Comments on: My Patients http://distractible.org/2008/08/22/my-patients/ Thoughts of a moderately strange (yet not harmful) primary care physician. Sun, 01 Aug 2010 02:44:35 +0000 hourly 1 http://wordpress.org/?v=3.0.1 By: Ken O. http://distractible.org/2008/08/22/my-patients/comment-page-1/#comment-2231 Ken O. Tue, 26 Aug 2008 10:35:37 +0000 http://distractible.org/2008/08/22/my-patients/#comment-2231 I see exactly where you're coming from. Pretty much everyone I know, if asked "who is your doctor?" replies with the name of their GP/PHP, or the member of that practice that they see most often. They signally do not reply with the name of a consultant in a specialty. I see exactly where you’re coming from. Pretty much everyone I know, if asked “who is your doctor?” replies with the name of their GP/PHP, or the member of that practice that they see most often. They signally do not reply with the name of a consultant in a specialty.

]]> By: dr. bean http://distractible.org/2008/08/22/my-patients/comment-page-1/#comment-2227 dr. bean Mon, 25 Aug 2008 19:31:01 +0000 http://distractible.org/2008/08/22/my-patients/#comment-2227 A lot depends on your local insurance market. In my area, there are a lot of "managed care" plans (including Medicare managed care) out there that market themselves aggressively to the employers; then for the employees they turn out to be pretty reasonable compared to other options since they are subsidized. Then the insuree/employee is locked in; they can't get a test or hospitalization or ER visit approved unless it is ordered by an "in-network" provider. So it makes no sense for them to pay out of pocket to see a PCP out of network no matter how good a service they get. A cash only doc can find him/herself squeezed out of the market. On the other hand, if you lived in an area with lots of non-contract workers (waiters, bartenders, fruit pickers...) a cash dr might be a great fit in the community and really find a niche/supply a need. A lot depends on your local insurance market. In my area, there are a lot of “managed care” plans (including Medicare managed care) out there that market themselves aggressively to the employers; then for the employees they turn out to be pretty reasonable compared to other options since they are subsidized. Then the insuree/employee is locked in; they can’t get a test or hospitalization or ER visit approved unless it is ordered by an “in-network” provider. So it makes no sense for them to pay out of pocket to see a PCP out of network no matter how good a service they get. A cash only doc can find him/herself squeezed out of the market. On the other hand, if you lived in an area with lots of non-contract workers (waiters, bartenders, fruit pickers…) a cash dr might be a great fit in the community and really find a niche/supply a need.

]]> By: Name your price « Off-White Coat http://distractible.org/2008/08/22/my-patients/comment-page-1/#comment-2206 Name your price « Off-White Coat Sat, 23 Aug 2008 17:09:48 +0000 http://distractible.org/2008/08/22/my-patients/#comment-2206 [...] of a Distractible Mind has a very well written post on the mess that is medical insurance.  One of my very good friends outside of medical school has [...] [...] of a Distractible Mind has a very well written post on the mess that is medical insurance.  One of my very good friends outside of medical school has [...]

]]> By: some dude named steevo http://distractible.org/2008/08/22/my-patients/comment-page-1/#comment-2205 some dude named steevo Sat, 23 Aug 2008 16:07:05 +0000 http://distractible.org/2008/08/22/my-patients/#comment-2205 Interesting post! I have been an employed physician throughout my career, but I have been contemplating starting my own office as a solo practitioner. I might try it in a few years, and this would be the way to go. One of my former colleagues has started his own office with a cash-only practice. He is a unique fellow who should do well with this mode of practice: <a href="http://ronmorrellmd.com" rel="nofollow">http://ronmorrellmd.com/</a> is the link to his practice. Interesting post! I have been an employed physician throughout my career, but I have been contemplating starting my own office as a solo practitioner. I might try it in a few years, and this would be the way to go. One of my former colleagues has started his own office with a cash-only practice. He is a unique fellow who should do well with this mode of practice: http://ronmorrellmd.com/ is the link to his practice.

]]> By: The Scrivener http://distractible.org/2008/08/22/my-patients/comment-page-1/#comment-2200 The Scrivener Sat, 23 Aug 2008 14:37:19 +0000 http://distractible.org/2008/08/22/my-patients/#comment-2200 Great post. I've had difficulty explaining to my non-med friends, especially one whose background is in economics, why the free market business model that works decently well in other areas doesn't really apply to medicine. Even though you're writing from a primary care perspective (and certainly that's been the hardest hit by the current reimbursement incentives), I think the same arguments apply for specialties too. There was a New York Times article a few weeks ago about dermatologists running two-tiered practices; the cosmetic, pay-up-front patients even get their own swankier waiting room, because God forbid they should have to be anywhere near those horrible people with acne and eczema! I've added you to my blogroll -- keep 'em coming! Great post. I’ve had difficulty explaining to my non-med friends, especially one whose background is in economics, why the free market business model that works decently well in other areas doesn’t really apply to medicine. Even though you’re writing from a primary care perspective (and certainly that’s been the hardest hit by the current reimbursement incentives), I think the same arguments apply for specialties too. There was a New York Times article a few weeks ago about dermatologists running two-tiered practices; the cosmetic, pay-up-front patients even get their own swankier waiting room, because God forbid they should have to be anywhere near those horrible people with acne and eczema!

I’ve added you to my blogroll — keep ‘em coming!

]]> By: CarolynH http://distractible.org/2008/08/22/my-patients/comment-page-1/#comment-2194 CarolynH Fri, 22 Aug 2008 21:31:56 +0000 http://distractible.org/2008/08/22/my-patients/#comment-2194 There may be an easier way to solve the financial woes. I went to see my neurologist this morning. The staff took my co-pay, and then told me the doctor was out sick. I was so shaken up after waiting six weeks to see him that I didn't even think to ask for my money back. What could be better than getting paid for not seeing patients. There may be an easier way to solve the financial woes. I went to see my neurologist this morning. The staff took my co-pay, and then told me the doctor was out sick. I was so shaken up after waiting six weeks to see him that I didn’t even think to ask for my money back. What could be better than getting paid for not seeing patients.

]]> By: #1 Dinosaur http://distractible.org/2008/08/22/my-patients/comment-page-1/#comment-2193 #1 Dinosaur Fri, 22 Aug 2008 20:12:07 +0000 http://distractible.org/2008/08/22/my-patients/#comment-2193 You're singing my song, Dude. But eventually what happens is that our duty to ourselves outweighs our duty to our patients; then we go cash-only. Many patients leave; we wring out hands at having abandoned them. Then, later, they come back, because what you (and I offer) is real, and worth paying for. January 1, 2011: that's my Quit Date for insurance. You’re singing my song, Dude. But eventually what happens is that our duty to ourselves outweighs our duty to our patients; then we go cash-only. Many patients leave; we wring out hands at having abandoned them. Then, later, they come back, because what you (and I offer) is real, and worth paying for.

January 1, 2011: that’s my Quit Date for insurance.

]]> By: John B http://distractible.org/2008/08/22/my-patients/comment-page-1/#comment-2190 John B Fri, 22 Aug 2008 19:18:24 +0000 http://distractible.org/2008/08/22/my-patients/#comment-2190 I have pretty good health insurance, thankfully. Yet I don't have a PCP, and I haven't, at age 36, had a physical in years. Why? Because I hate the rigamarole, and I hate not knowing how much I'm gonna pay. I hate having to find a doctor. I would love to have a PCP like Dr. Rob or the FP in this article below--and Dr. Rob, have you thought about converting to this type of practice? Seems like a win for everyone involved. http://www.physicianspractice.com/index/fuseaction/articles.details/articleID/1016.htm I have pretty good health insurance, thankfully. Yet I don’t have a PCP, and I haven’t, at age 36, had a physical in years.

Why? Because I hate the rigamarole, and I hate not knowing how much I’m gonna pay. I hate having to find a doctor. I would love to have a PCP like Dr. Rob or the FP in this article below–and Dr. Rob, have you thought about converting to this type of practice? Seems like a win for everyone involved.

http://www.physicianspractice.com/index/fuseaction/articles.details/articleID/1016.htm

]]> By: Ami http://distractible.org/2008/08/22/my-patients/comment-page-1/#comment-2187 Ami Fri, 22 Aug 2008 18:50:09 +0000 http://distractible.org/2008/08/22/my-patients/#comment-2187 And that is why insurance companies feel like they can take advantage of all of us. Insurance companies lack compassion. They are increasing their profit margins by bullying both doctors and patients. One problem with the huge deductible major medical plans: they arent much cheaper. We shopped around. With our regular, fairly low number of visits, we would have paid more to doctor and insurance combined than if we just got the insurance our company provided. And that is why insurance companies feel like they can take advantage of all of us. Insurance companies lack compassion. They are increasing their profit margins by bullying both doctors and patients.

One problem with the huge deductible major medical plans: they arent much cheaper. We shopped around. With our regular, fairly low number of visits, we would have paid more to doctor and insurance combined than if we just got the insurance our company provided.

]]> By: outre http://distractible.org/2008/08/22/my-patients/comment-page-1/#comment-2185 outre Fri, 22 Aug 2008 16:31:30 +0000 http://distractible.org/2008/08/22/my-patients/#comment-2185 I'm noticing lots of doctors, esp big name specialists in NYC not taking any insurance but writing off the difference between the out-of-network insurance reimbursement and their charges. This could be a way to go for some providers, but I doubt it'd work for PCPs considering the already low reimbursement rates. What I think is that people need to start seeing PCPs as the 'manager' of the specialists, instead of basing importance/value based on amount of specialized training one has. For me my neuro-onc happens to be the main go-to for all NF related things but my PCP still knows everything about NF and other things going on with me so really, he's just as important as my neuro-onc but my insurance co dosn't think so. BTW, if he ever goes cash-only I'm totally following but not the neuro-onc. I’m noticing lots of doctors, esp big name specialists in NYC not taking any insurance but writing off the difference between the out-of-network insurance reimbursement and their charges. This could be a way to go for some providers, but I doubt it’d work for PCPs considering the already low reimbursement rates.

What I think is that people need to start seeing PCPs as the ‘manager’ of the specialists, instead of basing importance/value based on amount of specialized training one has. For me my neuro-onc happens to be the main go-to for all NF related things but my PCP still knows everything about NF and other things going on with me so really, he’s just as important as my neuro-onc but my insurance co dosn’t think so. BTW, if he ever goes cash-only I’m totally following but not the neuro-onc.

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