Another cash-only practice debacle
I had an experience similar to internist Emily Kaufman Frank ["Why my cash-only practice failed," March 7, 2008]. Frustrated by the amped-up assembly line aspect of managed care, I created a cash-only practice, based
on the one-room, one-office micropractice model. I wanted to offer visits long enough to get to know my patients, be thorough
in handling the "laundry list," and have some time to address, in detail, truly important matters like prevention and nutrition.
My small but steady stream of new patients—from word-of-mouth referral—were very happy with the long visits and easy access
to me via cell phone or e-mail. But like Dr. Frank's patients, they frequently didn't submit claims and when they did, their
claims were often not paid because they had seen me out of network and hadn't met their deductible yet.
That gave them the impression of not being covered, and they were reluctant to come in for follow-up visits. But they didn't
hesitate to contact me via cell phone or e-mail with time-consuming, complex questions, often dripping with malpractice potential
(for example, an e-mail I received at 10 p.m. began: "My left arm is numb and a little weak . . ."). Before throwing in the towel, I decided to become in-network. However, the hassle of collecting from the insurance plan and
then the patient who hadn't met his deductible made me realize I had only replaced one stress (rushing to see 20 to 30 patients
a day in a conventional practice) with another (working and not getting paid). It was both sad and a relief to close my doors,
and somehow it's a comfort to know others have been in the same boat.
Julie Bolton, DO
Long Beach, CA
The future of concierge medicine
I'm currently completing my PhD dissertation on concierge medicine, and I read with interest your article, "Small practice evolution: The concierge practice" [May 2, 2008]. I've been following the development of concierge medicine for the past seven years. I believe it will survive,
albeit as a niche modality. The various permutations you discussed in the article will be, I believe, a real sea change in
medicine.
Leila M. Hover
Boonton Township, NJ
Will a single-payer system work here?
I appreciate family physician Wayne Strouse's enthusiasm for New Zealand's single payer healthcare system ["Talk Back," April 18, 2008]. However, he goes overboard when he says that New Zealand's healthcare expenditures are only 10 percent
of ours. It's more like 60 percent, if you compare percentage of GDP spent on healthcare, according to the Organisation for
Economic Co-operation and Development. But even so, there are several good reasons why our healthcare costs are higher:
- In a single-payer system like New Zealand's, collection costs are not included in operating expenses. Revenues are collected
as taxes, and the cost of collection is ascribed to the taxing authority.
- New Zealand's no-fault system decreases the need for defensive medicine, which inflates our health costs.
- The US bears a greater disease burden than New Zealand; for example, more illegal immigrants; more health problems stemming
from drugs imported across our open borders.
- Also, about seven percent of our population are military veterans (compared to one percent in New Zealand), some of whom
have serious medical and psychiatric disease. And 30 percent of our population (black and Hispanic) has a propensity for serious
cardiometabolic disease.
Although I never practiced in New Zealand, I did for a long time in Canada, which also has a single-payer system. At first,
it was great. However, once rationing, denials, hospital closures, and draconian taxes kicked in, I soon learned that all
that glitters is not gold
Calvin S. Ennis, MD
Escatawpa, MS
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