Here Is An Interesting Concept

This just arrived in my email.


Saving Money: You‘ve probably heard of Doctors Without Borders. Now get ready for doctors without insurance. Thanks to a little-known provision of the Patient Protection and Affordable Care Act, otherwise known as healthcare reform, beginning in 2014, a new type of medical practice will be allowed to compete within state-based insurance exchanges. They‘re called Direct Primary Care practices, or ―medical homes.‖ By eliminating insurance companies from the health care equation, these practices promise to lower the cost of medical care by up to 40%– according to some experts, the amount sucked up by insurance company profit and overhead. Rather than paying an insurance company every month for health coverage, you cut out them out entirely and pay a doctor or group directly. It‘s like a gym membership – you pay every month whether you go or not, but you can go as often as you want, whenever you want. No insurance, no deductible, no paperwork, no bill. The cost? $50 – $150 per month, depending on your age. And not only is this idea a money-saver, its proponents claim that it could also radically improve the quality of care you receive, because the doctors will be able to spend time with patients that‘s now spent on paperwork.

How can the simple act of eliminating an insurance company offer both lower costs and better care? To get an idea, consider your car insurance. Suppose that whenever you needed an oil change, an insurance company was going to pay the bill. You don‘t care how much an oil change costs – that‘s the insurance company‘s problem. But because they‘re paying, the insurance company only allows you to see a mechanic with whom it has negotiated rates and otherwise approved in advance. When you go to the shop, the mechanic has to keep detailed records of exactly what was done to your car and why. In order to get paid for their services, the mechanic will have to submit the proper forms – different for each insurance company they work with – then await approval. If the insurance company reviews the file and decides your car didn‘t really need an oil change, the mechanic provided services that may not have been necessary, or there‘s a deductible in your policy, they‘ll disallow the payment. The mechanic will then be forced to start over and collect their money from you.
Result? Your mechanic is going to spend a lot more time adhering to insurance company guidelines, filling out paperwork, and trying to collect their money – and a lot less time changing oil. Since they don‘t get paid for doing paperwork, they‘ll have to work longer hours, charge more, and/or spend less time with your car. In addition, they may find their job less rewarding, since rather than doing what they think is right, they‘ll instead be doing only what an insurance company mandates. The reason you don‘t have insurance for things like oil changes is that you don‘t need it. An oil change isn‘t a big enough expense to justify the added hassle, overhead and paperwork of working through an insurance company. Proponents of direct primary care offer the same logic for doctor visits. Forget the insurance – just pay a monthly fee and go see a happier doctor as often as you want. And that‘s where 90% of health care happens: in a doctor‘s office.
But what about the other 10% of healthcare that happens at a specialist‘s office, an emergency room or in a hospital? For potentially catastrophic costs, you‘ll still need insurance – just like you do for your car. So in addition to joining a direct primary care group, you‘ll still need insurance to cover hospital visits. But since that‘s all that‘s covered, it‘s theoretically much less expensive. Direct primary care isn‘t for everyone. For example, if you never go to the doctor, maybe you‘d prefer to just get a high-deductible policy and skip the $50-$100 month cost of a direct primary care practice. There will also be people (or employers) to whom even $50 a month per person is unaffordable. But this type of innovation could be a partial solution for some employers, as well as the millions who now pay for their own insurance. If you‘d like to see what this kind of health care solution looks like, you don‘t have to wait till 2014. Direct Primary Care practices exist right now. A nationwide list of direct primary care doctors can be seen at. http://www.dpcare.org/practices. For additional info on the

Laura

My former (thankfully) sleep doctor didn't take it so far as to eliminate insurance, but he did have an elite "club" of patients who paid an annual fee that gave them priority service, direct access through the doctor's cell phone, and guaranteed availlibility. I had to wonder if I might have gotten more respect and consideration if I'd "bought" his attention.

There is a local dentist who is cash only. He likes to keep life simple.

Interesting information, Ocean Going Gal. There is also a good article about direct primary care medical home plans on the Military Officers Association of America web site, http://www.moaablogs.org/healthcare/201 ... cal-homes/.

One of the reasons I get upset when the PPACA is characterized as a socialist or single-payer system is that it is full of provisions that authorize new ways of improving quality and saving money. There is a good summary at http://www.foley.com/publications/pub_d ... pubid=7141. It is because the insurance exchanges are designed to foster competition among competing plans that we can expect some of these innovations to be tried by organizations hoping to capture a larger market share by finding ways to increase quality or reduce costs. One of the most promising, in my opinion, is the affordable care organization (ACO), which is a plan whereby healthcare providers and insurers agree to a set of quality and efficiency measurements. Examples are hospital-acquired infection rates and readmission rates. To the extent that the providers do poorly in meeting these measurements, they lose part of their reimbursement. To the extent that they do well, they get to share in the cost savings. I know that the largest healthcare group in the Chicago area (Advocate) and the largest insurer (Blue Cross Blue Shield) have already announced such an agreement, and say they they began working on it immediately after the PPACA passed in response to its mandates.

None of the Congressional Budget Office estimates of future cost rely on any of these working. The CBO did not think it had a sound basis to estimate what savings these could generate. But the structure is there for trying such plans, and the potential for better or cheaper care exists as a result, in significant part through encouraging private entities.

Jersey Girl wrote:I wonder what some other folks think about this type of doctor's practice - almost like a club - pay $150 a month and go as often as you need to. I think it would be better if they had a practice with some specialists on staff - not just a primary doctor. Many people like me have to see specialists on a regular basis - cariodologist, endo, etc.

Including specialists sounds a lot like health maintenance organizations (HMOs), which have been around for a long time but never become truly popular. I remember taking a healthcare finance course back in the 1970s with an instructor who who seemed sure that HMOs would change the world. I liked the idea -- it seemed like going to the student health center. However, they always faced difficulty in the desire of people to have more choice. As an employer, my partners and I offer employees the choice between HMO and the more usual preferred provider organization (PPO) plans. Even though the former has lower deductibles and better benefits, almost everyone (including me) opts for the latter. I think most of us would be happy with the HMO most of the time, but if we have cancer or need heart surgery, we want to be able to shop for the best care we can get. Direct primary medical care may be an answer, combined with a "wrap around" insurance plan that covers serious acute care needs. In response to Jersey Girl's point, the concept is defined broadly enough to include all primary and preventive care, chronic disease management, and care coordination. So plans may emerge in which gynecologists or rheumatologists or other specialists take part, if they are, in effect, the patient's primary physician because of the need to manage a chronic condition.

A group of doctors got together and formed their own cooperative care group in our town--
cutting the insurance companies out of the picture.
It was called Health Central.
It was, in fact, an HMO and I never had such poor care in my life. BEWARE!