“Spitting in the eye of the village witch.” – More doctors are shunning private insurance:

The staff has shrunk to nine employee from 16. Fairfield now charges a flat fee of $65 for an office visit. Surgical fees vary by procedure.

He argues the arrangement is similar to how many dentists and most veterinarians are paid.

Fairfield said 170 patients have left the practice for other physicians who accept insurance. However, he noted, he has gained 471 new patients.

“Most patients understand why I did this and they appreciate the extra time I get to spend with them,” he said. “The staff is happy they have more time to talk with patients and their families. There’s a nice atmosphere in the office.”

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  • Anonymous

    “most patients understand why I did this and they appreciate the extra time I have to spend with them.”

    I’m wondering how much extra time he has to spend with patients if he lost 170 of them but gained 471? That means he is treating 301 more patients now than before..Is this some new math or what am I not getting about this? Does it not take more time to treat 471 pts. than 170?

  • Anonymous

    He is not going to gain patients at the same rate that he would if he was taking insurance…so he will probably have the same number of patients for a while and add only a few per month if that…when you take insurance you get all kinds of people who come in for sore throat, etc…just because they have insurance and want to use it and make the most of it…after all, it’s “free”, right?

    Now do you understand the “math”?

  • Anonymous

    NOPE, sorry I don’t…

    He says…”Fairfield has lost 170 patients from his practice that went to other practices that except private ins. However, he noted, he HAS GAINED 470 new patients.”

    What you have explained is something completely different that what the article states.

  • Anonymous

    If you have to pay 65$ for a visit, you go to the doctor less often than if you have to pay 10$ or nothing. So, 300 cash patients may actually use your service less than 100 BCBS patients

  • pelican

    I would also suggest that people who can easily pay $65/visit tend to be healthier than medicare/medicaid patients … if he lost a lot of ill/disabled/elderly chronic care patients, and has more healthy/working/young patients showing up with acute but mild issues because they know they’ll be able to get him to see their sprained ankle or sore throat, give them their shots for their vacation, or clear their kid for the soccer team … all on the same day, no waiting … that might be how more people end up taking less time overall (since he doesn’t have to deal with complex orders, multiple refills, arranging hospitalizations and specialist referrals, arguing with insurers), even with a longer “typical” visit length.

  • Anonymous

    Read the article. This is a dermatologist. Dermatologists don’t see “ill/disabled/elderly chronic care patients.”

  • Anonymous

    Gained/ lost is all relative to how frequently the patients are being seen. A patient being seen for acne every 3 months for medication management
    may represent more of a loss to the practice than one who comes in once yearly for an exam for actinic skin damage, yet each represents one “patient” to the practice. I don’t think you can infer a lot just by the numbers of patients alone. I guess he must still have an attractive practice, and even though he doesn’t participate in insurance plans, some will stay on and see him out of plan, at least until they can find someone else who is accepting new patients and who also accepts their insurance.

    It could take a couple of years to really see the result of this kind of practice change.

  • Anonymous

    Actually dermatologists frequently see elderly patients, some almost exclusively, especially in more sunny areas of the country popular with retirees. Some dermatologists I have shared patients with have restricted their practices to oncology treatment only, which is overwhelmingly a senior patient population.

  • Anonymous

    Dermatologist can easily avoid dealing with insurance anyway — just do more cosmetic stuff. No insurance that I know of pays for Botox, Restylane, laser hair removal, microdermabrasion, etc. etc.. And all of this stuff is expensive and ongoing. $600 per patient per Restylane every 6 months or so, a few hundred per Botox every 3-4 months…

    So, a dermatologist can easily loose insured patients. If he has more time, he can schedule more botox appointments.

    Not a very good example.

  • Anonymous

    A dermatologist could do this and probably not suffer much. There are not an overwhelming number of these specialists, most have busy outpatient practices only and maintain only courtesy hospital staff privileges (if any at all) with few worries about offending referring practitioners by not accepting popular plans (no matter how badly they treat specialists).

    My guess is that you will see more of this kind of practice in the future. Dumping the insurance company eliminates the need for verification protocols, verifying deductibles, collecting copayments, following up on third-party billing and inevitable downcoding, denials, collections and bad debt. A lot of administrative time goes into those kinds of practice activities. You could lose a few patients net and still not see a net revenue loss to the practice.

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