General Question

SEKA's avatar

Should doctors stop taking insurance?

Asked by SEKA (3767points) 2 weeks ago

This doctor has stopped accepting insurance patients and started charging a flat fee of $35 per visit for the same services that a Primary Care physician charges. He as no staff and claims to give better service than his counterparts who still accept insurance. He claims to be happier on his job thereby giving better service. What could possibly be the drawbacks of this type of doctor?

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28 Answers

gorillapaws's avatar

I don’t understand how he can run an office without a staff.

An office needs someone at the front desk, assistants to help room patients, check vitals, address medical issues over the phone (e.g. “I have a low grade fever, should I make an appointment to come in?”), manage prescription refills etc. He needs someone to send/receive medical records, referrals, order supplies, schedule equipment/facility repairs/upkeep, oversee the bookkeeping, marketing/website, manage the IT/electronic health records system, maintain credentialing, maintain memberships in the various professional organizations, coordinate legal issues, manage the various insurances for the practice (business liability, malpractice, etc.), oversee that regulations are being maintained, such as emergency plans for fire evacuation routes, gas leaks, etc.

I do a lot of this stuff in my daily job, and it’s just the tip of the iceberg. Excluding insurance will save some overhead (we have 1.5 employees who deal with scheduling, billing, insurance prior authorization, appeals, etc.). That’s just a small chunk of the overall care team we have though. I can’t imagine how one person could handle all of that, AND see patients all day, keep current on healthcare advances, and all of the other duties a physician has to keep up with.

Caravanfan's avatar

I can see being doctor with a staff of two, maybe—a medical assistant and an office clerk. But doing it by himself seems to me to be folly.

stanleybmanly's avatar

He would have a HUGE advantage in regards to the expenses around paperwork. In addition, were he to insist on strictly cash, paid up front, his operation becomes even more efficient and straightforward. The trouble with this model is with his own liability insurance. Can he operate a practice without it?

josie's avatar

Get ready to see more of that.
My girlfriend is a doctor.
Something that she and her generation of docs talk about is organizing and going on strike against any and all third party payers. Could be interesting.

I can get VA benefits, but until he retired I had a doc who charged an annual fee, and for that you got a certain number of office visits, prescriptions, and lab tests. It was cheap compared to third party payer programs.

stanleybmanly's avatar

I agree that the current setup is actually forcing workarounds.

elbanditoroso's avatar

The question comes down to finance.

Can the doctor have enough volume at $35/visit to:
1) pay himself a salary
2) pay for the equipment and medicines and diagnostic stuff necessary
3) pay his malpractice insurances
4) pay rent, utilities, trash removal, etc.
5) pay income and other taxes and social security etc.

Figure 4 people per hour so he would make $140/hr cross
multiply $140/hour x 2000 (hours per year)
his gross would be $280,000/year

I think that a doctor in a single practice would be very hard pressed to pay all the different types of expenses on that sort of rate.

Good for him if he can do it. But for how long?

snowberry's avatar

My health is best served if I pay out-of-pocket. It costs more, but my health is the better for it. I can order most lab tests online and pay pennies on the dollar what I’d pay if I allowed my doctor to do it. Once I get the test results, I share them with my doctor. It’s great!

LadyMarissa's avatar

I don’t see how he can efficiently do it, but it seems to be working for him now. I’ll be interested to see how it turns out in a few years from now!!!

One local chiropractor is doing something similar. He’s calling it a membership fee. He charges $55 per visit; however, IF you join his club, you can pay $80 per month & get one visit per week for a month for one person. For 2 people it’s $30 per week. I forget what the fee is for 3 people. His parking lot stays full. I haven’t tried him yet because I love my own chiropractor!!!

JLeslie's avatar

I’ve had two doctors who didn’t take any insurance and a dentist. They weren’t cheap, but their price was acceptable. The doctors spent much more time with me, and were very thorough, both were specialists.

One doctor was the only doctor in that office, and he had a receptionist and nurse. The other was part of a group, and the group had a receptionist and I think a couple of nurses.

I was able to file with my insurance, but I had high deductibles and the insurance could theoretically reject the claim.

By far, the money was worth it for the attention I received.

I don’t see why a female doctor couldn’t do it all. A male doctor would not be able to be alone with a female patient I don’t think. He would be taking a risk anyway, especially if the female patient was undressed.

As long as the office space was cheap it might work at $35 a patient. I think patients would easily pay $75 in a typical middle class area. Maybe he uses a service to do scheduling? That part would be tricky. I think the doctor can do the vitals no problem. Schedule half hour appointments, do vitals, talk to the patient and examine them. He’d have to check messages obviously, and deal with other phone calls.

SEKA's avatar

For those of you who can’t understand how watch this where he explains it himself. He has no receptionist opting for a ipad where the patient checks in on a kiosk style setup that directs the patient to a room where they can walk to themselves. He has no billing department because there is nothing to bill. There is no insurance department because he doesn’t deal with them. He is of the opinion that the average doctor makes about $35 per patient and the rest of the fee is overhead. He’s like the triage unit of the doctor’s office that keeps you healthy and out of the hospital where it can cost you thousands if not tens of thousands of dollars to get well. I’m looking forward to the follow-up interview to see how this turns out. He sounds like a doctor who truly cares for his patients and just looking for a better way to get to the end result for them. I’ll be keeping my ears open

Sagacious's avatar

He has another income stream or the practice is a sham front for something else. That is not enough to pay licensing and malpractice insurance.

SEKA's avatar

I don’t think he mentioned malpractice insurance, but he seems smart enough to cover his own butt

jca2's avatar

There are many doctors in NYC that are like that. They’re called “Boutique doctors.” They take no insurance, and you pay and then deal with your insurance company yourself.

I had an endocrinologist that was a boutique doctor. His fee was about $100 or maybe a little more. He was a great doctor. He would spend an hour with you. There was a receptionist and that was it. No nurses, nothing. He was in a mansion and you’d go in the side door where the receptionist was. She’d have you wait in what was the living room of the mansion. Then he’d come out, take you into his office, have a chat, look at your past records, then take you into the exam room. He’d examine you, then you’d go back to his office to chat some more, update prescription, etc. He was very laid back and very thorough.

I had a biopsy elsewhere and the pathology lab’s report for that place was three words. That’s what brought me to him. He sent those same biopsy cells to his pathologist, and the report was three pages long, very detailed.

He was worth what his fee was.

I don’t know how a doctor could do what he did for $35 per visit. The visit would have to be only 15 or 20 minutes long.

Sagacious's avatar

@jca True boutique doctors require a fee to be part of the practice. The fees I’ve known about were in the thousands of dollars annually. The doctor makes himself available when you need him….like being on retainer. There is no fee for actually seeing the doctor. These doctors are also called concierge doctors.

johnpowell's avatar

I have really waxy ears. And most people don’t think this is a thing. Wax doesn’t fall out of my ears. Every year or so a doctor has to look into my ear, then a nurse flushes as much as the can, then a doctor goes in with a curette. This can take hours.

My doctor, a GP in a private practice charged 56$ (cash) for this. It was a real building and not a van.

I later got insurance and had the same thing done and that 56 turned into insurance being billed 400.

The true price is probably somewhere in the middle.There is absolutely no way 56 covered the service I was provided. And I get that some people might take less time.

I do not see how reasonable service is provided for 35 bucks unless this is some sort of performance art.

I guess doable if you had lots of doctors and you were able to pool all the money in so the average became lower. Your cancers would balance out your common colds. But that sounds like socialism.

JLeslie's avatar

@Sagacious You are talking about a concierge/retainer doctor. I don’t think @jca2 means that type of doctor.

jca2's avatar

@Sagacious: @JLeslie is correct. My doctor wasn’t charging a fee to be part of his practice’s patients. He just didn’t take insurance, and you were on your own as far as what your insurance paid or didn’t pay, because you paid the doctor up front per visit.

YARNLADY's avatar

I seriously doubt a doctor alone can order and stock his own inventory, pay all his own bills, such as office rent, electricity, water, hazmat fees, taxes, etc, plus dispose of his own trash, clean his own office, and all the hundreds of little tasks a staff does daily.

JLeslie's avatar

I have to LOL a little that so many people think doctors are incapable of handling task like taking out trash and ordering inventory. I’m not directing that at you @YARNLADY it’s more of an overall observation from the thread.

I think doctors did it in the old days. Dr. Quinn seemed able to do it.

The doctor maybe isn’t going to make a fortune, but they might have a better balance and more relaxed.

jca2's avatar

@YARNLADY: I don’t think the doctor I went to cleaned his own office, although he may have. It would have to have been vacuumed and the exam room would have to have been mopped. The garbage would have to be taken out. I guess he could have done that but it’s possible he hired someone to do it.

@Sagacious: What is your point?

LadyMarissa's avatar

In thinking about doctors who can’t clean their own office nor take out the trash, I’d find that to be enlightening info as to whether I would want him taking care of my body!!! IF he is incapable of throwing a bag of trash into a dumpster, I would wonder IF he was capable of removing my appendix???

gorillapaws's avatar

@LadyMarissa It’s not about being incapable, it’s about efficiency. You guys are ignoring a ton of overhead costs of running a medical practice. You’re talking more than $10k per year in software and IT expenses alone, medical waste disposal is obscene, accounting fees, bookeeping, credit card processing fees. Even stuff you would never think about like table paper (I did some rough math and it’s like 0.37% of the cost of the $35 visit just in that sheet of paper, or around $1,000 per year in paper alone with a packed schedule) can have a real impact on the budget. Every minute the MD is mopping floors, taking out trash or polishing doorknobs, is time he’s not billing on the schedule, let alone simple medical tasks that take time but don’t require advanced skills like taking a patient’s temp, BP, weight, entering the data into the system etc.

Generally speaking, you want each person in a business spending as much time as possible doing the highest level skills they are capable of performing.

snowberry's avatar

@gorillapaws now that’s interesting about the table paper! Is it a law to have to use that expensive paper? I know the idea is to prevent infection but I can think of other ways it could be done. Besides, the paper doesn’t even cover the entire table exam pad! Wiping down the table and having sterile linen laid out over it would be just as good I would think. That’s what you get in a hospital bed after all.

JLeslie's avatar

I don’t always even get on the table when I go to the doctor. Depends on the doctor and why I’m there.

snowberry's avatar

As I think about it I have never seen anybody wipe down an exam table after I’ve been on it . All they’ve ever done is just rip off the used paper and put fresh on the table so it’s ready for the next patient. I know this is so because they do it before I even leave the room!

So even though paying an exorbitant price for “table paper” as you call it, Is the industry standard, doesn’t mean that it’s appropriate or even the healthiest thing to do!

So the next question is, how do they justify this expenditure? You might say, “Well, it’s what everybody’s doing (it’s the industry standard) and so this is what we have to do.” That’s a pretty lame excuse.

jca2's avatar

The doctor I was seeing was an endocrinologist, so he used the paper, but you’re sitting there with your pants on, and maybe you’d move your shirt for the heartbeat or the blood pressure, but otherwise, him feeling your neck didn’t require an exam gown or anything. If he saw one person per hour, that was not an exhorbitant expenditure per day as far as paper went. He probably had a cleaning service do the mopping and the vacuuming, which, let’s face it, you can get that for not too much money per day. He had a mansion but the part that the patients were in was the reception area (like an enclosed glassed in porch), the living room which was the waiting area, another area where his office was, and the exam room, which was like a small bedroom.

He also did training of other endocrinologists, so he had a room that was like a classroom with chairs in it (and another way to make money).

The receptionist had a laptop computer. Since they didn’t do billing or anything, they didn’t need a lot of computers or software. They didn’t need a lot of staff because there was no billing going on.

So my point is, all the things you may think of as expenses in a regular doctor’s office were not expenses for the boutique doctor.

JLeslie's avatar

I sit down in a regular chair half the time with my endocrinologist, I don’t even get up on the table.

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