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Doctors Going Broke

January 6, 2012 By Leave a Comment

Although most of us in medicine know the struggles of running a private practice, it is still disconcerting – albeit not surprising – to hear that some doctors are having to file for bankruptcy.

In an article on CNNMoney.com, some physicians talk about having to get business loans or use personal funds to keep their practices afloat. In some cases it is a matter of sudden changes in reimbursement policy, such as cuts in oncology pharmaceuticals; in others, it is the slow death of decreased revenue in the face of increasing costs.

For the rest of practices that are in a somewhat better situation, the annual drama in Washington DC over Medicare reimbursement has led to a paralysis in strategic planning of any kind. Doctors cannot plan for growth, for expansion, or for investment in new technology with the spectre of 30% fee cuts constantly looming over their heads.

 

Debunking The 7 Myths of Concierge Medicine

January 2, 2012 By Leave a Comment

Guest Post, John T. Kihm MD

Myths abound concerning concierge medicine (CM). Unfortunately these myths prevent good doctors from converting their practices to CM.  Let’s look at those myths—maybe you need to work on yourself and your own beliefs. If you practice quality medicine your patients will value you and your work and will pay a fee to join your CM practice.  CM is a value story.  If you provide solid value, you needn’t believe these myths–value trumps myth.

The myths:

  • My patients are not wealthy/can’t afford CM. I have a lot of Medicare/Medicaid patients.
  • My patients will not like this concierge idea.
  • My patients can’t do without me.
  • I have bad practice demographics. I am rural. My patients are too old. My patients are too young.
  • 24/7 coverage sounds too hard.
  • Is this legal? What are the ethics?
  • The conversion process will overwhelm me.

My patients are not wealthy.  If your patients value you and your work, you can devise an affordable program.  Patients will find the money to keep you if they value you.  Be creative with pricing if necessary.  You can make it work.  Amazingly, I have patients who live in housing projects who joyfully belong to my practice because they see the value.  Conversely, all of us in CM practice have wealthy patients who say the fee is too high, do not see the value, and do not join.  Patient income generally does not predict CM success or failure.  Perceived value predicts success.  Focus on value and the rest will follow

My patients will not like this concierge idea.  Do not project onto patients negative beliefs, as those beliefs may become unnecessary self-fulfilling prophecies.  Patients’ enthusiasm will mirror your own.  Patients possess a survival instinct and will recognize your opportunity for better care, along with your belief in providing that care.  Moral:  be enthusiastic!  Believe in yourself and your patients will follow.  Above all, emphasize value and opportunity in your CM practice.

My patients can’t do without me.  Primary care doctors are famously codependent.  Get over it.  Patients not seeing the value in your practice can and will vote with their feet.  You do not decide who can live with or without you—patients decide.  Patients who truly “can’t live without me” will see the value and stay with you.  There is nothing unethical about letting patients decide who they need.   Do not project your own needs onto your patients.  Patients who do not wish to stay with you are responsible for their own lives.  Let go of your codependency.

I have bad practice demographics.  You can overcome demographic obstacles by providing great value to your patients.  Patients of all stripes, ages, and locations will stay with you if you take excellent care of them.  For example, farmers in my practice understand, respect and value hard work.  All of my farmer patients signed my contract.  The elderly do tend to value their care more that the youthful, but the health-conscious young will sign-up as well.  Meet demographic challenges by making sure your patients see value.

24/7 coverage sounds too hard.  24/7 sounds impressive, and it does demonstrate value.  Taking call has never been easier for me.  First, with fewer patients in the practice, the calls decrease in proportion to number of patients.  Second, the very patients who respect and value me enough to contract with me demonstrate discretion in calling after hours.  Mutual respect is the norm in CM.  Inappropriate calls come few and far between, so 24/7 call is not hard.

Is this legal?  What are the ethics?  Concierge medicine is legal and is ethical. In CM, you provide a service for which patients pay. If you elect to file insurance, your CM practice needs to provide a non-covered service. Some argue that by charging a fee, you limit access to patients, hence CM is not ethical.  Your response should be, “I need to see fewer patients to practice a high level of care.  I cannot take care of all patients who need a doctor.  It is not my responsibility to see all patients or attempt to cure all of society’s ills.  I just focus on my own patients.”  Explain this truth to your patients. They will understand you.  It is ethical for you to stay alive and in business by practicing concierge medicine.

Conversion process will overwhelm me.  Conversion to a concierge practice is do-able, and challenging.  You have one chance to do it right.  We do not recommend going it alone.  Conversion need not be overwhelming.  Simply ask for help.

If you know in your heart that you need a better alternative than hamster treadmill high volume medical practice, consider concierge medicine.  Do not shoot-down CM based on any of the above myths.  Focus on value.  If you can provide value to your patients and if you want a better life for your patients and yourself, bust these myths and get going.  Contact us, we can help.

Dr. John T. Kihm blogs on ConciergeMedicineDirect.com – the original article can be read at Debunking the 7 Myths of Concierge Medicine

Will High Court Kill Healthcare Reform?

December 21, 2011 By Leave a Comment

Although most people like to think that the Supreme Court is above playing politics, some healthcare experts see signs that it might be leaning towards trying to gut the national healthcare reform law. An article on UPI.com says that the high court, dominated by a 5-4 conservative majority, has shown evidence of prejudicial behavior.

While some on the right have called for Justice Kagan to recuse herself – because she was “the Obama administration’s top courtroom lawyer when the Patient Protection and Affordable Care Act was rammed through Congress over bitter Republican opposition” – the left are calling for Justices Thomas and Scalia to withdraw from the case before they were wined and dined by the law firm that will argue the case before the Supreme Court.

Others say that there is a high likelihood that the Court will opt to punt on the controversial case by claiming that federal law bars court challenges such as this one that are brought by the states.

The Conservative Case for the Individual Mandate

December 19, 2011 By Leave a Comment

‘Tis the season of election campaigning and there is nothing quite so entertaining as watching politicians pensively reconsider their stances on important issues (er, I mean flip-flop). One of the biggest bones of contention in healthcare reform is the so-called individual mandate, seen as Big Brother imposing his socialist grip on freedom-loving Americans.

So where exactly does that mean? And who came up with that idea?

In an LA Times blog post, Walter Zelman, Chairman of the Department of Public Health for Los Angeles County, poses the question,

Would conservatives rather have government impose a financial requirement on people who choose not to buy healthcare, or have those who behave responsibly bear the financial burden of a few?

Although many conservatives today see the individual mandate as another example of government over-reach, the idea originated with moderate Republicans in the 1980s and 1990s, with Senators John Chafee (R – RI) and Bob Dole (R – KS) among them (as well as one Congressman Newt Gingrich). Their argument is that every adult that can afford insurance should buy it or else face some sort of penalty, else the rest of society has to pick up the tab. “Is it fair for the responsible to have to pay more in order to protect the rights of the irresponsible?”

Concierge Model Criticized for Worsening Doctor Shortage

December 12, 2011 By Leave a Comment

With looming reimbursement cuts a perpetual end-of-year drama, more physicians are foregoing insurance plans altogether and going into the ‘concierge medicine’ business.

But as an article on Fierce EMR reports, some are blaming this trend on a growing shortage of physicians.

In Vermont, one of a few states considering a single-payer system, the number of primary care physicians is becoming evident. Although the number of concierge practitioners is small – on the order of a few thousand – this has doubled in the past two years.

Doctors who are dropping Medicare are reporting less stress and more professional satisfaction, but apparently this is leading to many patients who can’t afford the cash-pay model to be dropped by their doctors.

Grandma and the Big, Bad SGR

December 8, 2011 By Leave a Comment

This video from the Texas Medical Association shows us the Medicare reimbursement issue from a child’s perspective.

Grandma and the Big Bad SGR!
A huge Medicare cut looms for doctors and Medicare patients. Who might that affect? People like grandma – and those who love her, as the child in this video shows. Unless Congress acts, on Jan. 1 doctors who care for Medicare patients face a 27.4-percent pay cut, because of a flawed funding formula called the SGR. Then millions of seniors (like grandma) and people with disabilities — and military families whose insurance is TRICARE — might have trouble finding a doctor´s care.

Debate Over Whether Medicare Pay Cuts Will Hurt Doctors’ Practices, Patients

December 7, 2011 By Leave a Comment

An article in the Washington Post discusses a rising debate over whether or not reimbursement cuts in Medicare will have a drastic effect on physicians or their patients as many medical advocacy groups are warning.

Some prominent healthcare analysts – including some from an independent agency advising Congress – say that the

…the problem is not that doctors will be short-changed, but that most will continue to be paid too much. And when it comes to hospitals, other experts contend the impending cuts are marginal enough to be easily absorbed and could even encourage more efficient care.

Much of this discussion centers on specialists, whom the experts quoted say always seem to make up for Medicare cuts by increasing revenue by other means. But “the picture is less rosy for primary care doctors, who have fewer opportunities to make up for stagnant fees by increasing their patient load or offering more costly treatments.”

Hospitals, on the other hand, were willing to go along with some of these cuts in return for supporting healthcare reform, since that would result in the addition to millions of newly insured patients. However, with many politicians vowing to repeal the legislation, and the Supreme Court about to review its constitutionality, hospitals could end up getting a double-whammy.

Beware the RACs

November 16, 2011 By Leave a Comment

Below is an actual letter received – and almost thrown away – by an employee of a medical practice. They almost threw it away because it looked like junk mail.

It turned out to be a letter from a RAC (Recovery Audit Contractor) who was auditing their practice. They figured that the letter was purposefully designed in such a way as to encourage disposal and thus possibly trigger additional charges and penalties. That practice now carefully combs through every piece of seemingly innocuous mail and they recommended for other practices to do the same.

Dirty Tactics of Those Medicare Advantage Plans

July 10, 2008 By 3 Comments

Once again we were saved from another Medicare cut at the last minute. cowboy-robber.jpgThis is really getting old. The only consolation is that for once it is getting more press coverage than in the past, mostly with the (correct) slant that these cuts will ultimately hurt Medicare beneficiaries. Several Republican senators changed their votes from their previous positions on HR 6331 to yes after receiving a lot of flack from their constituents, many of them physicians.

Someone (a Fox News follower) said, “There must have been a reason that those senators voted against it.” Well, yes, apparently there was. [Read more...]