Posted in Access to healthcare, Consumer-Driven Health Care, Defined Contribution Benefit Plans, Direct-Pay Medicine, Direct-Pay Practice Models, Economic Issues, Employer-Sponsored Health Plans, Health Insurance, Healthcare financing, Independent Physicians, Medical Costs, Medical Practice Models, Policy Issues, Tax Policy, third-party payments, Uncategorized

Who Pays for Your Healthcare Matters

By Robert Nelson

Zero co-pays. No co-insurance. No surprise medical bills! Considering the inflated prices we pay for healthcare, who could pass up that deal, right?

Are the new generation of value-based employer-sponsored Direct Contracting Health Plans, which often include Direct Primary Care, a great deal and more efficient use of our healthcare dollars? Absolutely yes!

real-health-care-expenditures-and-third-party-largerBut we can’t lose sight of the economic reality that individuals always pay the cost of benefits, either directly or indirectly.  And linking benefits to employment has been a colossal policy mistake and the genesis of job-lock and our 3rd-party payer system, which has been the source of runaway costs for 50 years. As the graph illustrates, insurance (3rd party payer) is now a near surrogate for total healthcare costs!

Don’t be fooled. Within the modern paradigm of healthcare financing, employers don’t pay for our healthcare. Our healthcare expense, no matter how it is structured, IS part of our compensation and a huge portion of of it.

images-223535545945618981307.jpgFACT: Every dollar of tax-favored benefits paid by our employer reduces our take-home pay.

The beauty of Direct Primary Care is the portability (no job lock) and affordability which can exist independent of the size or benefit package of the employer. But the foundation which aligns the incentives is based on the identity of the customer. This is why we have to be careful to match the buyer with the recipient of care whenever possible. To insert another 3rd party, even the employer, undermines the sovereignty of the patient and the independence of the physician.

The supply side of healthcare has served the wrong customers for far too long. DPC should not make that same fatal error by exchanging its essence for a pipeline of patients.

This linkage highlights the importance of policy decisions regarding use of HSA funds; the importance of allowing HSA dollars to pay premiums AND DPC fees can’t be overstated.

For DPC, and Direct Contracting at-large, to dig us out from under the boot of the 3rd party apparatus it must remain accessible to the sole proprietor, independent contractor and very small businesses that don’t have “health plans.” And moving to defined contribution plans and away from defined benefit plans will help get us there.

third-party-2Getting first dollar decisions in hands of consumers will also be deflationary and spur competition; and essential to the goal of eventual portability & ownership of benefits. To do otherwise, with too much focus on a new & improved generation of employer-sponsored healthcare plans, will lead us right back to where we started.

Posted in Access to healthcare, advance-pricing, Consumer-Driven Health Care, Direct-Pay Medicine, Direct-Pay Practice Models, Doctor-Patient Relationship, Economic Issues, Health Insurance, Healthcare financing, Independent Physicians, Medical Costs, Medical Practice Models, out-of-pocket costs, Patient Choice, Patient Compliance, Patient Safety, Patient-centered Care, Policy Issues, primary care, The Quadruple Aim, Third-Party Free Practices, Uncategorized, Wait times to see a doctor

More Patients Turning to ‘Direct Primary Care’ | Medscape

Christine Lehmann, MA

February 11, 2020

Having quick access to a primary care doctor 24/7 is very appealing to Mick Lowderman, 56, who is married with two children, ages 10 and 8. He pays a monthly membership fee to AtlasMD, a direct primary care practice in Wichita, KS.

Primary care is built on the long-term relationship between clinicians and patients. A 10- to 15-minute patient visit doesn’t support that relationship, Sullivan says.

When Kevin Boyd, 64, fell on his stairs in Wichita and broke three ribs, he didn’t go the emergency room. Instead, he called Umbehr, who told him to come to his office. He referred Boyd nearby for an X-ray and dispensed pain medications at his office. The total cost was $70.

In contrast, the first time Boyd fell and broke his ribs, he had Blue Cross Blue Shield and drove himself to the ER, where he saw the ER doctor, a radiologist for an MRI, and got shots for his pain. The total bill was $14,000, and he paid $2,600.

“I don’t put off care the way I used to because of the money I save,” says Boyd, who joined AtlasMD in 2015.
For his monthly membership fee of $75, Boyd gets several benefits, including unlimited 24/7 access to Umbehr by text, email, or phone, extended same- or next-day office visits, and free diagnostic tests and office procedures, such as EKGs, DEXA scans, and body fat analysis. If Boyd gets really sick and needs a house call, or if he needs a phone consult when traveling, those are also included in the fee.
Posted in Access to healthcare, Direct-Pay Medicine, Direct-Pay Practice Models, Disease Prevention, Doctor-Patient Relations, Health Insurance, Independent Physicians, Medical Practice Models, Sleep, Uncategorized

Sleep Medicine Specialist to Provide Direct Pay Video Consults to Patients in Georgia and South Carolina

Avinesh S Bhar, MD MBA

For the past year I have grown increasingly frustrated as our health care system has valued payer over patient, time and time again. Even our hospital administrators seem immune to care and compassion – the bedrock of my practice. My mission is to provide each patient with the right care, to the best of my abilities.

I want to be a resource to the pioneering group of practitioners (Direct Primary Care) who stepped out of the constraints of our current system to deliver care we all want to receive. We are trying to put the soul of health care back into the patient-physician relationship. At this time, we feel insurance companies increase friction and raise the cost of care.

~ Avinesh Bhar, MD MBA

Services include:

  • Initial video consults (either from the patients home or the referring practice using a smartphone and desktop)
  • Follow up (video)
  • Follow up (text):
    • I am offering this service to provide patients the flexibility of communicating directly with their physician without the formality of video.
  • Home Sleep Testing (HST): to include interpretation and physical copy of report.
  • I am setting up a DME company to ensure I can provide patients a cost effective and efficient care continuum for their pulmonary and sleep needs.

Dr. Bhar goes on to say, “My hope is to set up an efficient workflow to facilitate communication and follow up with DPC practices and patients. Through my website https://www.sliiip.com/ I provide video consultations (for first time visits and for complex follow ups) along with text messages (through a third party HIPAA compliant partner) for simple follow ups, medication refills and results notification.

I am currently licensed in GA and SC. I am also available for curbside consults to providers.

My website also has provider and patient resources https://www.sliiip.com/resources

 

To schedule a consultation visit https://www.sliiip.com/connect”

 

 

 

 

 

Posted in advance-pricing, CPT billing, Direct-Pay Practice Models, Economic Issues, Health Insurance, Healthcare financing, Medical Costs, medical inflation, Medical Practice Models, out-of-pocket costs, outcomes, Policy Issues, Protocols, Quality, Tax Policy, The Triple Aim, Uncategorized

How to Control Healthcare Costs: Know Why They are High

aaeaaqaaaaaaaapdaaaajdiwmmixztm3ltvinwetnddhmc1hmdu4lwy0ztq3mdaxy2i3oq

by Robert Nelson, MD

 

The formula for excessive Healthcare spending:

Most healthcare $$ resources tied up in premiums/billing cycle + lack of price transparency + Patients chasing benefits + Doctors chasing billing codes + No incentives to care about costs + Small Direct Pay market + Treatment Bias + Defensive Medicine + Unwise public policy and tax laws =

EXCESSIVELY HIGH SPENDING with low health value and low economic value.

Learn it.

Affect change where you can.

Pass it on.

Posted in Access to healthcare, advance-pricing, CPT billing, Direct-Pay Medicine, Direct-Pay Practice Models, Economic Issues, Education, Employee Benefits, Employer-Sponsored Health Plans, Health Insurance, Healthcare financing, Independent Physicians, Medical Costs, medical inflation, Medical Practice Models, Policy Issues, Price Tansparency, The Quadruple Aim, The Triple Aim, Third-Party Free Practices, Uncategorized

The Change We Seek We Must Create

lightbulb.solutionsThe reach and effectiveness of healthcare innovation and change is ultimately staked to how we pay for healthcare in aggregate. Building economic paradigms with more attractive price-value relationships will be the conduit through which change will emerge.

1.Employer education & engagement about the benefits of alternative health plan design based on maximal uncoupling from the BUCAHs.

2. Promoting opportunities for physician independenc apart from the price-concealing contractual third-party payment arrangements, and their co-conspirators, the giant NFP hospital systems.

3. Promoting / facilitating specialty and ancillary service cooperation / agreements which provide them revenue alternatives to the standard price-gouging CPT insurance billing protocols.

Posted in Access to healthcare, advance-pricing, Deductibles, Direct-Pay Medicine, Direct-Pay Practice Models, Economic Issues, Healthcare financing, Medical Costs, Network Discounts, out-of-pocket costs, Patient Choice, Price Tansparency

When our model hits home–the proof is in the pudding. – Direct Medical Care

https://directmedicalcare.wordpress.com/2017/03/30/when-our-model-hits-home-the-proof-is-in-the-pudding/