Archives

Priced Out of Health Insurance, Americans Rig Their Own Safety Nets

safetynet

When their son Sky was born four years ago, Lindsie and Chris Bergevin were hit with a big surprise: $7,000 in bills for the birth that their health plan didn’t cover. Sky was two when the couple jettisoned their medical insurance, which helped them eventually pay off the debt.

Now that they’re ready to have a second child, they’re not going back to their old coverage, with its premiums of more than $350 a month. Instead, they’ve patched together an alternative through a religious group and a primary-care doctor whom they can visit anytime for a monthly fee.

“I was so jaded with the whole health-care insurance situation,” Lindsie, 35, says. “I just didn’t want to deal with it.”

The Bergevins, who rent a snug little house near downtown Boise, Idaho, are joining a small but growing number of Americans rigging their own medical safety nets. They’re frustrated by the high costs, opaque pricing, and maddening bureaucracy of health insurance.

In their quest for a different way, they’re meeting doctors like Julie Gunther who are also fed up. These physicians have opted to reject insurance, instead charging patients directly in return for more personalized care.

“I like to think we can protect people in vulnerable moments where they’re going to get lost like a widget,” Gunther said, “because they’re not a widget for us.”

CONTINUE READING

Epiphany is providing health care for patients who can’t afford Obamacare

35p2

“Epiphany is a strange name for a medical company, but my partner, Dr. Bill Crouch, and I had an epiphany,” said Dr. Lee Gross, co-founder of Epiphany Health, 2975 Bobcat Village Center Road, North Port (EpiphanyHealth.org).

In 2010, they began riding the wave of a concept in health care that was just starting to swell. As a result, their small practice sees patients from all over the state — Lakeland, Orlando, Miami-Dade, Coco Beach. They drive across the state, Dr. Gross said, because they can afford what we’re doing here.

So what is it that makes Epiphany so different?

The two physicians had been in practice since 2002.

“We were in the rat race of independent practice primary care, where you’re trying to funnel the patients through as fast as possible, keeping office visits to seven minutes, fighting with insurance companies to get procedures and medications approved. It ended up feeling like we were treating the chart and the computer and the insurance company but not providing good medical care. We decided there had to be a better way to do this.”

Read the full article at the Charlotte Florida Weekly.

CONTINUE READING

The doctor is out? Why physicians are leaving their practices to pursue other careers

giatroi

This “bottleneck effect” doesn’t usually sour grads on staying the course, Fowler finds, but he does see plenty of doctors in the later stages of their careers hang up their stethoscopes earlier than expected. Some cite electronic health records (EHRs) as part of the reason — especially old school doctors who don’t pride themselves on their computer skills. New research by Stanford Medicine, conducted by The Harris Poll, found that 59 percent think EHRs “need a complete overhaul;” while 40 percent see “more challenges with EHRs than benefits.”

And then there are those doctors who left medicine because the cons of the job started to far outweigh the pros.

“I began to feel like an easily replaceable cog in the health care machine. With the [enforcement] of EHRs, I had to spend more time as a scribe. One night a child I was treating had a seizure and I couldn’t get the medicine to enable them to breathe because their chart wasn’t in the system yet. This kid was fixing to die and I, the doctor, couldn’t get the medicine. It was demoralizing.”

Baxter left pediatric emergency medicine to head a company that develops physiological products for personal pain management.

Read the full article at NBC.

CONTINUE READING

My wife’s story: Anatomy of an insane health care billing system

healthcare_000015121314

By Carl C. Schuessler

Recently, my wife went to the doctor with stomach issues.  The doctor recommended a simple diagnostic test called a HIDA scan.  We have an HSA high-deductible health insurance plan with a $6,450 deductible, meaning we would be paying for the procedure out-of-pocket until our deductible was met.

Before my wife left the doctor’s office, she asked the receptionist what she thought was a simple question: “How much is this going to cost?”

The receptionist had no idea — and she had no way to check.  She looked at my wife like it was an unreasonable question.  A manager contacted a third-party billing agency to get her a quote, which ended up being nothing close to what we actually paid in the end.

Economic models assume participants have perfect information.  In reality, they often have no information whatsoever.

Read the full article at Benefits Pro.

CONTINUE READING

This surgeon wants to offer cheap MRIs. A state law is getting in his way.

Dr-Gajendra-Singh-IJ2_9149

Dr. Gajendra Singh walked out of his local hospital’s outpatient department last year, having been told an ultrasound for some vague abdominal pain he was feeling would cost $1,200 or so, and decided enough was enough. If he was balking at the price of a routine medical scan, what must people who weren’t well-paid medical professionals be thinking?

The India-born surgeon decided he would open his own imaging center in Winston-Salem, North Carolina, and charge a lot less. Singh launched his business in August and decided to post his prices, as low as $500 for an MRI, on a banner outside the office building and on his website.

There was just one barrier to fully realizing his vision: a North Carolina law that he and his lawyers argue essentially gives hospitals a monopoly over MRI scans and other services.

Singh ran into the state’s “certificate of need” law, which prohibited him from buying a permanent MRI machine, which meant his office couldn’t always offer patients one of the most important imaging services in medicine. He has resorted to renting a mobile MRI machine a couple of days a week. But it will cost him a lot more over time than a permanent machine would, and five days a week, his office can’t perform MRIs.

Now Singh has had enough. He filed a lawsuit Monday in North Carolina Superior Court to overturn the state law, news that he and his attorneys from the Institute for Justice shared exclusively with Vox.

Singh specializes in complex liver transplants and surgeries to treat gastrointestinal cancers. He appreciates the importance of a good MRI. “Those patients need imaging. As a surgeon, we need to see what we’re going to do. We often need a lot of imaging,” he told me in a phone interview.

As Vox’s Sarah Kliff reported as part of her project to collect emergency room bills, Americans can sometimes be charged as much as $24,000 if they get an MRI at a hospital’s ER. Singh is offering a substantial discount on a medical service plagued by high costs.

But because his office can only offer MRIs twice a week, they must regularly turn away patients who need them — some of whom shouldn’t wait to get important medical scans.

“We lose all those patients,” said Singh, who also owns his own surgery practice.

Certificate-of-need laws were in vogue 40 years ago. But lawmakers quickly discovered that, in practice, they often served to protect hospitals from the competition. Forty-nine states had such a statute at one time, but in the decades since, 14 states have repealed theirs.

Read the full article at Vox.

CONTINUE READING

Is This What All Hospitals Think of Primary Care Docs?

DiTLFV9U0AAUWYg

Becker’s Healthcare spoke with Cathy Jacobson, president and CEO of Milwaukee-based Froedtert Health, prior to speaking on a panel at Becker’s Hospital Review 7th Annual CEO + CFO Roundtable titled, “The Digital Imperative: The Open & Shut Case for Innovation”.  All this gobbledygook means she is a pretty big deal to other administrators.  I was tipped off by Shane Purcell MD about her thoughts on primary care physicians highlighted in the piece:

Q: What’s one conviction in healthcare that needs to be challenged?

CJ: That every patient needs a primary care physician.  As we start stratifying our patients into distinct populations based on their health needs and develop that insight further into consumer driven wants, we are finding that a substantial sector of the population does not want or need a primary care physician relationship.  People need primary care but not necessarily a physician relationship. We need to stop trying to fit patients into our health system-driven model and develop the means to serve their health needs on their terms.  If we don’t, someone else will.

How does that make you feel?  Pretty crappy, right?  I have known this for a long time.  Hospitals want patients to be linked to THEM and not you as a doctor.  You should have noticed their commercials over the years with hospitals saying “as your healthcare provider”, etc.  It is about wordplay and confusion to make patients feel that the hospital is the doctor and the doctor is the hospital.   We know that this isn’t true. If doctors and nurses left the system then they pretty much just have an empty building.

Read the full article at Authentic Medicine.

CONTINUE READING

Legislation Allowing Patients to Use HSAs for DPC at Risk

hsa4_thumb

From AAPS:

Earlier this week we heard the good news that H.R. 365 was finally going to be considered by the House Committee on Ways and Means, bringing the use of Health Savings Accounts (HSAs) for Direct Patient Care (DPC) one step closer to reality.

Then we learned “a few small changes” had been made to the bill. Unfortunately the “few small changes” have greatly damaged the legislation.

You can read a copy of the latest bill here: https://goo.gl/B6imgQ.

Under the new language, DPC practices would have to comply with several federal requirements in order to become HSA-eligible. One provision limits the care provided under the agreement to specific CPT codes.  Another would prohibit DPC arrangements priced over a certain threshold from being HSA-eligible. Others further limit how the pricing can be structured and what care can and cannot be included. Specialists would be blocked from offering innovative HSA-eligible monthly membership payment arrangements.

You can read a full summary of the legislations status at AAPS.

CONTINUE READING

A different type of family medicine

Female doctor comforting senior patient in hospital

A growing number of doctors across the country fed up with the costs of medical care are switching to a model that cuts health insurance out of the equation, and two of those doctors are located in Moscow.

The direct primary care model means the doctor does not participate in insurance plans, and the enrolled patient pays a periodic membership fee rather than paying for every visit. The patient does not have a co-pay, and the membership fee goes directly to the practice instead of a third party.

According to dpcfrontier.com, there are nearly 850 DPC practices in the U.S.

Dr. Emily Todd will open her direct primary care family medicine practice July 23 on 904 S. Jefferson St., with a grand opening on July 25.

Todd said she was inspired to start her own DPC clinic after attending a conference where many doctors discouraged by the standard insurance model spoke of the benefits of direct primary care. Todd said she shared their frustration.

She said the increased overhead costs associated with insurance forces doctors into seeing more patients in a shorter period of time. She anticipates the direct primary care model will change that.

“It lets us focus on more personalized care and longer visits,” she said.

Read the full article at the Daily News.

CONTINUE READING

Why self-insurance strategies are out of whack and other realities for advisers

CBO

ook, I get it. The benefits business has changed immensely in the past decade and advisers are perpetually under pressure to show value to their clients. Actively seeking cost reduction in employer healthcare spend is a natural place to focus, and a vital one. The rising tide of advisers tackling the high cost of healthcare is not just highly commendable, it’s necessary.

But…the way it’s happening is whacko.

Here is the basic strategy for what the more hyperbolic advisers are calling a “revolution” in advising: Convert employers to a self-insured model; attack costs on multiple fronts by designing plans that make it easier to address high-cost usage patterns; go hard after wasteful PBM and carrier/provider network arrangements; promote healthcare consumerism and old-is-new-again strategies like direct primary care, and continually monitor and audit claims data to see where next attack high costs and waste.

But this approach isn’t so much a revolution as the way our business should have worked all along. Unfortunately, wasteful practices have embedded themselves so thoroughly that our methods for backing ourselves out of them only make sense inside the reality that is the U.S. healthcare system.

Read the full article at Employee Benefit Advisor.

CONTINUE READING

Stop the IRS from Blocking Patients’ Use of Health Savings Accounts for Direct Primary Care, Doctors and Patients Tell Congress

hsa4_thumb

The Association of American Physicians and Surgeons (AAPS) sent a letter today, signed by 1,125 doctors and patients, to the Senate Finance and House Ways and Means Committees encouraging expeditious approval of H.R. 365 and S. 1358. These bills would allow patients to spend their own Health Savings Account dollars on Direct Primary Care arrangements. The IRS currently prohibits this use.

In the letter, AAPS Executive Director, Jane M. Orient, M.D. writes:

The whole purpose of HSAs was to expand patients’ freedom to choose how to spend their own money for medical care. More and more patients, including Medicare beneficiaries, are choosing DPC, which often includes primary-care services, basic diagnostic tests, and commonly used prescription drugs at a package price. They like the up-front, affordable price and the prompt access to a doctor they know and trust. Yet the current IRS interpretation of Internal Revenue Code will not allow patients with HSAs to use their own HSA funds for DPC agreements nor permit them to make tax-deductible contributions to their HSA if they have a periodic DPC arrangement.

DPC is lowering costs for both patients and taxpayers. Prescription drugs accounted for $110 billion in Medicare spending in 2015, 17% of all Medicare spending. With DPC dispensing, the cost of pharmaceuticals can be as much as 15 times lower than pharmacy prices. And $17 billion was spent on potentially avoidable hospital readmissions. DPC patients have fewer hospital admissions because of prompt, consistent, personalized care of chronic conditions, and fewer expensive emergency department visits because of 24-hour access to a physician who knows them.

It is improper for the IRS to be picking winners and losers in medical financing and care arrangements. It is counterproductive for a tax collection entity to discourage arrangements that save federal dollars while improving medical care.

DPC also addresses the shortage of primary-care physicians by retaining physicians who would otherwise leave primary care practice or the profession altogether owing to “burn-out” from inability to serve their patients well under other practice models.

Please expedite consideration of S. 1358 / H.R. 365 and, if it cannot advance as a stand-alone measure, look for opportunities to include the language in other upcoming budget bills.

The full letter and list of signers can be viewed at: http:aapsonline.org/dpchsa. AAPS is also welcoming supporters who haven’t yet signed to add their names.

The Association of American Physicians and Surgeons (AAPS) is a national organization representing physicians in virtually all specialties and every state. Founded in 1943, AAPS has the motto “omnia pro aegroto,” which means “all for the patient.”

SOURCE Association of American Physicians and Surgeons (AAPS)

CONTINUE READING