Not accepting insurance or medicare/medicaid

[cbrons]

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Does anyone have any literature they can point me to on direct-pay models of practice (i.e. http://www.simpd.org/) where doctor is paid in full directly by the patient for all care? And also, your opinions - is it really only accessible to the wealthy? A family practice doctor I shadow told me about this and I was curious about reading more.

 

[NonTradMed]

I've read somewhere in USA Today that cash-only services (where people pay up front) is actually quite popular with the blue collar crowd who do not have insurance of any type and have only mild ailments to see the doctor about. There is certainly a market for the direct pay model but I think it takes a bit of time to find that niche.

 

[Dirt]

Pulling bullets out of gangbangers in your garage for cash money is a direct pay practice.

 

[masterofmonkeys]

concierge medicine is a viable model and hardly accessible only to the rich. Even the more high-dollar concierge plans compare rather favorably to the cost of comprehensive health insurance plans.

If I actually visited a doctor regularly I'd think a high-deductible insurance plan with a concierge physician would be an awesome plan. If I had children, I'd seriously look into it for myself as a health care consumer.

 

[Isoprop]

here's a really good thread from a few years ago:
http://forums.studentdoctor.net/showthread.php?t=135751

 

[sirus_virus]

Look at the crude math behind this business model. Assume every pt pays a minimum ~$75 per visit (people will pay this easily, they already do as copay often), and you are doing 40 pts a day (this is not unheard of especially since you have way less paperwork to do). You will rake in ~800K in sales working 5 days a week for 50 hours. If you work the same hours as a regular PCP which is 60 hours/week, then you might sell ~1 million dollars in services per year. Pay your staff, insurance and other overhead and you will still be better paid than your peers, with more pts under your belt and less paperwork (some of which will only result in $35 reimbursements). Believe it or not, this market is sitting right under the very noses of our so called "lowly paid PCPs". Most will give you 400 reasons why it can’t work, while the few savvy ones will find 400 ways to make it work. That is why society has only a few rich folks, while most are not.

 

[cbrons]

Look at the crude math behind this business model. Assume every pt pays a minimum ~$75 per visit (people will pay this easily, they already do as copay often), and you are doing 40 pts a day (this is not unheard of especially since you have way less paperwork to do). You will rake in ~800K in sales working 5 days a week for 50 hours. If you work the same hours as a regular PCP which is 60 hours/week, then you might sell ~1 million dollars in services per year. Pay your staff, insurance and other overhead and you will still be better paid than your peers, with more pts under your belt and less paperwork (some of which will only result in $35 reimbursements). Believe it or not, this market is sitting right under the very noses of our so called "lowly paid PCPs". Most will give you 400 reasons why it can’t work, while the few savvy ones will find 400 ways to make it work. That is why society has only a few rich folks, while most are not.

I love this quote. Yes it is definitely true but I did read the old thread another user posted and saw what you meant (a variety of reasons why this model would not work). I love the free-market. If I was towards the end of med school looking at residencies, I would consider primary care just to go ahead and do this. I just hope they don't make these types of practices illegal, which they probably will considering the socialists they have incoming.

 

[masterofmonkeys]

yeah the biggest danger to the concierge model is political interference ranging from creating direct legislation that impedes the implementation of this model to out and out socialized medicine.

If it's the latter, you will still have a successful practice, but you won't be seeing lower income people.

 

[WellWornLad]

concierge medicine is a viable model and hardly accessible only to the rich. Even the more high-dollar concierge plans compare rather favorably to the cost of comprehensive health insurance plans.

If I actually visited a doctor regularly I'd think a high-deductible insurance plan with a concierge physician would be an awesome plan. If I had children, I'd seriously look into it for myself as a health care consumer.

Huh? You can't compare "concierge medicine" to health insurance. Your fancy-pants PCP isn't going to take out your appendix or give you chemo. If you think it's worth it to pay thousands of dollars on top of your health insurance for a beefed-up version of what your health insurance is already providing, then chances are that you are indeed rich. Many middle class folk have a hard enough time just getting adequate insurance coverage.

 

[cbrons]

Huh? You can't compare "concierge medicine" to health insurance. Your fancy-pants PCP isn't going to take out your appendix or give you chemo. If you think it's worth it to pay thousands of dollars on top of your health insurance for a beefed-up version of what your health insurance is already providing, then chances are that you are indeed rich. Many middle class folk have a hard enough time just getting adequate insurance coverage.

Can't you get insurance that only covers stuff emergencies and "disaster" diagnoses so long as you buy it before the fact?

 

[Isoprop]

yes you can find a high-deductible catastrophic insurance.