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Moving away from public healthcare and towards private models
[By Jessica Socheski]
With the new healthcare system in effect, many doctors are moving away from public healthcare and towards private models. Instead of taking insurance, programs like the corporate wellness plans from MDVIP and other direct primary care doctors are choosing to deal in cash only with their patients. And in essence, they are cutting out the expense of a middleman insurance company.
Many doctors have taken it upon themselves to create a model that helps more than it hinders. Here are three reasons why doctors are choosing private healthcare over public.
1. The Patient Comes First
For many people, the new healthcare insurance price has skyrocketed, making it difficult to pay for healthcare let alone use it when needing a doctor. Direct primary care doctors provide their basic or preventative care that their patients can afford without using their insurance and meeting high deductibles.
Doctors who have embraced this model find they are able to offer their patients a variety of services for less money. This offers people the chance to receive quality care without paying an exorbitant amount. Without this model, many people would avoid the doctor all together, which could lead to serious undiscovered health problems.
2. Waiting Game
Since the Affordable Care Act, hospitals, urgent care, and public healthcare offices have noticed an increase in patients, leaving both waiting rooms and doctors inundated with patients. Unfortunately, this leaves doctors and nurses trying to juggle too many patients without enough help to accommodate them. Doctors are overworked and rushed, unable to spend a proper amount of time with a patient.
Consequently, the current healthcare model has pushed many public healthcare doctors towards privatized hair, leaving an even larger doctor deficit and nurse shortage in the public sector. But since these doctors have turned to private healthcare as their new business model, doctors have the time and availability to meet with their patients and build a relationship with them.
Under private healthcare, patients can schedule appointments with their doctors to have a proper visit where both the physician and patient feels they been given an adequate amount of time—the doctor for diagnosing and the patient for quality care.
3. Doctor Freedom
The direct primary healthcare model is not something entirely new. But it is just now growing in popularity as doctors and patients search for relief from a problematic system. Before congress passed legislation in 1973 that led to the expansion of prepaid health plans, the majority of physicians operated in a fee-for-service model.
Under insured health plans, physicians had little flexibility in determining what services they could provide and how to cut costs for their practices. Some insurance companies even dictate the hours during which doctors can be paid.
Image Source: http://www.newyorkmedicalservices.com
Assessment
By moving away from insured health, doctors are able to remove the shackles and dictate how they believe their patients should be cared for. Dr. Villarreal, a doctor in Laredo, Texas, states in regards to his direct primary business model, “To me, there’s no other way I would practice medicine. You feel like you’re a doctor again.”
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Filed under: Health Economics, Practice Management | Tagged: concierge medicine, direct pay healthcare, private pay medicine |
The Leading Business Education Network for Doctors, Financial Advisors and Health Industry Consultants 
Cash-only looks good to doctors
Experts say that cash-only practices are a workable business model when done the right way.
http://www.healthcarefinancenews.com/news/cash-only-looks-good-doctors?topic=22
But, it may be disruptive to others in the market.
Jack
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Really Direct Care
A movement is beginning. Employers are partnering directly with providers. Health reform and a more value-driven approach to benefit strategy have prompted some self-insured employers to work directly with providers through arrangements that include onsite health screenings, bundled payment activities, building narrow networks, centers of excellence and more.
William Rusteberg
via Ann Miller RN MHA
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Health Insurance Deductible Prevalence and Amounts
According to an issue brief by the Kaiser Family Foundation:
• 80% of workers with employer plans have a general annual deductible and, among those, average deductibles for single coverage are almost $1,800 in smaller firms and about $970 in large firms.
• Among all workers enrolled in a plan with a deductible in 2014, the average is $1,217.
• 25% of workers enrolled in a plan with a deductible at smaller firms have a single deductible of $894 or less while 25% have a single deductible of $2,500 or more.
• In larger firms, 25% of workers who are enrolled in a plan with a deductible have a single deductible of $500 or less while 25% have a single deductible of $1,265 or more.
Source: Kaiser Family Foundation
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High Deductibles
The days of having an insurance plan with only a co-pay is long and gone. At least 80 to 90% of all insurance plans have some form of a deductible associated with it – a trend I have seen grow by leaps and bounds over the past 10 years, especially with the push towards universal coverage. This increase in plans with deductibles does not only hit the consumer (the patient) in the pocket – but it also directly affects the financial health of your practice.
One of the first questions I ask clients when I do a site visit is: What percentage of your overall revenue is cash pay? A few years ago a practice could easily say 10% or less and be absolutely correct. The problem is most practices think this is still the case, when in fact it is not.
In order to prove my point I encourage all clients to run a report showing the breakdown of their revenue sources – more and more practices are finding about 25 to 30% of their overall revenue is actually cash pay, directly from the patient. After the physician and practice manager recovers from the initial shock of these percentages, they follow with the question: How could this be since 95% of our patient population is insured now? My answer – stop thinking that cash pay patients are only uninsured patients – think about cash pay in the form of any cash that comes to the practice from the patient such as co-pays, deductibles, and cash pay products and services.
With that said let’s talk about deductibles since a significant part of your cash pay revenue lies in its timely and proper collection. All practices must be organized in their approach in collecting deductibles as well as have clear policies to educate their patient population.
To begin, follow these simple steps:
1. Insurance verification: Do not leave it up to the patient to inform you if their deductible has been met – use some of the latest software that provides you with real time insurance verification information. Remember, verify insurance at least 48 to 72 hours prior to the visit to give you time to address any possible issues with the patient that may arise before they arrive.
2. Collect the deductible up front: Along with insurance verification software, there are other online software products that will allow you to estimate the cost of the procedure, or service being rendered, and how much the patient would have to come out of pocket in the form of deductible to the practice. I like to call these EOB estimates. Let the patient know that the deductible is expected to be paid prior to any service or procedure unless it is an emergency and in that case payment plans can be worked out.
3. Give time for payment: If the procedure or service is planned months in advance as seen with obstetric cases or major non-emergency surgery – it is valid to give the patient a payment plan so they have the opportunity to pay the entire deductible over time prior to the procedure – this takes some of the financial burden off of the patient (which they will appreciate) and also ensures your practice has collected all monies due to you.
4. Educate the patient: Be sure to educate the patient that the deductible is expected up front, explain to the patient it is part of their contract with the insurance company to meet out of pocket minimums – however create a policy that assures the patient that if the practice receives an EOB which shows the patient has overpaid, or no deductible was indeed required for that particular procedure or service, that a refund will be issued to them within 7 to 10 business days of receiving the notice. Be sure this rule is clearly stated in your financial policy that should be given to all patients when they join the practice, and when there have been changes.
Hopefully the four steps above will help assuage your fear of collecting deductibles up front and enable you to create a policy that not only ensures the financial health of your practice, but help your patients as well through the process.
Dr. Sloan-Kelly MD
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