Comments on: Doctors vs. Zombies

By: Karen Sibert

Karen Sibert — Wed, 17 Sep 2014 11:47:04 +0000

I admit to some jealousy! Any degree of control at all over medical practice seems like a dream. But for those of us in hospital practice like myself (anesthesiology), there just isn’t any way to do as you’re doing. Patients don’t come to see me personally; they present either through the ER or via their surgeons. My group pools all the receipts and gets paid through insurance, rarely via self-pay, or not at all. In the meantime, the hospital dances on the strings of the Joint Commission and CMS, and we all dance on the strings of the hospital. Oh well. Being a doctor is still a thousand times better and more personally rewarding than any other job I can think of, thank heaven. Haven’t quite reached zombie status yet.

By: @Consults4MDs

@Consults4MDs — Tue, 22 Jul 2014 20:06:08 +0000

I must say I am impressed with the huge step you have taken to take back your practice, provide superior healthcare, and hopefully make your practice profitable. I have worked in the healthcare arena for some time now and I have actually begun to build a consulting business for this reason exactly. I would love the opportunity to discuss this model and how you are faring in greater detail, as well as share my plans. I think you have made a tremendous advancement for the patients and your own freedom. I also think more Independant physicians need to adopt a similar model. Also I would love the opportunity to link to your blog or have you guest blog for me in the near future, people need to hear this message!

By: Perry

Perry — Sun, 20 Jul 2014 15:31:28 +0000

In reply to Rob. And no ridiculous paperwork to prove you did something for the patient, and no idiotic EMR system which interferes with face to face patient time.

By: Balboa

Balboa — Sat, 19 Jul 2014 21:24:58 +0000

In reply to Rob. Ah...right on

By: Rob

Rob — Sat, 19 Jul 2014 21:03:29 +0000

In reply to Balboa. In a way, but it is FAR more than I would get with capitation (which is usually around $10-15 per member per month (or less). The fact that I have no contracts with payors to keep track of, no auditors breathing down my neck, and only the patient to make happy is, however, the biggest difference.

By: Balboa

Balboa — Sat, 19 Jul 2014 20:59:14 +0000

In reply to Rob.

I’m not saying you should. I would like to see more physicians adopt this model… but I’m having trouble understanding the difference between the two options.

Your patients now pay you $30-$60 pmpm to manage their care.. isn’t that the same as capitation?

By: Rob

Rob — Sat, 19 Jul 2014 00:58:18 +0000

In reply to Balboa.

Why would I?

You work for whoever pays you. I work for my patients. This system is far better for me and for my patients, plus, it saves money for payors (I give more time to my patients, so they make better-informed decisions, like where the cheapest meds are, when they should go to the ER, etc). I am their health advisor or coach.

I’ve found a system that works far better and is much better for me, my staff, and my patients. Why would I leave that and go back to capitation?

By: Balboa

Balboa — Sat, 19 Jul 2014 00:48:44 +0000

Why not take capitation then? I see many providers abhor the thought of capitation from insurance companies. Is this just a who-pays-who type of thing?

By: @BobbyGvegas

@BobbyGvegas — Fri, 18 Jul 2014 14:51:11 +0000

In reply to Rob.

Well, we keep calling it “insurance,” but the large component that you obviously object to and have acted against is not insurance, it’s 3rd party pre-payment (economically inefficient) intermediation. I agree with your antipathy there. “Insurance,” properly, is hedge contracting against otherwise ruinous large adverse events. There is but one choice there: [1] risk-rated underwriting (mostly by the for-profit private sector), or [2] “social insurance” (e.g., Medicare Part A). I guess you could include in the latter the spend-down-to-penury means-tested Medicaid etc.

Short of full self-pay for everyone, there’s no getting around a need for insurance in health care — and all of the administrative heartburn it entails.

By: Rob

Rob — Fri, 18 Jul 2014 01:07:59 +0000

Insurance can’t be completely avoided, but we are in a third-party system that creates an envoronment where sickness and procedures are rewarded. Yes, that would still be the case for specialists doing procedures people will need at times, but it doesn’t have to be the case for primary care or for non-procedural care. The problem is that third-party payors no longer act like insurance companies (paying for unforseen expenses by charging a large group of people to be protected from those expenses). If primary care docs got out of this pay-for-procedure mindset and were instead working to minimize the number of people needing those procedures in the 1st place, they woud actually be doing something the insurance companies would like: lowering their risk. My goal with my patients is to keep them from spending their deductibles by keeping them as well as possible. I am the consummate bargain for the insurers (including the government) because I save them money while costing them absolutely nothing.