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I finally had a chance to read this article in the print version of Time magazine. Initially I was skeptical about this form of health care, but it seems to have been successful. At first glance it looks like concierge care, but is supposed to be a different type of practice, resulting in lower costs to the patient.
"The driving insight here is that primary care and specialized care have two very different missions. Americans need more of the first so they’ll need less of the second. And each requires a different business model. Primary care should be paid for directly, because that’s the easiest and most efficient way to purchase a service that everyone should be buying and using. By contrast, specialty care and hospitalizations–which would be covered by traditional insurance–are expenses we all prefer to avoid" Better Healthcare for Less Money: Medicine Gets Personal
I finally had a chance to read this article in the print version of Time magazine. Initially I was skeptical about this form of health care, but it seems to have been successful. At first glance it looks like concierge care, but is supposed to be a different type of practice, resulting in lower costs to the patient.
"The driving insight here is that primary care and specialized care have two very different missions. Americans need more of the first so they’ll need less of the second. And each requires a different business model. Primary care should be paid for directly, because that’s the easiest and most efficient way to purchase a service that everyone should be buying and using. By contrast, specialty care and hospitalizations–which would be covered by traditional insurance–are expenses we all prefer to avoid" Better Healthcare for Less Money: Medicine Gets Personal
I read the article, and as a patient concerned with care, I like the concept. I also recognize the burn out factor with primary care doctors who are forced to see too many patients per hour in order to make the income they desire and insurance companies dictate. I also recognize the financial gain for the doctors who's work day could be improved. But at present time, I don't see a over all cost benefit to the patient in terms of insurance cost.
Today's policies all have larger deductibles, so not only are we paying for Primary Care visits ourselves, we are paying for specialists and perhaps some procedures before any insurance money kicks in. In other words, insurance companies have already shifted that cost to us. So, if we could lessen that major medical deductible by say $1,200 it would make financial sense for us too? Are we going to cost the insurance company any less by adding another monthly insurance premium for ourselves for primary doctors? I don't think so.
We all ready pay for it ourselves now. It is just crappier care than it should be, and not fun for the Primary care doctors who want to make more money and not playing beat the clock. It seems that the financial savings (or gains, depending on how you want to look at it) was transferred to the doctor, not the patient. The patient gained maybe another five minutes, except for the initial consultation, but the cost benefit went primarily to the doctors. The exception being the doctor who provided medicine to the patient at cost and was able to save her money.
So to me, this model improves care to some degree for the patient but not necessarily cost savings. Many patients only see their primary physician once a year, so for them it will definitely wind up costing them more. The old method of combining a plan like this along side a cheap catastrophic plan no longer works, now that we have joined the rest of the civilized society and are trying to provide care for the sick as well as the poor and this cost must be passed on to those who can afford more.
My thinking is how do you combine a new model like this and incorporate it with other care, and be able to bring costs down across the board.
Many patients only see their primary physician once a year, so for them it will definitely wind up costing them more. The old method of combining a plan like this along side a cheap catastrophic plan no longer works...
It seems that if a patient paid $600 per year ($50 per month), or $780/yr, as Dr. Bliss charges in the article, plus the cost of an insurance policy that covers anything not covered by primary care, that would be a lot less $ than what most people are paying now.
I didn't know that this possibility even existed. "Under the ACA, individuals enrolled in a direct primary care medical home are required only to have insurance that covers what is not covered in the direct primary care program. Section 10104 exempts patients who are enrolled in direct primary care from the individual insurance mandate for primary care services if they have supplementary qualified coverage for other services. Individuals not enrolled in direct primary care are required under the ACA to have insurance that covers primary care." Direct Primary Care: An Alternative to Conventional Health Insurance
It seems that if a patient paid $600 per year ($50 per month), or $780/yr, as Dr. Bliss charges in the article, plus the cost of an insurance policy that covers anything not covered by primary care, that would be a lot less $ than what most people are paying now.
I didn't know that this possibility even existed. "Under the ACA, individuals enrolled in a direct primary care medical home are required only to have insurance that covers what is not covered in the direct primary care program. Section 10104 exempts patients who are enrolled in direct primary care from the individual insurance mandate for primary care services if they have supplementary qualified coverage for other services. Individuals not enrolled in direct primary care are required under the ACA to have insurance that covers primary care." Direct Primary Care: An Alternative to Conventional Health Insurance
I quoted $1,200 as the article further down said average cost was $100 month. If a "wrap around" policy could be purchased which made sense, I would be all for it, especially if they had an HSA available. I have a problem with our high deductible plans in that it does discourage people from seeing a doctor, when they perhaps should, as they might be able to catch a problem before it gets out of control. People say having skin in the game controls costs, and that is also true sometimes, but not so sure with Primary Care.
Actually contrary to popular belief, Americans doctor less than most other counties. As far as over use of imaging devices, I have mixed feelings on this. As an example, cancer is often detected by use of an imaging devise that was ordered to look for something else. This was my case, and I know is the case for many cancer patients. And since early detection in catching it before it progresses to stage III or IV is critical, and since 1 out of 3 people will get cancer, scans saves lives. There is just no reason for scans to cost the crazy prices they do here, when it countries like France charge 1/4th the price using the same machine. (and France is not a cheap place to live)
The practice that the article referred to in the article has seen a change over time. Where up to about 2010 you could get in to see the doctor quicker, now the biggest complaint is you can't get an appointment for over a month, so it appears they need more doctors (or less patients) now. I would like to see some form of direct payment succeed though, especially if we could also get the rest of health care costs down.
There was an article I recently read about why we pay so much more for health care than say for example France who is rated #1 in care and outcome. They said it was simple. They just charge more for services. Oh here I found it. Why an MRI costs $1,080 in America and $280 in France - The Washington Post
In fairness though, I must mention a few facts. French doctors receive about 20 percent less pay than American doctors. However, medical school for them like in most other countries is government subsidized. A savings of about $285,000. Secondly, our medical malpractice insurance for some specialties is much higher than in France. Those are the two factors that could justify the increase in income. But physician incomes are not the by any stretch the main cost factor in health care differences.
Don't want to get off subject of the original poster, but examining new concepts as stated in the OP article as well as existing ones in practice is a way to help solving our problems.
I have a problem with our high deductible plans in that it does discourage people from seeing a doctor, when they perhaps should, as they might be able to catch a problem before it gets out of control.
I also have a problem with the high deductible plans the way they are written now. However, this type of care apparently involves a different type of high deductible policy. The whole point of this type of care is that it encourages people to see the doctor for minor issues, leading to less expensive care when those minor issues are addressed.
From the Time article: "One of those new patients is Jim Papadem, an out-of-work printing-press operator in his mid-50s from Redmond, Wash., who had long ignored his deteriorating health out of fear that the cost of treatment would ruin him. “I was pretty sure I had diabetes, and it turns out I had atrial fibrillation too,” he says. At his first meeting with his new Qliance physician, Dr. Randy Leggett, Papadem detailed his many symptoms. Leggett dispatched him to an eye specialist for treatment of a diabetes-related condition...."
Quote:
The practice that the article referred to in the article has seen a change over time. Where up to about 2010 you could get in to see the doctor quicker, now the biggest complaint is you can't get an appointment for over a month, so it appears they need more doctors (or less patients) now.
Yes, apparently there's a shortage of primary care doctors now, because of the way the system focuses on insurance, paperwork, codes, # of minutes allotted per patient, etc, which is why Dr. Bliss in this article was so relieved to be rid of all that.
I finally had a chance to read this article in the print version of Time magazine. Initially I was skeptical about this form of health care, but it seems to have been successful. At first glance it looks like concierge care, but is supposed to be a different type of practice, resulting in lower costs to the patient.
"The driving insight here is that primary care and specialized care have two very different missions. Americans need more of the first so they’ll need less of the second. And each requires a different business model. Primary care should be paid for directly, because that’s the easiest and most efficient way to purchase a service that everyone should be buying and using. By contrast, specialty care and hospitalizations–which would be covered by traditional insurance–are expenses we all prefer to avoid" Better Healthcare for Less Money: Medicine Gets Personal
I read the article, and other than providing this service for lower monthly fees than those quoted for concierge services, purportedly so that people who aren't "rich" could afford it, it looks exactly like a concierge physician practice to me.
I don't know what fees are for concierge services these days are, but a few years ago I saw quotes for between $1500 and $2500 annually, I'm sure they've increased, but I guess the docs ( or their practice management companies) tailor their fees to attract the patients they want-if they want upscale patients they will charge upscale prices.
Are insurance policies for catastrophic and specialty care only even available these days?
I have this kind of care. I pay less then the fee in the article. I love it! I get as much time as I need with my doctor. All of my appointments have been a half hour to an hour long, depending on what was needed. I can call or email my doctor directly when I have questions or concerns. The quality of care is excellent.
I also have a problem with the high deductible plans the way they are written now. However, this type of care apparently involves a different type of high deductible policy. The whole point of this type of care is that it encourages people to see the doctor for minor issues, leading to less expensive care when those minor issues are addressed.
This is true. I used to have to be really sick to go to the doctor. Now I go for preventative care and I'm much more likely to call my doctor for minor things instead of waiting like I did before. Being able to have a true high deductible policy to compliment this model of care would be ideal for me.
I don't think that anyone would argue with you that a service like this is preferable in terms of care as opposed to the "run by" consultations most of us have with our primary care doctors. The question is, does it increase or decrease your insurance costs. At this juncture, you would probably pay more.
Now obviously, in the long term, if a doctor can catch a disease in it's early stages or even before it manifests itself, or encourage you to lose weight, it could save more expensive treatment down the road. That part is a given. That is if you have a good primary doctor who spends more than 8 to 10 minutes with you and actually takes an interest in your health.
When people talk about the merits of having skin in the game with health care, I really only think it is beneficial as they get to personally feel the sting of the high cost of treatment here, and hopefully giving rise to the need to do something about it. I don't think putting up financial barriers for people going to see the doctor is necessarily good medical practice, so better access to primary doctors could be helpful.
I think the ACA's attempt at getting people in by offering a free wellness exam was an attempt to solving this problem. But, it has back fired with silly coding work arounds to charge people anyway if the patient informs the doctor of any sort of problem. That obviously needs to be fixed.
We also have a problem with a shortage of primary doctors, and whether practices like this we are speaking of is enough to cure the problem I can't say. I don't think it is unless we employ other measures as well, as already the new format is rapidly changing as there are not enough primary doctors to begin with to service the 10 minute patients So increasing the supply of primary care doctors is paramount to it's widespread success.
Cost of medical school can be a big factor in the production of primary physicians, so sweetening that pot considerably might help. I think most medical students look at the cost/reward at the extended schooling to enter a specialty field, and decide a couple of extra years will pay handsomely for their extended time and investment. I fear a lot of choices as to which specialty to chose (or no specialty) is based on money as well as working conditions, not love of the bladder, anus, or heart. Though I am sure there are exceptions. Orthopedic surgeons are pulling in the biggest bucks now, so my guess is there is not a shortage of medical students entering this field.
As for the wrap around policies which exclude primary care physicians, there have been a few proposed but it appears they are meeting some state regulatory and legal issues as these groups are essentially acting as their own insurance company now.
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Last edited by modhatter; 01-04-2015 at 01:47 PM..
I don't think that anyone would argue with you that a service like this is preferable in terms of care as opposed to the "run by" consultations most of us have with our primary care doctors. The question is, does it increase or decrease your insurance costs. My guess, at this point is you pay more. Or no, I seem to remember you saying something about joining a church sponsored group that was very reasonable, unless I have you confused with someone else. I forgot what they are called.
Now obviously, in the long term, if a doctor can catch a disease in it's early stages or even before it manifests itself, or encourage you to lose weight, it could save more expensive treatment down the road. That part is a given. That is if you have a good primary doctor who spends more than 8 to 10 minutes with you and actually takes an interest in your health.
When people talk about the merits of having skin in the game with health care, I really only think it is beneficial as they get to personally feel the sting of the high cost of treatment here, and hopefully giving rise to the need to do something about it. I don't think putting up financial barriers for people going to see the doctor is necessarily good medical practice, so better access to primary doctors could be helpful. I think the ACA's attempt at that by offering a free wellness exam was an attempt to solving this problem. But, it has back fired with silly coding work arounds to charge people anyway if the patient informs the doctor of any sort of problem. That obviously needs to be fixed.
As for the wrap around policies which exclude primary care physicians, there have been a few proposed but it appears they are meeting some state regulatory and legal issues now.
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Before the ACA having this type of model with a true catastrophic plan was affordable. Now it's not because those types of plans have increased in price so much and they really still are catastrophic in most respects. I kept my doctor but no longer have health insurance. I wish I did but the price is ridiculous.
(You're confusing me with Kara regarding the church sponsored group)
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