And stats say that by the end of 2014, ~300 physicians commit suicide.
Tag Archives: dr josh
“Medicine is a business,” says Dr. Doug Nunamaker, “And how our nation’s doing it isn’t working.”
Listen to Drs. Josh and Doug discuss Direct Care in the latest episode of the Atlas MD podcast.
Ditching insurance companies and running a successful business isn’t for the faint of heart, but it’s the only way that family care will keep doctors and patients healthy and happy.
However, one of the biggest challenges for a new Direct Care doctor will be the transition. Which is why we recommend that patients pre-enroll in your Direct Care clinic before you make the switch. Feel out which patients are going to join you, and for those who aren’t ready to follow your lead yet, no worries. With the proper planning and commitment, you can help all your current patients find primary care, and run a profitable business.
If you’re considering a transition into this affordable, powerful alternative to the hurried world of fee-for-service medicine, make sure to visit IWantDirectCare.com. There, you can create a Clinic Account to let potential Direct Care patients know where you plan to offer cash-only medicine.
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.
Some people have a knee-jerk reaction when asked about direct primary care: “Only the rich can afford direct primary care” and the end result will be “fewer doctors seeing fewer patients”. These statements are true but ironically only in context with the current dysfunctional system that impairs quality by reducing actual patient care time. It’s this patient mill mentality that drives doctors away from a career in primary care, and further exacerbates the problem. Its leads to efficiency delusions like Meaningful Use Stage 2, and ICD-10 billing codes and fast-talking EMR vendors which all to the red tape that makes healthcare so needlessly expensive.
The current insurance-driven primary care system is underfunded and overburdened and gives poorer quality care than a direct care system would. The top 9 conniptions about direct care are as follows:
We’re back and a LOT has happened! Seriously, 2014 is going to be a year of paradigm shift — the status quo isn’t going to cut it if insurance premiums jump 50-60% and fee-for-service docs are being told to keep 6 months of cash on hand to protect themselves from ICD-10 payment delays. Great news, though, we’re working with large unions comprised of 10-15k employees — manufacturing unions, school district unions, others — and excited about how vital this could be in the spread of direct care. And there are more physicians cutting the red tape — A practice in Oklahoma opens April 1st; Dr. Michael in Missouri is almost ready to start operating cash-only; an office in New Mexico opens February 1st; and several more are slated for the next few months. Once this ball gets rolling, we’re convinced it’s not going to slow down.
In this episode, the docs outline best practices for direct care pricing, share a surprising story of insurance intimidation, and offer insight into the effects that insurance-free medicine will have on healthcare.
Happy New Year! The direct care duo starts 2014 with good news and exciting updates. We’re happy to report that we’ve been consulted by Kansas University; in the near future, more students will be getting a glimpse into the world of insurance-free medicine through their curriculum. International pins were placed on the I Want Direct Care map (including clinics and patients in the U.K., Vietnam, Argentina, and more). And a humblebrag warning: we were interviewed by Harvard Business Review, so keep an eye out for that.
We’re blessed to have been the thesis of Sam Jordan’s academic paper, “Medicine Shrugged.” Originally from Salina, Kansas, she’s now a freshman at George Mason University in Fairfax, Virginia and is majoring in Economics. She included email correspondences with Dr. Josh as part of her sources to build a case for free market medicine. Texts from Ayn Rand, Alan Greenspan and other intellectuals were cited alongside our personal experience.
Thanks to Sam, for letting us share her work with our supporters. We have to admit, we blushed when she compared us to Aluminum Company of America. ALCOA is known for its shining example of profit-maximization and price-minimization in Greenspan’s paper, “Trust.” It serves as a concise way of understanding our mission to cut the red tape. And yes, it’s true: we’re motivated to offer the best healthcare while making the most money possible. Sam had no hesitation in addressing that.
We’ve included the complete work below. Take a look. And if you’re interested in a digital copy of Sam’s paper, send us a line at hello[at]atlas.md …
And we’re back. You can stream the new Atlas MD podcast on iTunes. We’ve had some recent speaking engagements, one of which was with the Wichita Rotary. Little known fact, our local Rotary Club is the seventeenth largest in the world! Who’d have thought?
Also, thanks Dr. Ray Siedel from Ruidoso, New Mexico, who stopped in to discuss his direct care transition that’s happening over the next six weeks. We have multiple doctors scheduled to come in every week for the next month. We’re always glad to talk shop, so let us know if you want to stop in.
Apologies for the delay, everyone. We’ve had a bit of construction in the office here, and we’ve been on the road, too. That said, the next installment of our podcast is live on iTunes.
Obamacare was unrolled and docs are wondering what that means for direct care. For the most part, we are safe. Patients’ insurance plans, not necessarily. If you want to get a better understanding of the direct care landscape, there’s a great source, though. Just visit dpcare.org and have a look. There are tons of informative articles about the law.
In this episode, the team went to San Diego for an AAFP conference where they were bombarded with questions (arrived an hour early and stayed two hours late)! Then Dr. Doug shares a story of how the system prevents docs from practicing good medicine (and how he saw a patient immediately when her doc offered her an appointment 6 days later). Dr. Josh goes over more direct care math, and that’s just the beginning…
Oh, we’re heading out to a few different conferences where we’ll be talking to more docs about our model, including the Physicians Summit on Nov. 1. Maybe we’ll see you there, or elsewhere. As always, thanks for tuning in, and if you have any questions, please, send us an email: hello[at]atlas.md
If you were tuned in to Hannity’s radio program yesterday you might have heard Dr. Josh talking about direct care. The entire taping includes dialogue with Pat Buchanan, Dr. and Congressman Phil Roe, and Congressman Louis Gohmert. Dr. Josh was given the floor to fully outline why direct care MAKES SENSE. Anyone questioning the business side of running a “cash-only” clinic should pay close attention here. Josh takes a solid ten minutes to explain almost EVERY benefit that this model brings to healthcare, including the doctors enjoying their work, the patients receiving improved treatment, and insurance companies finding that direct care patients are at lower risk for chronic conditions (which allows for lower premiums which in turn can attract more subscribers.)