Physicians Revolution

IN THIS ISSUE:


Joint Economic Committee of Congress Holds Hearing on “Consumer-Directed Doctoring”

? Opening Statement by Chairman Robert Bennett (R-UT)

? Testimony of Dr. Robert Berry

? Testimony of Dr. Alieta Eck

? Testimony of Dr. Bernard Kaminetsky

? Testimony of Dr. Robert Berenson

“Medical Economics” Features Cash-Only Practices

HSAs Stimulate Cash-Only Practices

Joint Economic Committee of Congress Holds Hearing on “Consumer-Directed Doctoring”


The Joint Economic Committee of Congress held a hearing today on “Consumer-Directed Doctoring: The Doctor is in, Even if Insurance is Out.” Witnesses included Robert S. Berry, MD of the PATMOS EmergiClinic in Greeneville, TN, Alieta Eck, MD of the Zarephath Health Center in Zarephath, NJ, Bernard Kaminetsky, MD, FACP of MDVIP in Boca Raton, FL, and Robert Berenson, MD of the Urban Institute in Washington, DC. Chaired by Sen. Robert Bennett (R-UT), the Committee has been holding a series of hearings on cutting edge developments in health care, especially on how consumer choice in health care is revolutionizing American medicine.

Opening Statement by Chairman Robert Bennett (R-UT)


Senator Bennett began the hearing by pointing out that “many doctors are frustrated by the state of our current health care system,” especially “third-party entities interfering in their practice, pushing them toward a system that focuses on arcane regulations, not on patient care.” He said, “Today’s hearing will examine the experiences of innovative and entrepreneurial doctors who are responding to gaps in the current system by returning to an older style of medical practice?.” He added that “early evidence of consumer-directed doctoring suggests that some physicians and patients are reacting favorably to this [new] way of providing care.”

Testimony of Dr. Robert Berry


Dr. Berry testified that his clinic centers on “the unique needs of the uninsured [who are] the most cost effective healthcare consumers.” He used to be an Emergency Room physician and found that many of his patients who came in for routine services are “neither destitute nor derelict.” Rather, they are hard working people who pay their bills and resent how they are treated in government clinics. He posts his prices in the clinic and in advertising — $25 to treat poison ivy, $35 for a sore throat, $95 for a simple laceration. He said, “The only way that I can keep my prices so low is by avoiding the crushing overhead and hassles that other physicians allow third-party payers to impose on their practices.” He currently has nearly 5,000 patient charts, of which 51% are uninsured, 38% commercially insured, 8% on Medicaid, and 3% on Medicare. His break-even point would be 1.2 patients per hour, he is currently seeing 3 per hour, and would have an income 50% greater than when he was working in the ER by seeing 4 patients per hour. Dr. Berry says he is not alone in what he is doing and cites many other physicians across the country who are taking similar paths.

Testimony of Dr. Alieta Eck


Dr. Eck testified that in her state of New Jersey it is virtually impossible to buy health insurance unless your employer provides it for you. Due to misguided state regulations, the premium for even modest coverage for a single person ($1,000 deductible and 70/30 coinsurance) ranges from $912 to $4,419 per month. The number of people in New Jersey with individual insurance has plunged from 220,000 in 1996 to 90,000 today. In this environment, there are plenty of people who can afford to pay for services, but cannot afford health insurance. Her four-doctor practice takes no insurance but Medicare, and it employs only one full-time employee plus a bookkeeper and six part-time nurses and receptionists, quite a contrast from the 5 full-time employees per doctor that prevails across the country. Her testimony cites many examples of patients who have benefited from the services she provides.





Testimony of Dr. Bernard Kaminetsky


Dr. Kaminetsky said he joined MDVIP “in order to provide my patients with comprehensive preventive care services that unfortunately can no longer be offered in a traditional primary care setting.” He said when managed care came along it distorted medical practice by paying so little that physicians had to rush patients through the visit, precluding the time it takes to take a preventive approach to their medical needs. He pointed out that in a typical managed care practice with 2,500 patients, one would have to work 50 hours a week for 50 weeks to provide each one with a comprehensive hour-long physical exam – leaving no time at all for acute care needs. He joined MDVIP to get his case-load down to 600 patients, and serve each one well.

Testimony of Dr. Robert Berenson


Dr. Berenson provided the only sour note, arguing that these practices hinder cost containment efforts and “exacerbate current problems with access to services for the uninsured and underinsured.” He acknowledged the frustrations physicians face but believes these frustrations “represent symptoms of a system lacking universal, comprehensive health care insurance.” He concluded that “at its best, providing substantial health care services for much of the population outside of insurance is an elitist notion.”


The discussion after the testimony was largely friendly and productive, with even Congressman Pete Stark (D-CA) agreeing that there is merit to the approaches described by Drs. Berry, Eck, and Kaminetsky. His one concern was whether people will be able to effectively shop for medical services the way they can shop for other services. But the witnesses did a lot to reassure him on that point.


SOURCE: You may link to these and the rest of the testimonies at Galen’s web site: http://www.galen.org/ownins.asp?docID=633

“Medical Economics” Features Cash-Only Practices


The magazine “Medical Economics” picks up on this trend in an article headlined, “No Coding, No Insurers – No Kidding.” Senior Editor Robert Lowes says, “It might be time to consider a cash-only practice. Your income may drop, but your overhead will decrease and your job satisfaction could soar.” The Nirvana is described as “No more arguing with insurance clerks about denied claims. No more fears of a Medicare audit.” It cites Dr. Rick Baxley of Orlando who dropped all insurance contracts in 2000 and reports, “I earn roughly what I did back then, but I’m not working from 6 a.m. to 9 p.m. anymore. And I’m building relationships with patients, which is why I entered medicine in the first place.” Bethesda, Maryland internists Jane Chretien and Audrey Corson say they “have extended the length of the average visit from 8 minutes to about 25 minutes.” They maintain, “When visits are longer, you get to know your patients? You can put their complaints in a bigger context.” Dr. Vern Cherewatenko is cited as saying that “a cash-only soloist probably can operate with just a receptionist and a medical assistant.” The article provides some advice for physicians thinking about moving in this direction – cut ties with insurance companies gradually, starting with the worst payers; drop Medicare last, especially if you have a large number of patients on Medicare; “be prepared to scramble initially to make ends meet.”

SOURCE: http://www.memag.com/

HSAs Stimulate Cash-Only Practices


The advent of Health Savings Accounts is likely to stimulate this trend. An article in the “Indianapolis Star” reports, “When Karen and Roger Montembeault and their sons visit the doctor or buy a prescription drug, they pay the bill in full. No co-pays for them. And it’s not for lack of health insurance.” The family has just bought an HSA after having an MSA for four years, according to the article by Jeff Swiatek. He writes, “People with HSAs also have less reason to fight their insurance company over getting tests or other care because the insurer doesn’t bear the cost of the care, and least not until it exceeds the high deductible?” Dennis Casey, vice president at Anthem Blue Cross and Blue Shield is quoted as saying, “[HSAs] will be more than a niche product. We think there will be a growing demand as these products become more understood.” He expects 25% of the market will sign-up for HSAs. The article gives Dan Briggs, a local health care consultant as an example – “Briggs’ monthly premium runs $240 for his family of four, far less than the $800 he paid last year for a standard insurance policy. He pays the first $5,000 of his family’s medical bills each year. He likes that the policy is portable and he can keep it if he changes jobs.” (The article doesn’t make the calculation, but Mr. Briggs would be saving $6,720 a year in certain premiums in order to pay up to $5,000 in possible costs – not a bad trade, especially for lower-income workers).

SOURCE: http://www.indystar.com/articles/2/140969-6922-031.html

Please send all comments/questions directly to me at gmscan@aol.com.


“Consumer Choice Matters” is a free weekly newsletter published by the Galen Institute, a not-for-profit public policy organization specializing in research and education on health policy. Visit our website at http://www.galen.org for more information.


If you wish to subscribe/unsubscribe or update your address, please send an e-mail to galen@galen.org.





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About the author

IN THIS ISSUE:


Joint Economic Committee of Congress Holds Hearing on “Consumer-Directed Doctoring”

? Opening Statement by Chairman Robert Bennett (R-UT)

? Testimony of Dr. Robert Berry

? Testimony of Dr. Alieta Eck

? Testimony of Dr. Bernard Kaminetsky

? Testimony of Dr. Robert Berenson

“Medical Economics” Features Cash-Only Practices

HSAs Stimulate Cash-Only Practices

Joint Economic Committee of Congress Holds Hearing on “Consumer-Directed Doctoring”


The Joint Economic Committee of Congress held a hearing today on “Consumer-Directed Doctoring: The Doctor is in, Even if Insurance is Out.” Witnesses included Robert S. Berry, MD of the PATMOS EmergiClinic in Greeneville, TN, Alieta Eck, MD of the Zarephath Health Center in Zarephath, NJ, Bernard Kaminetsky, MD, FACP of MDVIP in Boca Raton, FL, and Robert Berenson, MD of the Urban Institute in Washington, DC. Chaired by Sen. Robert Bennett (R-UT), the Committee has been holding a series of hearings on cutting edge developments in health care, especially on how consumer choice in health care is revolutionizing American medicine.

Opening Statement by Chairman Robert Bennett (R-UT)


Senator Bennett began the hearing by pointing out that “many doctors are frustrated by the state of our current health care system,” especially “third-party entities interfering in their practice, pushing them toward a system that focuses on arcane regulations, not on patient care.” He said, “Today’s hearing will examine the experiences of innovative and entrepreneurial doctors who are responding to gaps in the current system by returning to an older style of medical practice?.” He added that “early evidence of consumer-directed doctoring suggests that some physicians and patients are reacting favorably to this [new] way of providing care.”

Testimony of Dr. Robert Berry


Dr. Berry testified that his clinic centers on “the unique needs of the uninsured [who are] the most cost effective healthcare consumers.” He used to be an Emergency Room physician and found that many of his patients who came in for routine services are “neither destitute nor derelict.” Rather, they are hard working people who pay their bills and resent how they are treated in government clinics. He posts his prices in the clinic and in advertising — $25 to treat poison ivy, $35 for a sore throat, $95 for a simple laceration. He said, “The only way that I can keep my prices so low is by avoiding the crushing overhead and hassles that other physicians allow third-party payers to impose on their practices.” He currently has nearly 5,000 patient charts, of which 51% are uninsured, 38% commercially insured, 8% on Medicaid, and 3% on Medicare. His break-even point would be 1.2 patients per hour, he is currently seeing 3 per hour, and would have an income 50% greater than when he was working in the ER by seeing 4 patients per hour. Dr. Berry says he is not alone in what he is doing and cites many other physicians across the country who are taking similar paths.

Testimony of Dr. Alieta Eck


Dr. Eck testified that in her state of New Jersey it is virtually impossible to buy health insurance unless your employer provides it for you. Due to misguided state regulations, the premium for even modest coverage for a single person ($1,000 deductible and 70/30 coinsurance) ranges from $912 to $4,419 per month. The number of people in New Jersey with individual insurance has plunged from 220,000 in 1996 to 90,000 today. In this environment, there are plenty of people who can afford to pay for services, but cannot afford health insurance. Her four-doctor practice takes no insurance but Medicare, and it employs only one full-time employee plus a bookkeeper and six part-time nurses and receptionists, quite a contrast from the 5 full-time employees per doctor that prevails across the country. Her testimony cites many examples of patients who have benefited from the services she provides.





Testimony of Dr. Bernard Kaminetsky


Dr. Kaminetsky said he joined MDVIP “in order to provide my patients with comprehensive preventive care services that unfortunately can no longer be offered in a traditional primary care setting.” He said when managed care came along it distorted medical practice by paying so little that physicians had to rush patients through the visit, precluding the time it takes to take a preventive approach to their medical needs. He pointed out that in a typical managed care practice with 2,500 patients, one would have to work 50 hours a week for 50 weeks to provide each one with a comprehensive hour-long physical exam – leaving no time at all for acute care needs. He joined MDVIP to get his case-load down to 600 patients, and serve each one well.

Testimony of Dr. Robert Berenson


Dr. Berenson provided the only sour note, arguing that these practices hinder cost containment efforts and “exacerbate current problems with access to services for the uninsured and underinsured.” He acknowledged the frustrations physicians face but believes these frustrations “represent symptoms of a system lacking universal, comprehensive health care insurance.” He concluded that “at its best, providing substantial health care services for much of the population outside of insurance is an elitist notion.”


The discussion after the testimony was largely friendly and productive, with even Congressman Pete Stark (D-CA) agreeing that there is merit to the approaches described by Drs. Berry, Eck, and Kaminetsky. His one concern was whether people will be able to effectively shop for medical services the way they can shop for other services. But the witnesses did a lot to reassure him on that point.


SOURCE: You may link to these and the rest of the testimonies at Galen’s web site: http://www.galen.org/ownins.asp?docID=633

“Medical Economics” Features Cash-Only Practices


The magazine “Medical Economics” picks up on this trend in an article headlined, “No Coding, No Insurers – No Kidding.” Senior Editor Robert Lowes says, “It might be time to consider a cash-only practice. Your income may drop, but your overhead will decrease and your job satisfaction could soar.” The Nirvana is described as “No more arguing with insurance clerks about denied claims. No more fears of a Medicare audit.” It cites Dr. Rick Baxley of Orlando who dropped all insurance contracts in 2000 and reports, “I earn roughly what I did back then, but I’m not working from 6 a.m. to 9 p.m. anymore. And I’m building relationships with patients, which is why I entered medicine in the first place.” Bethesda, Maryland internists Jane Chretien and Audrey Corson say they “have extended the length of the average visit from 8 minutes to about 25 minutes.” They maintain, “When visits are longer, you get to know your patients? You can put their complaints in a bigger context.” Dr. Vern Cherewatenko is cited as saying that “a cash-only soloist probably can operate with just a receptionist and a medical assistant.” The article provides some advice for physicians thinking about moving in this direction – cut ties with insurance companies gradually, starting with the worst payers; drop Medicare last, especially if you have a large number of patients on Medicare; “be prepared to scramble initially to make ends meet.”

SOURCE: http://www.memag.com/

HSAs Stimulate Cash-Only Practices


The advent of Health Savings Accounts is likely to stimulate this trend. An article in the “Indianapolis Star” reports, “When Karen and Roger Montembeault and their sons visit the doctor or buy a prescription drug, they pay the bill in full. No co-pays for them. And it’s not for lack of health insurance.” The family has just bought an HSA after having an MSA for four years, according to the article by Jeff Swiatek. He writes, “People with HSAs also have less reason to fight their insurance company over getting tests or other care because the insurer doesn’t bear the cost of the care, and least not until it exceeds the high deductible?” Dennis Casey, vice president at Anthem Blue Cross and Blue Shield is quoted as saying, “[HSAs] will be more than a niche product. We think there will be a growing demand as these products become more understood.” He expects 25% of the market will sign-up for HSAs. The article gives Dan Briggs, a local health care consultant as an example – “Briggs’ monthly premium runs $240 for his family of four, far less than the $800 he paid last year for a standard insurance policy. He pays the first $5,000 of his family’s medical bills each year. He likes that the policy is portable and he can keep it if he changes jobs.” (The article doesn’t make the calculation, but Mr. Briggs would be saving $6,720 a year in certain premiums in order to pay up to $5,000 in possible costs – not a bad trade, especially for lower-income workers).

SOURCE: http://www.indystar.com/articles/2/140969-6922-031.html

Please send all comments/questions directly to me at gmscan@aol.com.


“Consumer Choice Matters” is a free weekly newsletter published by the Galen Institute, a not-for-profit public policy organization specializing in research and education on health policy. Visit our website at http://www.galen.org for more information.


If you wish to subscribe/unsubscribe or update your address, please send an e-mail to galen@galen.org.





SHARE THIS ARTICLE

About the author