Category Archives for "Medical practice"

Aug 04

Direct Patient Care – Is it really a good idea?

By Dennis Hursh | Medical practice

I have recently been involved with two physicians who have each set up a “direct patient care” practice. I have no idea if this is going to be a trend, but I hope it will be.

I  suspect that if you have seen one DPC practice, you have seen one DPC practice – so I hesitate to talk about the “model”. Nevertheless, I think talking about how these two practices operate might stimulate conversation, and get other physicians thinking about “taking the plunge”.  Both the practices have a few things in common.

First, they do not accept insurance, unlike concierge practices which still accept insurance and charge an additional membership fee on an annual basis. One of the practices I represent does give its patients CPT codes to assist in obtaining reimbursement, but the other does not. The practices charge a fixed monthly fee for “all-you-need” care in the practice, ranging from $10-$100 per month (based on age) in a primary care practice, and $25-$45 per month for a gynecological practice. Foregoing insurance reimbursement allows for a  bare-bones staff, since billing is accomplished automatically through a charge to the patient’s credit card each month. By saving a massive amount of overhead, the physicians are able to limit  the size of their practice and give the attention to each patient that the physician feels is required. (No six patients an hour in these practices!)

Secondly, they provide continuous, 24/7 access to the patients in their panel for acute issues via email, text, and/or phone. Patients are given the physician’s cell phone number for after-hours care.

In addition, they both have access to discounted pricing from a radiology facility, a lab, and several specialists, saving the patients even more money.

The primary care practice has been established longer, and it has developed a host of enhancements for its patients.  The practice has its own dispensary, where patients can get their generic medications at wholesale with a very modest mark-up of 10%.  The physician has saved patients hundreds of dollars a year (for some patients, thousands of dollars) over the cost of medicine through pharmacies.

Even without the discounts, patients can potentially save a great deal of money with these practices.  Instead of paying a hefty co-pay every time they see the physician, patients in these practices just pay one fixed monthly fee, which is often very close to the cost of a single co-pay.

Most importantly, the patients get a physician that has the time to get to know them, and spend however much time is needed to treat him or her. Office visits typically range from 30-60 minutes per patient.

The physicians get to spend most of their time healing patients, rather than supervising a massive staff and fighting with insurance companies.

The physicians can’t escape every woe, of course.  HIPAA, CLIA, OSHA, etc. are still applicable.  If they are treating Medicare patients, they need special waivers, and a patient contract must be developed.

Still, DPC seems like a great thing for patients and physicians alike.

Time will tell if this model fulfills its promise – but early indications are that it will!


Jun 07

Shifting Alliances

By Dennis Hursh | Medical practice

I was recently at a meeting where a respected physician leader made a fascinating observation. It is his belief that the new emphasis on value-based contracting and risk-based contracting is changing the historic alliances between physicians and hospitals on one side of the table, and payers on the other side of the table.

He believes that the new contracting paradigms are creating alliances between physicians and payers on one side, squared off against hospitals on the other side. If you think about many of the new initiatives coming out of CMS (care coordination management codes, for example) a common thread seems to be that paying physicians a little more can generate huge savings on what would otherwise be spent on hospital services.

At the risk of sounding like a broken record, I think this is great news for physicians. Hospital consolidation continues at a dizzying pace, creating massive enterprises with seemingly unlimited resources. And yet, the entities holding the money (payers) finally seem to realize that the folks in the white coats, if properly compensated and incentivized, can effectively bend the healthcare cost curve.

In Pennsylvania, the market I am most familiar with, physicians are organizing clinically integrated networks designed to work with the payers to move money from the “hospital bucket” to the “physician bucket”. It is not going to happen overnight, but physicians are going to take back control of healthcare.

Who (other than hospitals) would not be encouraged by that?

Apr 15

My Doctor Made a Mistake

By Dennis Hursh | Medical practice

Last Tuesday and Wednesday were not good days.  Tuesday I was on a clear liquid diet all day, until 5 or so when I began ingesting what Dave Berry has called a “nuclear laxative”.  The reason for these festivities was that my PCP had ordered a colonoscopy for yours truly.  She had looked at the chart, noticed the colonoscopy I had in 2011, and ordered another one following a standard 5-year protocol.

For those who are unfamiliar with the process, I would commend Dave Berry’s excellent exposition of the medical, psychological and plumbing aspects of preparation for this particular procedure.

Suffice it to say, preparation for a colonoscopy isn’t something you want to do for a good time.  However, as a good little patient, I dutifully paid my dues and went through the process.

Wednesday morning, I met a charming nurse, who carefully went through my history, meds, allergies, etc.  She made sure that all the proper “prep” had been accomplished.  (Let me assure you, it most certainly had – I had, in the vernacular of veterans of the procedure,  “prepped my brains out”).  As she looked at my chart, she pulled the reports on the last two colonoscopies I had, in 2011 and 2014.  We were a bit confused as to why I needed a colonoscopy just two years after my last one, especially since the doctor who had performed the 2014 procedure recommended a follow-up in 5 years.  Those of you who are especially good at math may have figured that I needed a colonoscopy in 2019, NOT 2016.

A call to the PCP revealed that she had missed the 2014 procedure, and we decided that I could leave without having the physician explore my innards.  When I got home, I had the following message in the patient portal:

“This was totally my mistake. Now that I look through the chart, I see that he did have it done in 2014 and does not need it. I am SO sorry”

That response prompted this post.  Here’s the thing – I can’t agree with her analysis.  Was this “totally” her mistake?  Was it too much to expect the patient to remember he had undergone this procedure two years ago? Is the health system maybe a teeny tiny bit responsible for scheduling her patients like an assembly line, so she has to rush through encounters?  Could the insurer be slightly responsible, for putting physicians and health systems in a position where they can’t survive unless they grind through patients?

Let’s face it, no matter how rushed things get, the buck stops at the physician with hands on the patient.  We absolutely have to give these folks time to do what they’re trained to do.  As professionals, physicians are always going to accept blame for anything they are involved in – but it’s time that we recognize that the problem with American healthcare isn’t the physicians, it’s the system that doesn’t allow our physicians to do what they’ve been trained so well to do.

So, Laurie, I forgive you.  But the next time we meet, I will be singing the Colonoscopy Song.

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