Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Why patients should pay doctors directly

Stephen C. Schimpff, MD
Policy
November 25, 2012
677 Shares
Share
Tweet
Share

There are distinct advantages for the patient who pays the primary care physician (PCP) directly: higher quality, lower cost and greater satisfaction.

The fundamental problem in health care delivery today is a payment system that is highly dysfunctional leading to higher costs, lesser quality and reduced satisfaction. The core problem? The patient is no one’s customer. With employer-based insurance, the physician’s customer is the insurance company that sets the rates, defines the rules and accepts or denies the bill. And the insurer’s customer is the employer. This is much different in concept and function than the professional-client relationship with your lawyer or tax accountant. Those relationships are direct; you establish your requirements, negotiate the fee or choose a different provider. In medical care, the patient has no standing in the financial arrangement whether employer-based insurance or Medicare or Medicaid.

Add to this the non-sustainable business model PCPs find themselves in today. Insurers have kept reimbursements flat for a decade or more. Meanwhile office costs have risen. With more expenses and static revenue, the PCP tries to “make it up in volume” by seeing more patients for shorter visits. Twelve to 15 minutes may be fine for a quick blood pressure medication check or a sore throat but it is not enough for good preventive care. Nor is it adequate for the patient who has a complex chronic illness (e.g., diabetes, heart failure or cancer), which consumes 70-85% of insurance claims paid. This patient will need a multi-disciplinary team of providers to render all the care needed. But the team needs a quarterback and if care is not well coordinated by the PCP, the number of specialist visits will skyrocket, as will tests, procedures and expensive prescriptions.

How will primary care be paid for if not by the insurer? By the patient paying directly.

When it is his money, he commands more physician time, the time needed to do careful assessments, to call a needed specialist and describe the rationale for the referral and to request a prompt appointment. When it is the patient’s money, he will begin to challenge the doctor – “Do I really need to take that test, visit that specialist or take that prescription?”  “Will the result of that test alter my care or is it just to ‘be complete’”? Questions like these lead to better care and lower costs.

With a direct payment arrangement with the physician, patients can buy a high deductible policy with its lower premiums for the unexpected expensive needs. The patient and physician now have a direct professional business relationship. And the patient begins to take a much more active role in the entire care process.

Direct payment saves the doctor time and money (estimated to be about $58 per visit) by not having to do the billing functions. This savings alone could allow for more time with the patient at the same level of reimbursement as what insurance pays today.

Some employers make high deductible options available; this should be the standard, with savings going to a health savings account (HSA) to use toward paying for primary care. Medicare does not have a high deductible option, although it should. The Affordable Care Act allows for high deductibles in the insurance exchanges but not for Medicare where there are also no HSA options. High deductibles would be a useful accommodation and help bring down – today – the spiraling costs of Medicare.

The ACA also mandates that approved preventive care, including screenings, be offered with no deductibles or co-pays by both commercial and government sponsored insurance. Why not let the individual choose to either pay for preventive care directly or have free preventive care with correspondingly higher premiums.

Absent change in the insurance model, PCPs are taking steps on their own to change their business parameters. Large numbers are simply closing their practice and being employed by the local hospital. Others refuse insurance, expecting only direct payment. Other PCPs are switching to a retainer-based practice where they charge $1,500-$2,000 per year. They agree to reduce the number of patients followed from 1,500-2,000+ down to about 500. This allows for the time PCPs need to give comprehensive preventive care plus orchestrate the multi-disciplinary team care for patients with complex chronic illnesses.

There is a strong need now to change the professional relationship so that the patient has reason (dollars) to take control of their doctor-patient relationship. Direct payment for primary care services creates the appropriate professional-client relationship that leads the PCP to deliver quality and service while investing the patient in the responsibility of taking ownership of his own health and wellness. These are changes in the delivery system that need to occur and the sooner the better.

This post appeared as an Op Ed in the Washington Times, October 17, 2012.

Stephen C. Schimpff is an internist, professor of medicine and public policy, former CEO of the University of Maryland Medical Center and is chair of the advisory committee for Sanovas, Inc. and the author of The Future of Medicine – Megatrends in Healthcare and The Future of Health Care Delivery- Why It Must Change and How It Will Affect You.

Prev

A doctor reflects on the cusp of retirement

November 25, 2012 Kevin 4
…
Next

Does the use of digital medicine preclude human connection?

November 26, 2012 Kevin 3
…

Tagged as: Primary Care, Public Health & Policy

Post navigation

< Previous Post
A doctor reflects on the cusp of retirement
Next Post >
Does the use of digital medicine preclude human connection?

More by Stephen C. Schimpff, MD

  • Beyond the EpiPen: Irrational drug prices are now pervasive

    Stephen C. Schimpff, MD
  • We are all aging every day. But mostly we ignore, do not recognize, or deny it.

    Stephen C. Schimpff, MD
  • Take a pill and stop aging. Really?

    Stephen C. Schimpff, MD

More in Policy

  • Why the WHO’s pandemic accord is critical for global health care

    Elizabeth Métraux
  • The revolutionary Kaiser-Geisinger deal: How health care giants are reshaping the industry and empowering patients

    Robert Pearl, MD
  • Unveiling the intricate link between housing costs and health care

    Harvey Castro, MD, MBA
  • Uncovering the truth about racial health inequities in America: a book review

    John Paul Mikhaiel, MD
  • Why affirmative action is crucial for health equity and social justice in medicine

    Katrina Gipson, MD, MPH
  • The untold story of Hispanic/Latino health: Why subgroup data matters

    Matthew B. Alonso
  • Most Popular

  • Past Week

    • Physician entrepreneurs offer hope for burned out doctors

      Cindy Rubin, MD | Physician
    • Why doctors aren’t to blame for the U.S. opioid crisis [PODCAST]

      The Podcast by KevinMD | Podcast
    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Unlocking the secrets of cancer conferences: an end-of-life counselor’s journey among pharmaceutical giants

      Althea Halchuck, EJD | Conditions
    • We need a new Hippocratic Oath that puts patient autonomy first

      Jeffrey A. Singer, MD | Physician
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
  • Recent Posts

    • The tragic story of Mr. G: a painful journey towards understanding suicide

      William Lynes, MD | Physician
    • Healing trauma and reconnecting: Unmasking the impact of dissociation [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why the WHO’s pandemic accord is critical for global health care

      Elizabeth Métraux | Policy
    • The revolutionary Kaiser-Geisinger deal: How health care giants are reshaping the industry and empowering patients

      Robert Pearl, MD | Policy
    • The escalating violence in health care workplaces: a critical problem facing the nation’s health care system

      Harry Severance, MD | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 39 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Could Semaglutide Help Curb Addictive Behaviors?
  • 'If the Narcan Isn't Working, Give More' and Other Myths About Naloxone Use
  • CDC: Children's Brain Infections Rose Last Winter, But Remained Rare
  • Inside the Fight Against Burnout Amid the Chaos of War in Ukraine
  • Cardiovascular Risk Models Still Fall Short for Arthritis Patients

Meeting Coverage

  • Cardiovascular Risk Models Still Fall Short for Arthritis Patients
  • De-Escalated Surgery Suffices for Low-Risk Cervical Cancer
  • More Evidence Backs Gout Benefit for Gliflozin Agents
  • Reaction to FDA's Approval of Upadacitinib for Crohn's Disease
  • CDK4/6 Extends Reach Into Early-Stage Breast Cancer
  • Most Popular

  • Past Week

    • Physician entrepreneurs offer hope for burned out doctors

      Cindy Rubin, MD | Physician
    • Why doctors aren’t to blame for the U.S. opioid crisis [PODCAST]

      The Podcast by KevinMD | Podcast
    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Unlocking the secrets of cancer conferences: an end-of-life counselor’s journey among pharmaceutical giants

      Althea Halchuck, EJD | Conditions
    • We need a new Hippocratic Oath that puts patient autonomy first

      Jeffrey A. Singer, MD | Physician
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
  • Recent Posts

    • The tragic story of Mr. G: a painful journey towards understanding suicide

      William Lynes, MD | Physician
    • Healing trauma and reconnecting: Unmasking the impact of dissociation [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why the WHO’s pandemic accord is critical for global health care

      Elizabeth Métraux | Policy
    • The revolutionary Kaiser-Geisinger deal: How health care giants are reshaping the industry and empowering patients

      Robert Pearl, MD | Policy
    • The escalating violence in health care workplaces: a critical problem facing the nation’s health care system

      Harry Severance, MD | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Why patients should pay doctors directly
39 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...