Responding to patient concerns after changing my practice

Below find excerpts of an email sent by a faithful reader.  I have included the whole text, but broken it down to respond to each point accordingly.

I have really enjoyed your blog postings and the sensitivity you showed toward patients. But, your new venture is a real turn off, and makes it hard for me to want to read your posts anymore.

I have been waiting for this.  Expecting it.  I knew that when I changed my practice model there would be anger and disappointment.  For this reason, I have gone to the trouble of telling each patient face to face in the office when they come in for an appointment.

This has been my decision.  I will own up to it.  I won’t hide behind a formal letter or slink out of the room.  If patients are upset, I will soak in the anger and accept it.  I owe that much.

So far I have received mostly understanding with a smattering of joy and disappointment.  My patients know me very well, they don’t believe I mean them harm.

My dear reader, sometimes you have to look eye to eye to see into some one’s soul.  A blog, unfortunately, does not allow for that.

As a patient (not yours), it seems like you are abandoning patients who do not have the money to pay your new fees for which you will take no insurance. Instead of staying in the trenches and finding the insurance battle with them, you seem to be washing your hands of it and leaving them on their own. Onward to people with disposable incomes to pay for handholding.

On the contrary, I’m still taking insurance.  For fifty percent of my practice: nursing home, hospice, and palliative care there will be no extra charge.   These are some of the most difficult and high risk patients.  I will continue to stay in the trenches and battle for them.

I am changing, however, my outpatient primary care practice.  I will charge a yearly fee along with billing insurance.  The yearly fee pays for uncovered services like home care, cell phone access, and prolonged visits.  I believe this is a fair trade off.

My perception may well be wrong. Perhaps I did not listen carefully enough to your explanations. I want to believe that you are who you appeared to be, a great, caring physician. But, I thought that you might like to know that at least one of your loyal blog followers doubts that now. Take care.

I would like to think that I am still perceived as a great, caring physician.  I would also hope to be viewed as a strong patient advocate.  But the problem is, I can’t protect my patients from the ridiculous, pervasive stupidity of medicare and our modern day insurance Goliath.

I can keep bending, and giving, and finding ways to work around the vicious beast.  Or, I can choose to step out of the lion’s den.  I will not be an enabler of this broken system.

Change will only come when doctors and patients alike are willing to stand up and say enough is enough.

I am in the unique position to do just that.

Jordan Grumet is an internal medicine physician and founder, CrisisMD.  He blogs at In My Humble Opinion.

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  • azmd

    “Instead of staying in the trenches and fighting the insurance battle with them…”

    I am old enough to remember a time when you went to the doctor, paid their bill and submitted it to your insurance company for reimbursement. If the insurance company tried to screw you out of your payment, you took it up with them, or, to better effect, the HR department of your employer.

    I still, twenty years later, find it extremely puzzling that physicians somehow ended up in the middle of payment issues between their patients and the patients’ insurance companies. How did we, who went to school to learn how to take care of sick people, end up in a place where a lot of our work actually has to do with running interference between large corporations and their unhappy clients?

    • querywoman

      There was an even older time in which doctors didn’t collect money the day of the visit and routinely billed for their services. Of course. many patients ignored their bills!
      And an even older time in which patients paid with produce or whatever they had!

      • azmd

        Honestly, there are days when I think being paid in produce would be an improvement over the current situation.

        • querywoman

          AZMD, produce is direct pay! Insurance companies have always been chinchy A-holes!

        • WarmSocks

          I’d love to be able to pay my doctor with fresh vegies from my garden — or maybe a side of beef.

    • SBornfeld

      It’s a little bit like my auto body shop. I’m sure running a practice has always been a business. But the numbers are just out of hand–for everybody.
      We will always need our physicians. And physicians will always require protracted, expensive educations. They will always be valued to the societies in which they operate.
      In the mean time, if we forget this, we’ll get everything we deserve–and less.

    • querywoman

      Insurance increased the prices and makes the physician’s share a higher percentage. The ultimate goal for a lot of docs is being able to charge insurance type rates and not take insurance up front. Of course, a lot of cash only docs charge more than insurance rates.
      You don’t have to accept insurance and could charge lesser fees. The problem with that is the average American doctor has already been raped by another third party payment system, the student loan system, and has debts to repay.
      The third party payment systems have corrupted both education and health care incredibly. It’s indentured servitude.

      You could charge lower rates and go into an Income Based Repayment plan and have a smaller or even zero co-payment and still keep your medical license, without having to serve in some special program to earn student loan relief.. I’ve been puzzling about that more. I must examine the IBR program more to see if it would work for recent medical grads.

  • Dave

    Even before the days azmd mentions below, “doctor bill insurance” as it was called then was not a prerequisite for care. I know people from my parents and grandparents’ generations who paid out of pocket for cancer treatment, from start to finish, without any insurance. They were not rich, just lower-middle class mill-worker types, but somehow they could do it. I can’t imagine something like that today, even if someone saved every spare penny they earned in an HSA.
    I know there are countless reasons for the evolution since then, but I’m hopeful that more physicians doing what you’re doing will work to bring those days back in some form. It won’t fix everything, and might make things temporarily worse as more physicians prune their practices, but in the end it may just help reorient things.
    I wish you the best of luck with your new direction. You didn’t spend a decade in training to become an insurance adjuster.

  • Suzi Q 38

    My dentist will not accept my insurance, so I pay him upfront, then bill the insurance on my own.

    How much is your yearly fee for outpatients?

  • HJ

    Practices that charge a fee are for those sick enough to make the extra money put into healthcare worthwhile. Not only do you abandon those who are sick and unable to pay, you abandon those who are healthy or those not sick enough to need cell phone access.

    • Daniel

      For some people, paying the physician directly would actually result in cost savings. It depends a lot on how the practice is structured and how high the fees are. If the physician gets paid more, the patient pays less, and the patient gets better overall care… it’s win-win-win all around (except, perhaps, for the insurance execs).

  • Daniel

    I’m generally healthy. I have health insurance, just in case something major happens, but it often makes no sense. Even when I did have something major happen, I still had to pay a significant amount out of pocket, and the amount the insurance company paid didn’t come close to what they’ve collected from me over the years. I spend thousands of dollars on insurance, not to pay for my own medical care, but someone elses.

    If enough doctors reject the current system, maybe insurance companies will be forced to change. But will it be for the better?

  • dontdoitagain

    My primary care doctor has a fee for unlimited office visits. It’s $900 a year for a family. $350 for a single person. I rarely go to the doctor more than once every 2 years as a condition of employment, but still this is such a bargain! Compared to the THOUSANDS my employer spends for somebody who seldom goes to the doctor, it’s wonderful. I’m happy that he has this option. While it doesn’t cover outside things like lab tests or hopitalization, it’s perfect for people like me who only have insurance for the part of the year we are employed. (construction)
    The deductable on my health care plan is $2500 for the family per year. With my doctors plan I don’t have to worry about that unless I have a catastrophe. This, I think, is the wave of the future.

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