April 9, 2014
Originally posted on KevinMD.com
This post deserves a caveat — healthcare shouldn’t be a political issue. When someone comes into my office because they have chest pain, I don’t ask them “What’s your political leaning?” before administering care. And now after reading about the recent delay of ICD-10 in Congress, I realized that my choice in practicing Direct Care was the most political and least political thing I could have done.
April 9, 2014
Projecting future physician workforce needs is a challenging calculation. You have to consider multiple variables to avoid missing the mark. In the mid-1990s, the American Medical Association confidently predicted that the penetration of managed care would lead to a large “physician surplus” and convinced Congress to cap the number of graduate medical education (GME) positions subsidized by the Medicare program. By the look of things today, that might not have been such a wise move.
April 4, 2014
MARCH 26, 2014 – Growing up, Erin Havel’s family saw one family physician. That doctor gave her mom medical care when she was pregnant, delivered her when she was born, gave school shots, wrote prescriptions for any virus that came up, and helped her grandparents with geriatric care. This was well-rounded family care at its a finest.
However, things changed when her doctor retired. Patients were transferred to a new doctor, with his eyes on the dollar sign.
April 3, 2014
There’s been more than 30 million individuals affected by health data security breaches since 2009. These breaches are swiftly becoming a costly expense to healthcare organizations worldwide.
March 31, 2014
According to Afshine Ash Emrani, MD, the worst news in healthcare isn’t antibiotic resistance, drug-drug interactions, hospital-acquired infections, and definitely not the alarming rate of obesity in our youth.
No, the worst news is the increasing number of dissatisfied physicians.
March 28, 2014
For decades, primary care physicians ran their offices in a “physician-centric” manner. PCPs ran their offices during convenient hours, rarely reached out to patients when they weren’t in the office and spent virtually no energy building their brand or their patient experience.
March 26, 2014
Originally posted on KevinMD.com
Emergency departments in U.S. hospitals see copious patients who aren’t terribly ill, but don’t have insurance and need somewhere to go. I see some of these patients when I moonlight on nights and weekends at a local county hospital. Sadly, these patients run through a gantlet of expensive tests — I’m required by protocol to administer them. The reality is that 80% of what I see in the ER is “family medicine after hours.” I could just as safely see these patients in my own direct care practice, saving them time and money.
It’s not that hospitals aren’t aware of how silly these tests are, and what a waste they are for less endangered patients. But there’s not much they can do about it. In desperation, some 50% of acute-care hospitals have begun charging a fee in the $100-$150 range for a patient deemed safe to be seen in a less acute setting who remains determined to stay in the ER. This can even include hospitals with urgent care centers on-site. And that’s on top of the care that’s provided.
Let’s break some numbers. According to the American Hospital Association, in 2012 hospitals had uncompensated care costs of $45.9 billion, spread across about 5,000 hospitals (including both charity care and bad debt). That equates to 6.1% of their total expenses, the AHA reports.
So who’s ready to cut some red tape? For $150 I’m more than happy to see an urgent patient and give them a 3-month subscription to my practice.
You know how that one urgent care trip usually turns into two because your doctor is so harried that he or she can’t make a proper diagnosis? Yeah, that doesn’t happen with Direct Care. Instead, I’ll call you or text you or Direct Message you on Twitter (your call) and make sure everything’s going okay. And if it’s not, instead of ignoring my outreach and hoping the problem goes away, because you don’t want to pay another $150 for ten minutes with us, you can get all the help you need for free.
Oh, and you can come in and see me anytime for three months (if you’re between 18 and 44 years old)
And are you really, really short on cash? Remember that we’re a business, and we’re here to negotiate. The power of direct care is that bureaucracy isn’t looking over our shoulder extorting us to administer needless procedures just so they’ll pay us, which forces us to try to racketeer our uninsured patients.
No, here, in Direct Care, we do what WE want to do. That means serving patients and keeping the lights on, without someone else’s oversight.
March 26, 2014
Originally posted on Kevinmd.com
In 2010, I started practicing Direct Care in Wichita, KS. I steadily built a full roster of subscribers who pay between $10 and $100 per month to see me whenever they need to, for as long as they need to, however they want to (at their home, in my office, or via the Internet), all with zero copay.
Recently, a patient of mine developed ongoing shoulder pain. He’s middle-aged, insured, in good health overall, and as expected, refused to get an MRI.
As a direct care practitioner, I act as my patients’ family doctor — routine checkups, consultation, etc. — and as their personal urgent care physician – lacerations, broken bones, earaches, and stomach flus — I can handle all of this at no extra cost.
I write and fill their prescriptions, some as low as pennies per pill. Patients do pay for their labs and panels, but our wholesale rates come out lower than the copay of most insurance plans.
I even have someone who helps them find super affordable wrap-around insurance plans in case of major trauma.
Just last week this same patient called me up first thing in the morning: He was in severe pain.
“Dr. Josh, I’m ready for that MRI.”
So I immediately made the call to a local lab technician, because I wasn’t fifteen minutes behind my third appointment scheduled for the first hour of my day like most doctors working within the traditional fee-for-service model.
Because of the relationship I’ve built with the lab, my patient owed only $400 for the MRI, instead of the out-of-pocket cost of $1,500 that’s billed standard.
Within 45 minutes, my ailing patient was leaving the lab. Within a few hours, I was reviewing the results [Josh, please tell me the results here > … ].
But critics are probably shaking their head, wondering why this man would want Direct Care when he’s currently insured.
Well, the thing about insurance is that in almost all cases, patients need to meet their deductible in order for insurance to cover things like MRIs. An Obamacare silver plan comes with a $3,000 deductible — twice the amount due! If they went to the same lab and used their insurance, they would owe $1,100 more out-of-pocket.
And they would still owe that monthly insurance premium that’s really only there in case of major trauma.
And they would risk having to go to an overpriced ER if they had any trouble late at night or on the weekend.
It’s worth remembering that insurance is a business and they sell their benefits like every other company. Major Medical will typically offer “free preventative care” in effect saying, “as long as you see an overworked doctor of our choosing, you pay nothing.”
Except you do pay. You pay by waiting 18 days to get an appointment. You pay when doctors talk to you for 7 minutes and have to look down at your chart to remember your name. You pay when these doctors refer you to the same lab for the same MRI and you’re indebted $1,500 because you haven’t met your deductible yet.
That’s why it baffles me when people have knee-jerk reactions to paying cash for medical services.
“Oh, cash-only medicine, that’s only for the rich,” said an associate of mine while we were in L.A years ago. She went on to manage Patient Experience for the prestigious USC Medical Center, a place even the insured might only dream of receiving care.
Then there are critics who say things like, “You doctors seeing fewer patients will reduce access to primary care.”
Or our favorite gripe, “You’re going to create two-tiered healthcare.”
As a Direct Care practitioner I take offense to these attacks because they lack perspective. Do critics of an affordable option that delivers real value want healthcare without any tiers? And what would this tier look like? Millions losing existing coverage, rising premiums for small businesses, cheap Obamacare plans sneaking in absurd drug costs…
To me, this sounds like a universal healthcare system that equally fails all people of all socioeconomic backgrounds.
Why would someone criticize me when I tell people, I’m happy doing what I’m doing, I’m happy to consult other doctors in doing similar work, and I’m happy to motivate students to choose family medicine instead of a specialty?
Critics see affordable cash-only doctors as the root of our doctor shortage. I see us as a viable long-term solution. When students begin to perceive the financial and emotional benefits of practicing family medicine – two things I can personally vouch for their attainability – then this doctor shortage might actually be addressed.
And when critics want to examine the chip on their shoulder, I’ll be glad to negotiate for them.
March 25, 2014
The March 31 deadline for enrolling in Obamacare is coming! Millions of Americans have already lost their own private health insurance policies. Many more are facing rising premiums for their current plans. Small businesses are already facing tax hikes. And all of this because of the costly requirements of the new healthcare law.
March 24, 2014
President Barack Obama promised affordable health insurance under his new law, and yes, Americans with serious illnesses are finding plans with relatively low monthly premiums. In a lot of cases, they’re getting first-time access to health insurance. But these cheap plans come with a staggering cost.