These Doctors Got Fed Up With Insurance. Now They Treat Their Patients Like Valued Customers.


One of the most profound changes to American health care brought about by the Affordable Care Act is that it drove thousands of independent doctors to throw in the towel and join large hospital networks This is particularly true of primary care doctors

As the rules involving medical records, billing codes, and prior authorizations have gotten more complex, physicians find they can’t survive without joining large healthcare networks And they’re increasingly demoralized 48% of our present family medicine, primary care workforce says that they're leaving within the next three years Doctors feel disconnected and burnt out We're seeing that in medicine, it's an epidemic

We gave away our business years ago to businessmen and they screwed us So now it’s time to take it back Today there’s a small, but growing movement of doctors who are opting out of the traditional health care system by no longer accepting insurance They gathered at a conference in Washington DC earlier this year This new approach is is called “direct primary care,” but it’s essentially a throwback to an era before insurance companies were responsible for covering routine services like ear infections or strep cultures

When I started my practice in 2011, depending on your definition, there was maybe a dozen, or a few dozen at most, doctors who were operating in this model You know the direct primary care movement has grown, there's now 600 to 800 practices and you know, more doctors than that When companies like Aetna, Blue Cross, and Oxford started signing the checks for even minor health care expenses, it had a destructive impact on the doctor-patient relationship The Direct Primary Care movement is an attempt to reverse this damage Pretty much everyone except the patient controls the money

And that pretty much runs the show Dr Ryan Neuhofel, who’s been running his own direct primary care practice in Lawrence, Kansas since 2011, has a page on his website that lists the cost of each procedure, which the patient, not the insurance company, actually pays I think what most people are accustomed to is someone managing their healthcare For a lot of reasons, because we've been doing that for so long, they just cannot imagine what it would look like if they were just paying their doctor

Need an x-ray? That’s $25 to 40, along with a monthly subscription fee that runs from $35 for minors to $130 for a family of four Because I’m membership supported I know what my monthly revenues are going to be, so if someone calls me, says, “hey doc, I got this rash, can I send a picture to you” sure, send me an email, show me the picture, I give you advice If it's something I can manage, that's medically appropriate with a text message or email or phone call I do it So I would say probably half of all of the care and advice I give is just remote, I don't have to bring people in for an office visit you know every time they have something minor Direct Primary Care doctors are able to charge less than traditional practices because the lack of coding and billing requires less staff to maintain the practice

When you're the only staff you do everything, literally! In a fee for service world, every moment a patient isn't walking through the door is lost money So most doctor's offices need to average 20-30 sometimes 40 patients a day just to make a good business out of it And I don’t have to worry about that But fundamentally whenever you work in partnership with your patients without the interference of a third party it really changes everything for the patient and the doctor So we're able to be very creative in meeting their needs, able to give them transparency in pricing, and just redesign the entire health care experience around what patients really need as opposed to us being distracted by all of the third party coding and billing and all those things that the normal health care system has

Premiums too high, deductibles too high, copayments too high- The new Republican Trump care bill is every bit as mean as the old one If we continue to let them have all the control, there's no chance We can aid in that being direct primary care and not play the game of the insurance But ultimately the patient controls their own destiny, both in their own personal health care, as well as their health care dollar There are some changes to the tax code that could speed adoption

The IRS doesn't allow patients to use their tax deductible health savings accounts to pay direct primary care doctors In fact, just having a direct primary care subscription disqualifies you from contributing to an HSA at all Dr Neu and others have been meeting with lawmakers and proposing legislation to change this We are not trying to be shut out of the system, we're not living off the reservation just because we're cowboys

We're doing it so we can provide good care, but at the same time we do need to find out how we integrate with the larger health care system It is so much about that relationship that we're forming with our patients and that's what really improves health outcomes Thank you for coming in doctor- I guess before we had a name for it, before there was direct primary care, we couldn't really envision a way out of it I'm talking collectively for doctors across the country But now that there's a name for it, now that there's a clear vision of what direct primary care is, and what being a great doctor looks like, more and more students and residents are aspiring to become direct primary care docs

Here's the thing, so you can be the doctor you trained to be, you can be the doctor you dreamed to be when you were a kid, and you have the opportunity to do it with no bureaucratic drag The main reason I started my practice and I started thinking about it in late medical school, early in residency, before direct primary care was even a thing, was because I wasn't hopeful that, you know, Washington DC or a state capitol or insurance companies or employers or really anyone, could or would fix primary care And so I can't really say that I'm super optimistic that the politics and the powers that be are going to understand this or get it right, but I think that the way that we're approaching it with this grassroots movement is the only way to force that change

Source: Youtube


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