Sunday, April 26, 2009

"Main Street" Health Care Reform- Pay Cash, Bid for Discounts

Last week, I opened a discussion about our nation's struggles with health care. My heart went out to the comments from readers, who have life threatening illnesses, and cannot afford the care they need. It's clear no one's happy out there, and the demand for change is rightfully at a fever pitch.

The frustration is not one-sided. Many doctors and health care providers are unhappy and downright angry. They hate the bureaucracy and demands of the insurance industry that drains staff time, pays them a fraction of what the service is worth, and takes them away from patients.

Dr. Cara Barker, a popular Featured Contributor at Huff Po wrote:

"After 41 years a a clinician, I am seeing increasing numbers of us look to other venues to provide what we can without the nonsense that we call the health care system. What we've got is a disease care system, not health care.

I just left an international training and met doctors, nurses, psychologists, etc. who have been outraged by the intrusion of third party payers, (for profit) who have eroded, along with pharmaceuticals, really good care. It costs an average of $150-$250K just to get through the training. With catastrophic liability insurance costs, people like my colleague, Dr. Shapiro, (Ob-gyn) are leaving their practices. Many are not able to take a paycheck, just to keep providing care. No wonder we are looking in other directions to attend those who want wellness."

No one can run a business and consistently lose money - so what are the alternatives? How do we take health care reform to Main Street? Many doctors are leaving insurance reimbursement behind, and offering their services for direct payment. One option for general care is through 'concierge medicine.' Heard of this one yet? It's like an old fashioned doc for a modern price.

For an annual fee of around $2,000/year, you can buy into your doctor's practice, and enjoy the luxury of being seen anytime you want. Concierge doctors drastically limit the number of accepted patients, so they can be available to take your calls, advocate for your needs and give you the personal attention you deserve.

Some complain the concierge docs must be greedy little worms to charge so much to see their patients, but let's dig a little deeper. The field of general medicine is one of the most challenging to make a living. Many have had to leave their practice, or take up side work, to stay alive. The reimbursements are so low, they are forced to quadruple the amount of patients seen in an hour.

What used to be a 20-30 minute check up is now relegated to about 5-10 minutes. Ever sat in an exam room with a stupid paper gowns for about an hour, waiting for the doctor to finally come rushing in? The experience is less than pleasant as they zoom through the appointment in about 4 minutes, and then dash out again.

I spoke with Dr. Lisa Sanders about some of these issues and challenges. Sanders is a former Emmy award winning broadcast journalist with CBS, who launched a second career in medicine. She practices and teaches Internal Medicine at Yale, writes the popular "Diagnosis" column in the NY Times, and is the inspiration and medical consulting producer for the hit Fox TV show, 'HouseMD.'

"The medical stories on the show are based on facts, and the character of 'House' is pure Hollywood,"
Sanders jokes.
"I have been amazed how many people tell me they wish House was their doctor,"
she says more seriously.
"When I ask them why they would want such a nightmare, it seems people can look past his grouchy exterior, and it is being the center of medical attention that they crave."
Dr. Sanders takes care of the very poor in her clinic, and acknowledges she could not survive on what she earns seeing patients, if Yale did not provide her a salary. She shared an example of a typical day:

"One day I saw about 10 patients. Many of them had very complicated issues, with a lot of medicines to review, and I only had about 20 minutes. Guess how much I got paid for those patients? About $40.00 each. At the very end of the day, someone came in with an in-grown toenail. Guess how much I got paid for that? About $350 - almost as much as all the other patients combined."
I asked her what does this mean for doctors to survive?

"I guess I would have to be removing a lot more toenails."

Another new idea to put patients and doctors back together, sans insurance, came from a few cutting edge doctors, seasoned exec's and investors; who created an online marketplace for health
in a website called PriceDoc or They currently offer services for dental care, vision, cosmetic, walk-in clinics, chiropractic and alternative health. The site just opened in the Seattle market, and is generating a buzz.

Those in Seattle can type in a desired service, and a list of providers pops up with background information, credentials, and a list of what each procedure costs. This alone is revelatory. Where else can you go to compare the prices of a regular dental check-up, lasik surgery or laser hair removal? Here's the biggest twist: some of the procedures are available for a discounted "Make An Offer" option, similar to Priceline.

Sarah Ames is a 27 year old resident of WA who is employed, but does not have dental insurance, and wanted "Invisalign" braces. She called two dentists in her area for price quotes, and then found out about via a friend from Facebook. She searched the site, and found a price that was lower than the other two dentists- plus an option to "Make An Offer," from Dr. Tulay Kent. She did, won the bid - and ended up saving $1700. Wow, not bad!

Dr. Kent is a well respected dentist in Seattle,and said she loved that potential new patients can review her credentials, services, and prices online, and believes it will help build stronger relationships. When asked about the "Make An Offer" option, she explained the reduced fees are still comparable to insurance payments, yet without the hassle. This allows her staff to focus on the patients and handle more important projects.

People can't afford health care, and the entrepreneurial spirit will help us get there, both in big steps and small steps. It's time to tear down the walls and create a new marketplace for our health based on trust, experience and fairness.

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