Comments on: The consequences of making medicine a business http://www.kevinmd.com/blog/2009/01/consequences-of-making-medicine.html Tue, 14 Feb 2012 23:00:00 +0000 hourly 1 By: Anonymoushttp://www.kevinmd.com/blog/2009/01/consequences-of-making-medicine.html#comment-89281 Anonymous Sun, 18 Jan 2009 13:40:00 +0000 http://clients.emmense.com/kevinmd/2009/01/the-consequences-of-making-medicine-a-business.html#comment-89281 Concierge Doc:<br/><br/>I offered the German proverb above--and sort of agree with you but the proverb still applies. In your cash price system, patients are offering their money to hire a physician--and a physician is what they get. They value you for your professionalism (skills and ethics) and don't see you as just a faceless utility that they have to go through "to get a test" and have it paid for by insurance. <br/><br/>So the Art is following the money because you structured your practice so that the the payment structure will reinforce rather than conflict with the art of traditional Hippocratic medicine--which is the ethical way of mixing business and medicine. Good for you. Concierge Doc:

I offered the German proverb above–and sort of agree with you but the proverb still applies. In your cash price system, patients are offering their money to hire a physician–and a physician is what they get. They value you for your professionalism (skills and ethics) and don’t see you as just a faceless utility that they have to go through “to get a test” and have it paid for by insurance.

So the Art is following the money because you structured your practice so that the the payment structure will reinforce rather than conflict with the art of traditional Hippocratic medicine–which is the ethical way of mixing business and medicine. Good for you.

]]> By: Conciergedochttp://www.kevinmd.com/blog/2009/01/consequences-of-making-medicine.html#comment-89279 Conciergedoc Sun, 18 Jan 2009 08:00:00 +0000 http://clients.emmense.com/kevinmd/2009/01/the-consequences-of-making-medicine-a-business.html#comment-89279 Since I started my own "cash practice" nearly 2 years ago, there are only 2 times I order expensine unecessary tests, or send soft referrals to specialists - either when it's really medically indicated based on evidence of benefit - or when I practice defensive medicine. <br/>My cash paying patients pay for my time, plain and simple. There is no need for me to do holters, echos, ultrasounds, ekgs, spiro's, screening hearing tests, ABIs, x-rays, nerve conduction studies, and bladder scans or anything else in ordere to generate $120+ per encounter. There are very few indications of biopsies, or joint injections. My $1500 per patient fees removes all incentive (both concious and unconcious) for me to add wastefull ancillaries. Toss in the fact that my patients can pay for the membership out of HSAs, we are saving the system money, my patients time, and improving the quality of care. I recently ran a quality reports run show how good of a job I'm doing. Colonoscopy, mamogram, pap smear, flu and pneumovax rate are greater than 90%. Zostervax for 60 and older is 75%. Average diabetic a1c is still a little high though at 7.3 and 73% of my hypertensions qualify as controlled. BP<140/90 on 2 successive visits. Aspirin use is at 85% for males older than 65. 85% of my a fib patients are on coumadin and the 15% not are clearly documented why not. Therapeutic Vitamin D levels in 100% of my patients. <br/><br/>The cash model works, plain and simple. Here, the money follows the art of medicine.<br/><br/>*quality numbers are currently based on a small sample size Since I started my own "cash practice" nearly 2 years ago, there are only 2 times I order expensine unecessary tests, or send soft referrals to specialists – either when it's really medically indicated based on evidence of benefit – or when I practice defensive medicine.
My cash paying patients pay for my time, plain and simple. There is no need for me to do holters, echos, ultrasounds, ekgs, spiro's, screening hearing tests, ABIs, x-rays, nerve conduction studies, and bladder scans or anything else in ordere to generate $120+ per encounter. There are very few indications of biopsies, or joint injections. My $1500 per patient fees removes all incentive (both concious and unconcious) for me to add wastefull ancillaries. Toss in the fact that my patients can pay for the membership out of HSAs, we are saving the system money, my patients time, and improving the quality of care. I recently ran a quality reports run show how good of a job I'm doing. Colonoscopy, mamogram, pap smear, flu and pneumovax rate are greater than 90%. Zostervax for 60 and older is 75%. Average diabetic a1c is still a little high though at 7.3 and 73% of my hypertensions qualify as controlled. BP<140/90 on 2 successive visits. Aspirin use is at 85% for males older than 65. 85% of my a fib patients are on coumadin and the 15% not are clearly documented why not. Therapeutic Vitamin D levels in 100% of my patients.

The cash model works, plain and simple. Here, the money follows the art of medicine.

*quality numbers are currently based on a small sample size

]]> By: CKakutaniMDhttp://www.kevinmd.com/blog/2009/01/consequences-of-making-medicine.html#comment-89267 CKakutaniMD Sat, 17 Jan 2009 04:32:00 +0000 http://clients.emmense.com/kevinmd/2009/01/the-consequences-of-making-medicine-a-business.html#comment-89267 Although those of us trying to do primary care feel this acutely, you can also see this being played out to its logical conclusion in specialty care as well. A FP colleague from Arizona was telling me that is is next to impossible to find a dermatologist willing to take on any medical cases such as tough to treat eczema, etc. They only want to do cosmetic work. Seeing patients that need education and medication treatment just doesn't pencil out. Although those of us trying to do primary care feel this acutely, you can also see this being played out to its logical conclusion in specialty care as well. A FP colleague from Arizona was telling me that is is next to impossible to find a dermatologist willing to take on any medical cases such as tough to treat eczema, etc. They only want to do cosmetic work. Seeing patients that need education and medication treatment just doesn’t pencil out.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2009/01/consequences-of-making-medicine.html#comment-89260 Anonymous Sat, 17 Jan 2009 01:08:00 +0000 http://clients.emmense.com/kevinmd/2009/01/the-consequences-of-making-medicine-a-business.html#comment-89260 Die Kunst geht nach die Geld. The art follows the money. Die Kunst geht nach die Geld. The art follows the money.

]]> By: Careyhttp://www.kevinmd.com/blog/2009/01/consequences-of-making-medicine.html#comment-89255 Carey Fri, 16 Jan 2009 21:50:00 +0000 http://clients.emmense.com/kevinmd/2009/01/the-consequences-of-making-medicine-a-business.html#comment-89255 Great post. The consequences of making medicine a business is reminiscent of recent posts including the kidney drama as well as Pauline Chen's lastest article about the challenges of putting a price on compassion. Together, they raise a central question about our medical and healthcare system. And as mentioned, influences how physicians and other medical practitioners make decisions as well as the role patients play in her or his own care. But making medicine a business carries much greater weight about what "counts" or what gets "reimbursed" as you stated and framing medicine as a business demands a certain kind of communication and decision making process as well as influences the culture medical students are being educated and trained for. And if medicine is framed as a business, we must, together, enhance the inclusion of wider social values and underrepresented groups and interests into medical practices and decisions. Furthermore, what's getting counted for at the expense of something else like compassion, collaboration, and community must become part and parcel of today's medical students training and culture. Moreover, this responsibility should not simply fall on medical students and doctors but also the responsibility of patients who become active agents in their own care. Doctors need our help and we need their guidance to rearrange the extent to which money is enmeshed with medicine and how medical decisions are made and how they could be made differently. This agenda is not about what doctors or patients want but about a conversation that isn't taking place. This conversation must happen in order for all providers and patients to decide how medicine gets done and what should "count." After all, business can be a productive word if (and only) the communication is transformed. Thanks for the insightful post.... Great post. The consequences of making medicine a business is reminiscent of recent posts including the kidney drama as well as Pauline Chen’s lastest article about the challenges of putting a price on compassion. Together, they raise a central question about our medical and healthcare system. And as mentioned, influences how physicians and other medical practitioners make decisions as well as the role patients play in her or his own care. But making medicine a business carries much greater weight about what “counts” or what gets “reimbursed” as you stated and framing medicine as a business demands a certain kind of communication and decision making process as well as influences the culture medical students are being educated and trained for. And if medicine is framed as a business, we must, together, enhance the inclusion of wider social values and underrepresented groups and interests into medical practices and decisions. Furthermore, what’s getting counted for at the expense of something else like compassion, collaboration, and community must become part and parcel of today’s medical students training and culture. Moreover, this responsibility should not simply fall on medical students and doctors but also the responsibility of patients who become active agents in their own care. Doctors need our help and we need their guidance to rearrange the extent to which money is enmeshed with medicine and how medical decisions are made and how they could be made differently. This agenda is not about what doctors or patients want but about a conversation that isn’t taking place. This conversation must happen in order for all providers and patients to decide how medicine gets done and what should “count.” After all, business can be a productive word if (and only) the communication is transformed. Thanks for the insightful post….

]]> By: Anonymoushttp://www.kevinmd.com/blog/2009/01/consequences-of-making-medicine.html#comment-89249 Anonymous Fri, 16 Jan 2009 17:59:00 +0000 http://clients.emmense.com/kevinmd/2009/01/the-consequences-of-making-medicine-a-business.html#comment-89249 You've set up a false argument because you're confusing business with bureaucracy. All of this baloney you cite are attempts by government and third party payer bureaucracies to limit care and care payment.<br/><br/>The small parts of medicine that have free markets such as cash practices and uncovered elective procedures are largely free of these hassles. You’ve set up a false argument because you’re confusing business with bureaucracy. All of this baloney you cite are attempts by government and third party payer bureaucracies to limit care and care payment.

The small parts of medicine that have free markets such as cash practices and uncovered elective procedures are largely free of these hassles.

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