Comments on: Why primary care doctors need to practice insurance free medicine

By: Fray

Fray — Tue, 09 Feb 2010 14:56:15 +0000

“Your unlimited access to self referral to specialists who do not communicate with one another and duplicates tests is what is bankrupting Medicare and the reason healthcare is in trouble.”

During my zebra episode, my FP consistently sent me to the urgent care clinic…in a different building…no communication between them even though they were part of the same system. If he had been in the loop, he would have noticed frequent episodes of chronic cough that urgent care treated with antiboitics (this urgent care was staffed by doctors) I did visit my FP finally waited during a particularly bad episode. He that my my coughing wasn’t an big issue and that I should stop running and begin a walking program. I self referred myself to an allegist/asthma-who got things under control, realized more was going on, and referred me to a pulmonologist who then recommended a consult to a infections disease specialist (they communicated very well). When it was apparent the weight loss I was experiencing needed attention, I went to my FP, wasn’t up to speed, even though all specialists had sent him a report. He spent most of the appointment reading my chart and didn’t referred my out. When I asked about nurtrition…he said drink carnation instant breakfast.

I wouldn’t go to neuologist for a headache…and the sinus trouble I do have is treated with a neti pot…and the discovery of a food allergy…something I discovered through my naturpath.

I do go to my physical therapist for supposedly muscle/skeletal problems…The last time I went to my FP for an injury, he gave me a presciption of naproxen…After years of pain and some research, I asked him for some exercises…and he referred me to a orthopedic surgeon…I found a good doctor that specialized in sports medicine…referred to PT, discovered years of not treating the problem had left permanent damage.

I chose my FP for an ear infection…something any nurse practitioner could have diagnosed. I was given antibiotics and when the fluid didn’t clear, I was referred to a ENT (which was a waste of time and bankrupting the medical system.)

“Then who collects the medical records into one place and monitors all medications and checks for interactions? No one, as this is the uniqueness of primary care.”

I do. I know every test I have had and the results. I remember what the doctor has told me and I keep a copy of those medical records and bring them just in case clarification is needed.

By: JD

JD — Tue, 09 Feb 2010 13:42:48 +0000

>>You are not paying full fee, only the allowed amount your health insurance “allows” to be paid on your visit. So you are getting a discount through your insurance even though you are paying more than just your usual copayment. And if you have a HSA account you can use that money to pay for the out of pocket costs of the deductible payment.>>

This is all academic for me, as neither of the two companies from which I have to choose my individual plan offer HSAs.

My original point remains: why not remove insurance companies entirely from primary care and charge patients appropriately and fairly? Taking the cost of the insurance company and all personnel associated with filing claims would of course drop overhead and, as someone else mentioned, allow the market to control costs as physicians’ prices would become transparent. If I were paying out-of-pocket, why should I have to pay the insurance company to negotiate prices for me?

By: j.

j. — Tue, 09 Feb 2010 00:37:25 +0000

Fray said, “the specialist can find the zebras better than the FP”. Ok, you pick a neurologist (say for a really bad headache) and since he is used to seeing the “zebras” he goes straight to the MRI that costs thousands of dollars to your insurance company, only to find out that it is your sinuses and not supposed to be a neurology appointment at all and then you go to an ENT (another specialist) that ordered a CT of your head and treats your sinuses with Nasonex and Saline spray, which your FP is very well trained in doing. If you had gone to the FP he probably would have diagnosed sinuses without the MRI because he sees sinus infections all the time and even if the head needed a scan to confirm chronic sinusitis he would have ordered a CT which is much less expensive than the MRI. Plus the visit codes for the specialists cost your insurance company more than primary care.

Your unlimited access to self referral to specialists who do not communicate with one another and duplicates tests is what is bankrupting Medicare and the reason healthcare is in trouble.

Also the Bach study showed that an elderly patient can see as many as 14 different specialists and with not one of them being a primary physician. Then who collects the medical records into one place and monitors all medications and checks for interactions? No one, as this is the uniqueness of primary care.

By: DR PJ

DR PJ — Tue, 09 Feb 2010 00:18:08 +0000

This is all interesting discussion. Fray, I’m very sorry about what happened with your health, and all the frustrations you endured. I truly hope you’re doing better now.
Dr. Berry, your clinic sounds wonderful. With my streamlined, private-pay-only practice, some of the best rewards I’ve gotten (besides the “freedoms” you mentioned in your article) have been the grateful thank-you’s from patients because I took extra time to discuss their needs. That’s priceless, and it is even better when they refer their friends or acquaintances to me because I’ve been able to help them when no other doctor had the time to carefully address their issues. No one can really adequately describe the pressure-cooker that being entangled with insurance plans feels like–especially if the physician is also responsible for overseeing employees’ concerns and making enough to keep the office open. That’s what was going on with my former practice that I closed in 2008, after insurance reimbursements became so poor. And, to top it all off, I found that no one at the state or federal level was really holding the insurance companies accountable. They may say they are, but when it comes down to it, chances are they won’t do anything to stop such practices as wrongfully denying payment on legitimately-filed claims or processing claims (even electronically-filed ones) in an efficient manner. It seems that the burden is on the healthcare providers to do all of the work, and MAYBE we can get paid–when dealing with insurance companies.

Dr. Berry, you’re right–it is very freeing to be out of that pressure cooker!

By: Fray

Fray — Mon, 08 Feb 2010 23:31:28 +0000

“So you are getting a discount through your insurance even though you are paying more than just your usual copayment.”

I often see complaints about insurance reimbursements not being adequate. A high deductible doesn’t help the doctor by increasing cash flow or eliminating insurance billing overhead. I went to a cash only specialist. He gave me a receipt with a code and I filed the claim myself. No discount.

“Remember you pay for their knowledge and ability to fix/prevent/recognize complications.”

“okay I’m done, throwing in the towel. I obviously cannot compete with someone so smart that they can predict when these “zebras” are going to be present.”

If you can’t find a zebra then what’s the point? Or perhaps that is my point… a specialist can find the zebra better than an FP and since they cost the same for an office visit…

By: j.

j. — Mon, 08 Feb 2010 17:02:18 +0000

In answer to questions of affordability of high deductible plans out of pocket pay for Primary Care:
You are not paying full fee, only the allowed amount your health insurance “allows” to be paid on your visit. So you are getting a discount through your insurance even though you are paying more than just your usual copayment. And if you have a HSA account you can use that money to pay for the out of pocket costs of the deductible payment. So
with most High Deduct. plans the bill is run through the health insurance company and the physician’s office is told by the health insurance how much you owe, and unless they have invested in “time of visit real time pay” software this can take a month or two, then the physican’s office must pay for a statement to be sent to you to tell you what you owe. Usually what is “allowed” is about 50 to 60 cents on the dollar, therefore the physician billing the insurance for more than what he would normally charge, is only trying to get more than that nominal payment for the professional work done. What other secondarily educated professional would take this B.S.?? Primary Care Physicians go into the profession because they are benevolent, but when benevolence is constantly being expected and taken advantage of and not appreciated or respected, then at some point one has to take steps to survive. Your plumber to save your pipes is paid more on the dollar with less training costs, less overhead and less regulation headaches or administration costs than a primary care physician is to diagnose and treat a life threatening condition. Boy our priorities are messed up aren’t they? We will pay more for a car tune up to keep our car going than an annual physical to keep our bodies going. When they are gone the specialists are going to miss them as they will be forced into doing primary care and the public will wonder why all of a sudden the specialists are going concierge, cash pay and those that don’t seem distracted and in a hurry all the time.

By: Surgical Resident

Surgical Resident — Mon, 08 Feb 2010 15:46:37 +0000

okay I’m done, throwing in the towel. I obviously cannot compete with someone so smart that they can predict when these “zebras” are going to be present. Good luck with all of your wellness problems.

By: JD

JD — Mon, 08 Feb 2010 13:51:06 +0000

>>If there were only high deductible plans, then all primary care doctors would take direct payment. They would not only have to compete on quality, but on price.>>

Sure. That’s my point: at this time, in this market, a high deductible plan is not the answer for someone like me – even if I could find one that were otherwise appropriate (and as I mentioned earlier, I have only two companies to choose from in my state).

By: Fray

Fray — Mon, 08 Feb 2010 05:43:27 +0000

“I mean, 6 weeks for an abx, seems excessive”

So you question a board certified doctor on his recommendation.

“What if that NP did not think about that cut extended into your joint (and hence should have been injected) or what about the scar formation across a joint??”

My spouse fell off his bike, went to his primary care physician’s (an MD) office and was stitched up by an nurse practitioner-no doctor involved. If it’s such a bad thing for nurse practitioners to practice medicine, why do doctors use them? Of course, we paid a doctors fee for a nurses treatment.

“Remember you pay for their knowledge and ability to fix/prevent/recognize complications.”

And that’s great but during that moment when I needed my FP to consider a zebra (and this has happened more than once) or to look ahead and prevent a complication, it didn’t happen. I check in with my pulmonologist twice a year…he even remembers that I run and asks me about competition. He was the one concerned about bone loss…complications of being thin. It was the infectious disease specialist that saw depression, not the FP.

By: Fray

Fray — Mon, 08 Feb 2010 00:39:12 +0000

“PS: This is the internet and I am not going to get into diagnosis…”

Well, joe, you already have decided that a naturpathic physician can not possibly gotten the right diagnosis and treatment without knowing the entire situation. Do you feel that way about the pulmonologist? My FP made a similar mistake…and one of my biggest regrets is trusting someone who didn’t have the time to care.