Eric Hartley: Doc opts out of system


Dr. Laurie Poss has a message for the health insurance industry: “We don’t want to play anymore.”

For years, Dr. Poss has been feeling more like a factory worker than a family doctor. With insurance reimbursement averaging $23 a patient, her practice has become an assembly line.

She has to see six patients an hour, sometimes seven, at her Crofton office to make a living and pay five staffers and two physician assistants.

It became so unfulfilling and grinding there were days she said she went home crying.

“What I went into medicine for is no longer there,” she said last week.

About five years ago, Dr. Poss, who’s practiced in Anne Arundel County since 1986, started to seriously consider leaving medicine.

Instead, as of Jan. 31, she’s starting a so-called “concierge service,” meaning patients will pay an annual fee for highly personalized care, including unlimited office visits and access to the doctor any time by phone and e-mail.

Best of all, as far as she’s concerned, she’s saying goodbye to the insurance companies that tell her how to treat her patients.

She joins a small but growing number of doctors in “concierge” or “boutique” medicine. MDVIP, a Florida company that helps similar practices start up, lists 25 Maryland doctors on its Web site, none of which are in Anne Arundel.

According to published reports, officials at the Maryland Insurance Administration, who did not return my call, are investigating whether some “concierge” practices constitute a form of insurance and thus are subject to regulation. And some fear that the spread of concierge practices would mean fewer options for patients unable to afford them.

Dr. Poss said the attorney she consulted to make sure her practice was legal warned her “You’re under a microscope.”

As we spoke in Dr. Poss’ new office on Admiral Cochrane Drive outside Annapolis, I asked her about the irony of a liberal like her – someone who used to take pride in seeing medical assistance patients because many other doctors refused – starting a seemingly exclusive boutique practice.

Dr. Poss said a practice like hers is only expensive in the short term. About 400 people have signed up so far, and not all of them are wealthy. The practice will be limited to 750 patients, compared with more than 10,000 on the rolls in her current one. (Yes, ten thousand, though many don’t come for years at a time if they’re not sick, a phenomenon Dr. Poss calls “boomer medicine.”)

Martin Keithline of Davidsonville, a longtime patient of Dr. Poss’ who also works part time in her office, said the new practice will enable him to pare back his insurance to a plan that covers catastrophic care. He thinks it could actually save him money.

In addition to providing better care, Dr. Poss is returning to allowing patients to take control of – and responsibility for – their health care. In the short term, that might mean they spend more money. But in the long term, it’s probably a good thing for our health and pocketbooks.

Our current national approach to insurance defines the phrase “penny wise, pound foolish.” We spend more than anyone on health care – as a percentage of our economy, nearly twice what nations like Germany, Canada and France do – but still can’t find a way to insure everyone.

We think nationalized “single-payer” medicine, which Dr. Poss supports, would be too expensive. But, in fact, we already have a super-expensive version of it: People without insurance use the emergency room as their primary care physician, ultimately costing all of us more.

The rest of us, who have insurance, are still removed from responsibility for the actual cost of our health care.

Decades ago, people paid whatever doctor they wanted to go to and got reimbursed if they had insurance. Managed care changed all that, limiting choice. And now, some don’t even want to pay their $20 co-pay, Dr. Poss said. They complain, “I pay enough for my insurance.”

In the current system, the financial incentives are out of whack. Imagine, Dr. Poss said, if you could go to a grocery store and throw $100 worth of food in your cart, but pay only $20 because you and your employer kicked in some money to the grocery stores every month.

Would you be likely to shop carefully? What do you think would happen to food prices?

Dr. Poss, who’s in her 50s and lives near Crownsville, grew up on Long Island, N.Y., then went to Yale University and medical school at the University of Pennsylvania. She practiced emergency medicine at Johns Hopkins Hospital and the University of Maryland’s Shock Trauma Center before going into family medicine.

Dr. Poss, who wears her blonde hair pulled back, has a throaty laugh along with her New York accent. She doesn’t look like a doctor: When we met, she wore bright colors and a South American shawl called a ruana draped over her shoulders.

She ditched the white coat years ago, believing it makes people nervous. And yes, she’s used to being greeted with: “You’re the doctor?”

Each patient who signs up for the new practice, called “My Doctor Cares,” will be given an initial health survey and evaluation, a complete physical and a summary of what they need to do to get healthier.

“The health care system has for so long been geared toward sickness,” Dr. Poss said. “I’ve been trying to get my patients into a wellness mode.”

Later, she said: “I think every doctor wants to practice like I’m structuring this practice. That’s why we went into medicine.”

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