Staying Independent...Together

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   RE: going direct pay - I think
 From: Margaret Coughlan
 To: Member Forum
 Posted: 02-16-2018 09:06
 Message: Hello everyone,
I am still out here too, just don't log in and communicate as often. Congratulations Lynn on making the jump! I have limited the insurances I accept over the years, down to about 5. Fortunately, many of my patients who have plans that I do not accept, are willing to pay cash for a visit. I charge $85 for regular visits and $150 for physicals/DOT physicals. I keep talking about, but never act on, trying to get an annual fee for noncovered benefits. I feel that if I can get an extra $100/person/year to help cover my Athena EMR/Portal and the concierge type of care that I give without charging concierge prices, I would feel better. I definitely do not want to become employed again. I am making a living but do get frustrated with less reimbursement from the private insurances than the employed practices get, but am definitely happier than those docs I think.
Margaret Coughlan
Millbrook, NY
Solo since 2007

Margaret Coughlan
Original Message:
Sent: 02-15-2018 08:44
From: Lynn Ho
Subject: going direct pay - I think

Interesting Jenn
wondering - are the priors and referrals coming from patients in the DPC part
patients with managed medicare that require referrals I am requesting they move to straight medicare which does not require referrals or priors
because I will be unable to do referrals if not contracted provider, as far as I can tell
what % of people moved to DPC from your practice and what percent left, do you have a number?
I saw Hint Health showed some person from a traditional practice, only 7% of his patients followed him . of course, he had 3000!
I expect my percentage will be more

Lynn Ho

Original Message:
Sent: 02-14-2018 17:12
From: Jennifer Mcconnell
Subject: going direct pay - I think

Wow, thank you sad on one level, you, Jean, Brady, and several others were such champions of the IMP movement.  It is incredible the way that healthcare is headed, with little slowing it down.  I hope it truly does implode at some point so that we can try to rebuild it from the bottom up.

That being said, I transitioned my half of the practice to DPC last July, it has gone very well.  Unfortunately, I am still stuck doing prior auths for medications, some specialists and much of the testing I order.  Do you have thoughts on ways that you will try to decrease that burden?

Jennifer McConnell,MD
Maranacook Family Health Care
169 South Road
Readfield, ME 04355
(207) 620-4449 (phone)
(207) 685-3208 (fax)

Original Message------

So, I think Jean will be the last original IMP standing.

At the end of this year, I plan on severing my insurance contracts and going direct.
I am tired of working 65-75 hour weeks with fully half of my time spent on the demands of insurances - documentation, billing, coding, referrals, prior authorizations, and "quality ( read - checking boxes and pasting text blocks)"
Although in my IMP practice as it stands now,  I could continue to work and earn enough to live well ( about $120-140K per year), I asked myself: why am I working this hard to make insurance companies richer?
After Jan 1 of this year, the 2 biggest insurers in the state began to require 100% specialist website referrals for their respective managed medicare and -caid products, and  I saw my admin work spike another 2-3 hours per week: I also saw the writing on the wall. This incessant grinding down of the primary care work force cannot end well for us (the grindees).
For the past 3-4 years, I worked within the state's quality organizations and the health insurance commissioner's office to try to change the flawed quality measurement system towards more sensible, less burdensome quality measures based on HowsYourHealth, but at our last meeting 2 weeks ago, I realized the obvious truth:  that these bureaucrats really have no intention of changing the rules for small practices to make "quality" work less burdensome. Another pipe dream, up in smoke.
These two realizations coming together have finally cracked my rose colored primary care lenses. This crazy health care wealth extraction system is not going to change, not one iota, until it implodes.

The direct practice upstairs is doing quite well, due to the scarcity of quality primary care in RI.
I'm going to charge the old IMP standard of $1/day for no holds barred primary care ( way less than the going rate of the folks upstairs, who are 25- 50- 75-100 $ per month, depending on age).  I expect I will keep around 1/4- 1/3 of my 750 patients ( we will see! )  so I will get to breathe.  Perhaps I will travel around the country a  little and visit you guys ! For every 100 paying patients, I will see 15 medicaid or medicare patients that don't have the resources to pay me ( I have the list percolating now). Going to use HintHealth for collecting money; possibly may moonlight a little at the Navy base or the University Health center if needed.

Hurrah ! I 'm embarking on another IMP adventure !


Lynn Ho

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