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    Patients who pay flat fee save


    Patients who pay flat fee save

    I read your "2012 State of Primary Care" (August 10 issue) article with interest.

    An interesting thing to look at is the role of concierge practices in the new healthcare system. My practice, in particular, focuses heavily not just on the management of chronic illness but on wellness and prevention. Most doctors in regular practice don't have time for this.

    The patient pays a flat fee to our practice, and we don't take any insurance at all. However, when patients are under Medicare, they cannot get any reimbursement for their fees. In fact, a practice such as ours saves Medicare a lot of money by avoiding unnecessary emergency department visits and extraneous testing, medications, and consultations. Also, our patients are more likely to have advance directives in our practice than in other practices.

    We were talking about medical homes (and "our medical family") long before it became popular.

    Rockville, Maryland

    Cash-only practices provide savings

    With all the coming reforms in medicine, comprehensive primary care as we once knew it will give way to midlevels performing most of primary care in the future. Or, primary care physicians will leave the current mess of insurance and government-controlled practices and once again go into cash-only solo practice or small group practices totally independent of any insurance or government payment system.

    Concierge medicine has already taken this approach with a lump-sum annual payment, but there is also room for "pay as you go" primary care.

    I was in private practice for 25 years before becoming an employed physician. I could see a lot more patients than I can see now, and I was infinitely more satisfied professionally. I'm sure my patients were more satisfied then also.

    I had my own electronic health record (EHR)/computerized billing system in private practice. What drove me to become employed was the ever-increasing time spent with Occupational Safety and Health Administration regulations, Clinical Laboratory Improvement Amendments regulations, and fighting with insurance and government payers. Now that I am employed, there are others in the system who help fight the insurance and government payers. But I am still somewhat involved, not to mention the ever-increasing demands of documentation for things like meaningful use and endless EHR drivel for the simplest of office visits.

    This ultimately means I do not have the time to see the number of patients I used to see in a day. I'm sure that those who support all of this regulation and documentation will say it is all about quality, which is an overused and ill-defined word in medicine today. Quality to me means that I am board-certified in my specialty of family practice and maintain my competency though continuing medical education and testing. Past that, it amounts to being moral and ethical, and as we all know you cannot legislate ethics and morality.

    If primary care was carved out of the insurance picture and physicians opened office practices on a cash-only basis, a lot of patients would be happy to pay an office visit fee slightly above what they now have to pay for a co-pay.

    This office visit fee would be a lot less than what it is now with commercial insurance and Medicare because it would not include the cost of hiring staff to process patients' insurance claims and spend time on the phone fighting over payments and denials. There would be more price competition with this type of practice and competition among providers would keep costs down. Patients not on Medicare would still need hospitalization insurance, but this should be a cheaper premium than they are now paying if the primary care/outpatient portion was carved out.

    Branson, Missouri


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