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CMS Seeks Comments on Medicare “DPC Model”

CMS Seeks Comments on Medicare “DPC Model”

“The Direct Primary Care (DPC) model is burgeoning as patients yearn for quality time with their doctor at an affordable price,” writes Marilyn Singleton, MD, JD in a recent oped.

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https://mailchi.mp/aapsonline/cms-dpc-model

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More on Medical Practice Business Costs

Unknown and Under-Appreciated by Many

By Rick Kahler CFP®

I recently talked with an administrator of a private medical practice about some of the financial challenges she faces in dealing with the medical system, insurers, and patients.

Some of the insights she gave me into the realities that private physicians face in providing medical care were rather disturbing.

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Here are a few of them.

Let’s start with the insurers who account for the bulk of their revenue. Many payments for procedures from insurance companies (including Medicare) are below the cost of providing the service. This forces physicians to make up the difference on other procedures or find other sources of income to sustain the profitability of the practice.

Conversely, in markets that have just one hospital, the insurance companies have no leverage. If the insurers won’t pay what the hospitals demand, the hospitals can threaten to drop out of the network, leaving the insurers with nowhere to send their insureds in those markets. The insurers end up agreeing to pay the hospitals more.

Charges for services provided in-house at the hospital can end up being substantially higher than those same services done by outside providers.

Example:

She gave me an example of a lab test that cost $1,500 to $2,000 at the hospital lab but $35 to $80 at an independent lab. Patients do have the option to direct the hospital to use an independent lab. But, how many people know that and will have the presence of mind to make the request? While it makes financial sense to price-shop if you have a high deductible HSA plan, there isn’t much incentive if your plan has low deductibles.

Collections

Another challenge is collecting from patients. She says a surprising percentage of Americans maintain checking accounts with no money or keep checks from accounts which have long been closed. While writing bad checks is a crime, those who game the system know they can probably get by with writing a low-dollar check because the cost of pursuing justice is much more than the check is worth.

Most companies would never do business with such a person again. Healthcare professionals tend to have a bias toward giving everyone services, so these same people do return requesting care. She said she and her physician employer have had huge internal arguments about this. Her position is that these people take advantage of the physician in a premeditated fashion and don’t deserve to be extended services. The physician argues that everyone, even deadbeats, deserves healthcare. Since the practice doesn’t provide life-and-death services, she was able to get the physician to agree that if someone has an outstanding bill they need to settle it upfront, in cash, before any new services are provided.

Then there are those who use credit cards and then fraudulently dispute the charges. Some providers let this go because of the difficulty of proving that the charge is legitimate. It requires photographs of customers during the transaction, copies of driver’s licenses, customers’ signatures on the paperwork, and notarized statements from the provider verifying that this was the person who received services and presented the credit card.

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SSNs

A final interesting point concerned patients’ Social Security numbers. She said the only time these are ever needed is when an outstanding bill is sent for collection. Otherwise, they are never accessed or used.

Assessment

Finally, she was quick to add that only a small fraction of their patients premeditate stealing from them. She also stressed that not all insurance companies or hospitals behave unethically, and some do wonderful, humane acts of kindness. Nevertheless, the lack of integrity that does occur on both sides is infuriating and adds to the cost of health services.

Conclusion

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Dr. Michel Accad: Why Can’t We Pay Cash for Doctors?

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By Michel Accad MD

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Money

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Dr. Michel Accad: Why Can’t We Pay Cash for Doctors?

About

Dr. Michel Accad is a practicing cardiologist who blogs for a medical audience at alertandoriented.com

Conclusion

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What If You Could Start From Scratch – Doctor?

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How would you restart your career in medicine?

[By Dr. David Edward Marcinko MBA CMP™]

[By Hope Rachel Hetico RN MHA CMP™]

dave-and-hope9We’ve known this physician-client-friend for 10 years, and while he didn’t tell us what he wanted to discuss, we knew it was important.

After exchanging pleasantries, he shocked both of us: He said he’s totally unfulfilled in his current job and wants to do something new.

We were floored because he is an outstanding doctor – at the top of his game. From the outside looking in, he appears to be “living the dream”.

After that bombshell, we asked him the question we couldn’t get out of our mind: “Are you afraid?”

“Yes,” he said; “Afraid and relieved.”

His relief stemmed from the fact that he is going to shed the tremendous demands of being a doctor at the highest levels. He was afraid because he didn’t know what was next.

We thought afterward, “What a courageous and totally refreshing move.”

ME-P Doctors, Advisors and Consultants

A Fantasy Reboot

That dialogue triggered a larger internal conversation within; and with others.

  • What would you do if you could start from scratch?
  • How would you proceed if you could just wipe the slate clean and restart your career in medicine?

For those quietly pondering a similar path, three great opportunities seem crystal clear.

First, we would create our own practice playbook. Discard the ready-made choices served up by your old practice. For the independent physician today, there’s almost infinite variety. The pleasure in creating your own approach is that there are so many options. Your patients will appreciate the greater choice and flexibility, too.

Second, we would whole-heartedly embrace technology; but not necessarily EHRs at this time. Rather, build your own HIT framework to complement your medical practice. Innovate across your entire operations – everything from medical records, to online appointment access, secure FAX machines, to patient portals and laboratory results reporting to your own mobile phone app. Freeing yourself from your current archaic technology will be life altering by itself.

5 new rules for how doctors interact with health care IT

Third, cull the difficult people from your life. These are the naysayers who weigh you down – superiors, colleagues or patients. Negativity is corrosive, and it always lingers. It also distracts you from giving others your best. While you’re at it, cull the skills you mastered to survive in your career so you can focus on those that really matter.

Non-Traditional Doctors

Case Model

So, we wanted to share one of the all-time greatest reboots we know because it shows what is possible if you believe in yourself.

A decade ago, one of our osteopathic physician clients delivered some bad news. She was quitting her job as a medical associate, to transition into her own direct pay practice.

At the time, this was unheard of: No one walked away from a potential medical practice partnership to become a solo physician. But, Sue had a different vision. She wasn’t fulfilled and she knew it. With the support of her husband, she decided there was a better way. So she started from scratch.

How did it work out?

Unbelievably well – but NOT overnight!

With our meager assistance, Sue’s been cash flow positive for the last 7 years, and now earns more money than before, with less stress; and she is the captain of her ship. A few colleagues who have worked with her have even gone on to achieve comparable success. She’s become a role model to others too, and she remains one our heroes.

The Decision

Starting from scratch may or may not translate into more money, but it often means this: More happiness in your life. Sue’s decision, just like our friend who bared his soul to us over coffee, were both made for the right reasons.

We wish our friend well on his journey, confident knowing that a happy ending is just over the horizon for him, too.

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Assessment

Send us your own success/failure story, so we might learn from you. Would you even stay in medicine or transition/begin another career; anew?

Conclusion

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3 Reasons Doctors Are Ditching Insurance And Offering Care For Cash

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Moving away from public healthcare and towards private models

[By Jessica Socheski]

jsWith 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.

 Three Reasons Doctors Are Ditching Insurance And Offering Care For Cash

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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.”

Conclusion

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Understanding the Domestic “Shadow Economy”

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Is the US Economy Strong OR Not?

By Dr. David Edward Marcinko MBA

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Dr David E Marcinko MBARecently, new highs for the DJIA and some better than expected jobs numbers pointed an outward sign of the US  economy’s continued — though sluggish — recovery from the Great Recession.

Workers in the Shadows

But, there may be another explanation for why consumers keep spending more despite higher payroll taxes and more pain at the gas pump.

Edgar Feige PhD Speaks

That reason is a thriving shadow economy, estimated to have reached as much as $2 trillion last year, according to a study (.pdf file) co-written by Edgar Feige, an economist at the University of Wisconsin-Madison.

Assessment

A shadow economy is one where workers turn to employment that pays under-the-table. While that sometimes includes illegal activity, such as drug dealing, much of the shadow economy today appears to be in areas like service work such as babysitting; medicine, eye, foot and dental care; and working construction jobs for cash.

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Conclusion

And so, are new medical practice business models like retainer and concierge medicine, direct/private pay, or cash care more or less prone to participation in the underground healthcare economy?

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More on the Doctor Salary “WARS” – er! ah! … CONUNDRUM!

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Compensation Trend Data Sources

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By Dr. David Edward Marcinko MBA

[Editor-in-Chief] www.BusinessofMedicalPractice.com

Related chapters: Chapter 27: Salary Compensation and Chapter 29: Concierge Medicine and Chapter 30: Practice Value-Worth

 

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PERSONAL PREAMBLE

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Physician compensation is a contentious issue and often much fodder for public scrutiny. Throw modern pay for performance [P4P], and related metrics, into the mix and few situations produce the same level of emotion as doctors fighting over wages, salary and other forms of reimbursement.

This situation often springs from a failure of both sides to understand mutual compensation terms-of-art when the remuneration deal was first negotiated. This physician salary and compensation information is thus offered as a reference point for further investigations.

Introduction 

More than a decade ago, Fortune magazine carried the headline “When Six Figured Incomes Aren’t Enough. Now Doctors Want a Union.” To the man in the street, it was just a matter of the rich getting richer. The sentiment was quantified in the March 31, 2005 issue of Physician’s Money Digest when Greg Kelly and I reported that a 47-y.o. doctor with 184,000 dollars in annual income would need about 5.5 million dollars for retirement at age.

Of course, physicians were not complaining back then under the traditional fee-for-service system; the imbroglio only began when managed care adversely impacted income and the stock market crashed in 2008.

Today, the situation is vastly different as medical professionals struggle to maintain adequate income levels. Rightly or wrongly, the public has little sympathy for affluent doctors following healthcare reform. While a few specialties flourish, others, such as primary care, barely move.

In the words of colleague Atul Gawande, MD, a surgeon and author from Brigham and Women’s Hospital in Boston, “Doctors quickly learn that how much they make has little to do with how good they are. It largely depends on how they handle the business side of practice.”  And so, it is critical to understand contemporary thoughts on physician compensation and related trends.

Compensation Trend Data Sources

A growing number of surveys measure physician compensation, encompassing a varying depth of analysis. Physician compensation data, divided by specialty and subspecialty, is central to a range of consulting activities including practice assessments and valuations of medical entities. It may be used as a benchmarking tool, allowing the physician executive or consultant to compare a practitioner’s earnings with national and local averages.

The Medical Group Management Association’s (MGMA’s) annual Physician Compensation and Production Correlations Survey is a particularly well-known source of this data in the valuation community. Other information sources include Merritt Hawkins and Associates; and the annual the Health Care Group’s, [www.theHealthCareGroup.com] Goodwill Registry.

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Assessment

However, all sources are fluid and should be taken with a grain of statistical skepticism, and users are urged to seek out as much data as possible and assess all available information in order to determine a compensation amount that may be reasonably expected for a comparable specialty situation. And, realize that net income is defined as salary after practice expenses but before payment of personal income taxes.

Conclusion

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