176 contracts with various insurance companies and HMOs. Medicare will punish a physican who provides a cash discount to a patient. Balance billing is also prohibited.
The result has been reluctance on the part of physicians to see Medicare patents or HMO patients, both of which have poor reimbursement schedules.
* The proportion of people reporting problems seeing their primary care physician rose from less than one-quarter (23 percent) to one-third over the four-year period.
* Nearly one-quarter reported problems taking time from work to see a physician.
Here is one model.
Take DocTalker Family Medicine. This is the Virginia medical practice of Dr. Alan Dappen. Patients can schedule an in-office appointment or even request a house call, but about half of his consults are by e-mail or telephone.
Like an attorney, Dappen bases his consultation fees on the amount of time required. All patients must have an initial face-to-face consultation to establish care. There is no membership fee, but patients who prepay $300 annually receive a discount of about 25 percent. Each five-minute phone consultation or e-mail consultation costs $25. Nonmembers can buy services a la carte for $33.33 per five-minute block after a $150 initial check-up.
The office does not bill insurance companies for services, but most patients can easily file their own claim. Patient records are kept electronically for easy access.
The other common model is the “retainer practice” model.
Concierge medicine is normally associated with personalized services for the wealthy. These services can sometimes be expensive – in some cases more than $2,500 per year per person. However, in suburban Collin County north of Dallas, Texas, physician Nelson Simmons offers a version of concierge service for less than $500 per year. Aimed at small business employees who would otherwise likely be without employer-sponsored insurance, Simmons’ practice has attracted about 70 small business owners who pay $40 per employee per month. In return, employees get same-day primary care services and steep discounts on diagnostic tests and specialist care. Enrollees must pay out-of-pocket for specialist care, surgeries and diagnostic tests – but Simmons negotiates the rates, which are typically much lower than what others pay.
The $2500 usually includes all primary care services for the same annual fee. Doctors are starting to drop out of the old insurance model and this bodes ill for the corporate model of Obamacare.
Tags: health care
At a certain point the Democrats – and I fear with some Republican support – will start pushing for the legal/regulatory “corralling” of doctors.
By this I mean they’ll attempt to prevent Doctors from opting out of insurance – at least government insurance.
Unconstitutional? Sure it would be. Would that stop them? No. And do you trust the Supreme Court to defend the Constitution? I don’t.
BILL
[…] A major consideration for the HSA patient is the fact that medical fees are grossly inflated by Medicare and insurance […]
[…] this article: More on cash practice of medicine « A Brief History… Share and […]