Doctors explore payment options

By Laren Hughes Hall
Staff Writer

The days of co-pays and deductibles could be coming to an end as more doctors rebel against insurance companies that refuse to pay a fair amount for their services.

While reimbursements decrease and overhead costs rise, some physicians are finding it difficult to break even, said Catherine Smoot, a Salisbury ophthalmologist and delegate to the American Medical Association. In response, many have begun to explore their options.

“People say a medical crisis is looming, but we’re in it and all patients are being affected,” Smoot said. “The bottom line is that (physicians) aren’t going to participate with these insurers cutting back what they are willing to pay for services.”

Ocean City physician William Greer decided six months ago to try something new — an innovative treatment method known as membership medicine. For an annual fee, patients get personalized care and 24-7 access to a doctor. His practice is the first of its kind on the Shore and in the rural United States.

“Patients are giving money to insurance companies that don’t want to give it up. I think it’s insane for an insurance agency to tell the patients and I what we should be doing,” said Greer, noting that he and his colleagues on the Shore are the lowest paid physicians in the country. “I don’t want to practice the way insurers are dictating to us.”

The majority of medical professionals aren’t ready to follow in Greer’s footsteps, but are making strides to increase profits. Some doctors no longer accept insurance, requiring payment in-full when services are rendered and others place the burden on the patient to recover money from their insurance company.

Those who do accept insurance are oftentimes forced to accept more daily appointments, creating longer waits and less time with the doctor, Greer said.

“Everyone in health care is working at break-neck speed and I don’t think that’s wise,” he said. “This is not an assembly-line type job.”

As operating costs increase and profits fall, Smoot predicts more medical professionals will search for alternative ways to conduct their business.

“Whether it be membership medicine or forming large practices, (doctors) can’t continue to survive and thrive in this environment,” she said.
‘What price is your life?’

Membership medicine, also known as boutique service, is relatively new, but as more doctors embrace the notion and other options arise, Smoot said people will be forced to make specific choices about their healthcare.

“I hear patients time and time again getting more frustrated about waits in the office and this may provide them with an opportunity for a different type of practice,” she said. “It’s just like people who would rather shop at Nordstrom’s and pay for extra service rather than buy their clothes at Wal-Mart.”

At 72-years-old, Craig Oliver has dealt with his fair share of medical problems. He’s had heart trouble, his knee has been replaced and he’s suffered from shortness of breath due to blood clots in his lungs.

Because of his medical history, he’s willing to pay extra money for immediate care.

“When you have critical health issues, you need medical help and you need it now,” said Oliver, who pays a $1,200 annual fee plus the cost of office visits to be a member of Greer’s office. “You ask what price is medicine, but what price is your life?”

After four years of providing care to about 2,500 patients and battling with Medicare for higher reimbursements, Greer found himself overworked, stressed and constantly worried about his finances.

“I got so frustrated with the process and after 18 to 20 years nothing changed for the positive and I knew I had to do something else,” said Greer, who decided to explore membership medicine last year. “The only way I see to make a family practice work in our environment is to see 35 to 40 patients per day. I shouldn’t have to become a volume physician if that’s not how I want to practice.”

Six months after altering his practice, Greer now has about 440 patients and his profits have increased dramatically.

His time with patients is not limited, everyone understands their diagnosis before they leave and Greer can always be contacted — even when his office is closed.

“Most people think this is about rich people, but that’s not the case,” he said. “The people who want my practice are either really sick or they don’t want to be waiting around.”
‘It’s hard on most people’

Family physicians aren’t the only medical professionals changing the way their patients pay for treatment.

For about 10 years, Joseph Gore’s dentist office in Salisbury has required patients to pay for treatment at the time of their appointment, Dental Assistant Susan Bradford said. It is then up to the patient to seek reimbursement from their insurer.

Prior to that, the dentist waited for reimbursements from the patient’s insurance company. But when checks weren’t cut in a timely fashion, Bradford said the doctor altered his payment process.

And Gore’s not alone, she said. Many in the dental industry are now accepting compensation for their services up-front.

“I don’t see any dentists who wait for insurance anymore or who don’t accept payments from patients,” she said. “Most practices do it our way.”

To patients like Wanda Morgan, the thought of having to pay out-of-pocket for medical expenses is scary.

“It’s hard on most people, especially older people who are on a fixed income,” the Salisbury resident said. “I mean, for some it comes down to whether they’re going to eat this week or pay for a doctor.”

That’s why Bradford said she doesn’t think health insurance will ever become obsolete.

“I don’t see how it could,” she said. “Where would people go? They rely on insurance.”

And while Greer admits he saw declining profits before he embraced membership medicine, he doesn’t believe his new practice is the answer for everyone.

He hopes medical professionals will continue to explore their options, creating more payment options for those in need of care, he said.

“Everyone wants to come up with a national heath care system that fits everyone, but that’s not possible. We need basic health care provided by the government and a whole bunch of different choices,” he said. “I don’t think there is a single solution for 300 million Americans.”
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