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Primary Care Is Being Crushed By A Paper Weight

Ever wonder why your physician only spends 5-10 rushed minutes with you during your office visit? You may think it’s because there are simply too many patients vying for her time, but that’s not the real reason. The root cause is that health insurance companies are stealing time from your visit by requiring excessive documentation from your doctor. She can’t give you the time you need, because doing so would put her out of business.

In a special report on the administrative burden of healthcare, MedPage Today revealed that PCPs spend about one third of their income on documentation required by health insurers. Because they run a business with thin margins, they must increase the volume of patients they treat in order to cover the salaries of the staff required to manage this “paper weight.”

About 49% of all physicians have said that they are considering retiring or quitting medicine in the next two years (the rate is lower for specialists), largely because of increasing documentation requirements and decreasing reimbursement.

Primary care is hardest hit by costs of coding and billing requirements, since they charge relatively little for their individual services. Imagine the difference in complexity between freezing a wart versus removing an appendix. Yet the number of people required to document, code, and process the paperwork for those two procedures are similar. The reimbursement, however, can differ by thousands of dollars.

The average PCP requires 4.5 staff to manage the administrative challenges associated with practicing medicine. If you consider that the average annual income for a PCP is $149,200, then it’s easy to see why a PCP’s income barely covers staff salaries, let alone the overhead associated with office space, supplies, and computer technology.

How can family physicians survive in this hostile reimbursement environment? There are really only two choices: to work in large group practices or to cease accepting insurance. (Of course, I’m leaving out the third option: to choose a different career).

I have decided to join an insurance-free practice. Now, before you assume that this means “concierge medicine” with exorbitant membership fees – let me tell you that it’s not what you think. DocTalker Family Medicine simply charges an hourly rate for my time – and I do whatever is appropriate for the patient, whether it’s a house call, an office visit, an email, or a phone call. There is no membership fee, people can pay with their credit card, cash, check or PayPal, and once we’ve met in-person and a full history and physical is performed, much of their care can be accomplished remotely.

So what does that cost? The average patient in our practice spends $25/month on their primary care needs. Isn’t that amazing? We can charge reasonable rates because we’ve reduced office staff from 4.5 to 0.5 people/provider and we pass on the savings to patients. We answer our own phones, we see almost all patients within 24 hours, and we’re available 24/7 by phone and email. And you know what? We’re happy to do it because we find meaning in every interaction. We aren’t being crushed by a paper weight.

As healthcare reform moves forward, and new ways are sought to wring money out of a crazy and convoluted system, it might just make sense for some of us to opt out and get back to basics: a doctor or nurse available 24/7 for your primary care needs at a price you can afford. No red tape, no unnecessary office visits, no insurance company hassles.

Anderson Cooper sent a reporter to our practice to see for herself what hassle-free medicine actually looks like. I hope you enjoy the segment… and if you’re in the DC or Virginia area, please check us out for yourself!

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7 Responses to “Primary Care Is Being Crushed By A Paper Weight”

  1. Sam Gaines says:

    I’m fascinated by this idea, Dr. Val. Two questions:

    * Do you think this approach (insurance-free PCP practices) is doable anywhere?
    * Does this approach inhibit referrals to insurance-accepting specialists in any way? (I ask this because that’s where the catastrophic type of expense is quickly encountered, usually.
    * Is there such a thing as a national directory for cash-only PCPs? (This would save me a bundle, frankly, and give me better care at the same time.)

    My current PCP is so overwhelmed with patients that he has maybe 5 min. to spend with any one of us, but it’s what he has to do to survive, even in the large practice he’s a part of. I know he’s not happy with this (and I’m not, either), and I can’t help but wonder if this business model you are now a part of — cash-only — wouldn’t make much more sense everywhere, at least as an alternative to what we have now. Thanks for posting this!

  2. Diane says:

    I could never imagine paying a Doctor , I guess because I never had to .My Doctor sees patients 2 evenings a week & I can spend 5 mins. or half hour if I had to & he would not blink an eye.
    Then again , I am in Canada .

  3. Linda, USA says:

    I want to see that video! This is something that doctors should be advocating more because it DOES free up those doctors who aren’t just in it for the money, who don’t want the hassles of insurance companies, and who still want to practice medicine.

    My questions would be about costs of lab tests, xrays, and preventive medical tests that can find out if you DO have anything going on.

    If the costs of all this is less than what we pay for insurance premiums and out-of-pocket costs, then I’m all for this approach.

    Anderson, let us all see this type of information. It’s the first I’ve heard about it.

  4. Kristina says:

    i think this is a fantastic idea… now if we can get the rest of the country on board?! how will this affect the large medical cases out there, ie. heart surgeries or things of that nature? Will the cost be higher at the time of the surgery, or will there be payment plans etc? Just a thought, but overall, I think this is a great idea..

    and yes I have worked in the medical field doing coding, it is a bigger pain than anything… but with this plan, I would say, waiting room time, would be cut in half, or more, and quality time between doctor and patient increased two-fold..
    just my thoughts on the matter!

  5. I work with Val at Doctalker Family Medicine and would like to respond to these great comments.

    Referrals to specialists are no problem if pt has Medicare or PPO insurance, we can refer to “in network “ labs and x-rays etc and get the test covered. Seeing an out of network PCP only changes their cost in the Priamry care arena but not to any other part of the insurance paid system.

    For labs we have an account with a local lab and pass through the costs of the lab so if people have a prepaid account we can pay for them directly. We add a 10 minute adiminstration fee ($45.00) so the best example is if you’re a male getting labs for a physical exam (which includes: CBC w DIFF w PLATLETS, METABOLIC PANEL, Comprehensive

    By the time you pay the administration fee and we deduct money out of the account the total is $70.00.

    If the patient prefers to pay the lab for the tests… The total is about $550.00 (That’s how much the mark-up on labs is when patients as consumers “don’t care” about the price of labs when the insurance company is “protecting” them.

    We also work with a local x-ray facility that works with cash paying patients and has reduced rates for immediate payment so that many of the standard x-rays are very reasonable pricing.

    An example is a patient who had injured his hand. WE saw him in the office he went and paid cash for the hand series x-ray and I called him back with the report a few hours later= normal

    He commented that he couldn’t remember the last time in his life (50 yo) that he could get a problem looked at immediately, pay cash for the doctor and the x-ray and the total.

  6. I help run a large physician’s practice and medical billing and consulting firm. I hear doctors complaining about insurance reimbursements and requirements all the time. In almost all cases the real reason for their complaining, after asking the right questions, has to do with how they run their business and not so much with the insurance companies. But the insurance companies are easy to blame. Make no mistake, I have no love for insurance companies, I battle with those shysters everyday trying not to pay but you have to assess the practice and find the real reason doctors are stressed. Remember, doctors are trained in healthcare, not in business and workflow management or medical billing. I have heard of doctor’s offices that have lost hundreds of thousands, if not millions of dollars over the years due to poor business practices. A good management team would take the administrative burden off of them so they can practice medicine. I feel bad for those docs and their staffs.

  7. Sam Gaines says:

    Thanks, Dr. Dappen (and all the other posters, too) for thoughtful posts. If I may ask a follow-up …

    So, for a typical annual physical, with the standard blood work (lipids, A1C or other diabetes testing, PSA), I’d be looking at roughly $70 out of pocket and get a response on labs etc. far more quickly? Did I understand you correctly, Dr. Dappen?

    Mr. Oliverez, I don’t doubt what you say is true. There are so many challenges with running a business anyway that I’m not surprised that doctors, given their focus on the health of their patients, aren’t necessarily the best at running the business sides of their practices, generally speaking. I wonder how much waste that actually accounts for, with respect to all the other usually cited sources of waste in the system. (I’m asking sincerely, not a loaded question.)


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