For More Quality Time With Patients, Some Physicians Fire Insurance Companies
A type of old-fashioned medical practice is making a comeback in some corners: While most physicians contract with one or more insurance companies, some are no longer accepting health insurance at all. They want to increase their quality time with each patient, reduce hassles, and return to their passion – healing people.
In medicine’s past, the physician – little black bag in hand – had more time with each patient to listen to his or her concerns and develop a treatment plan for care together. With no insurance copays or deductibles, the patient paid for his or her care, sometimes even in chickens or other livestock.
Then came “managed care,” HMOs, copays, deductibles, preauthorizations, billing hassles, and more. In the opinion of many physicians and patients, the health insurance model of care greatly interfered with the patient-physician relationship. Doctors and patients no longer had control of the health care decision-making process. Instead, a third party, the insurer, influenced it. “Over the years, the [health insurance companies] have certainly interfered with the patient-physician relationship,” says TMA President Josie R. Williams, MD. “They have become the unseen but ever-present censor of what the doctor orders.”
The new deluge of paperwork forced physicians to hire more office staff to keep up. “When I started filing managed care claims in the early 1990s, I had to add two full-time employees just to handle the added paperwork,” says Austin family physician William E. Jones, MD. Twenty years ago, an average physician employed at most, two office staff. Today, a physician employs on average four to six office staff. That is one reason why today 62 percent or more of a physician’s revenue goes to operating costs.
“The patients, doctors, and patient care seem to take second fiddle to [insurer’s] profits, insurance codes, preapprovals, business plans, and the like, all controlled by business types in suits who have never directly helped a sick person in their life,” says Tomball emergency medicine specialist David Gerber, MD. “The first questions patients are asked when they see a doctor is ‘What kind of insurance do you have?’ not ‘What is bothering you?’ ” He feels physicians are forced to ask that up front.
“The insurance system that pays physicians is a volume-driven system that doesn’t allow for the extra time you need to spend with some patients,” explains Austin family physician Sidney T. Robin, MD. Dr. Jones says he “had to see a lot more patients every month just to cover the additional staff’s salaries and benefits.”
“Enough,” say some physicians, and are opting to pare back to the old ways. They no longer sign contracts, enroll in a private health insurer’s network, or accept any insurance at all. Instead, a patient who wants to visit them pays a fee directly to the physician for whatever care they receive. “It’s a step forward to the past,” said Dr. Gerber. “I’m just like an old country doctor: Hang out a shingle, take care of patients, and charge a fair price.” He believes now he is freer to concentrate on his patients.
“To me, it’s old-fashioned medicine,” agrees a patient of Dr. Robin. In 2000, Dr. Robin also began to eliminate insurance from his practice. Eventually, he adopted an annual-fee model, a “membership-based” practice. (Some refer to them as “concierge” or “boutique” medicine practices.) In that model, the patient gains year-long access to his or her physician’s care by paying a yearly fee. Patients have 24-hour-a-day access to the doctors, same-day appointments, no-waiting office visits, as much time with the physician as the patient needs, and in some cases, the physician’s cell phone number. Dr. Jones eventually restructured his medical practice this way.
A 2005 U.S. Government Accounting Office study reported a small number of physicians, located primarily on the East and West coasts of the United States, practicing under the annual-fee model. A majority of the 112 survey respondents were primary care physicians. Many physicians believe practicing without enrolling in insurance networks is risky, though they certainly feel the pinch of “managed care.” So while not all physicians want to choose this practice model, some find it the best route back to good old-fashioned doctoring. And for these doctors, it does not matter if the patient is uninsured, as are one-quarter of Texans. Physicians are free to provide charity care or see patients for substantially lower fees as easily as they always have.
“Medicine is supposed to be about love and nurturing, and about having fun with our patients, maybe even a hug once in while,” Dr. Jones explains. “It is not supposed to be about how to operate a faster conveyor belt.”
TMA is the largest state medical society in the nation, representing more than 43,000 physician and medical student members. It is located in Austin and has 120 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.