Paying An Annual Fee to Keep Your Doctor

I recently was informed by one of my clients that he is being “courted” by a company that helps doctors trim their practices to 400-600 patients. These patients will be invited to stay with the practice by paying an annual fee to have better and more access to their doctor by having less wait time for an appointment, longer appointments, and the doctor’s cell phone number or other personal information to use for communication.

I am not sure how I feel about this new niche being carved out on the business side medicine. I am told that it is not the same as a doctor creating a boutique practice, one in which insurance is not accepted. The company courting my client is currently reviewing various aspects of the practice not the least of which are the demographic, insurance and age factors. Through use of marketing tools as well as I guess some quantitative and qualitative analysis, the company will decide which patients should be invited to stay with the practice for an annual fee (I have heard these fees to be between $1500 and $2000 payable over four installments).

As a billing service, I will not lose this client because insurance will still be billed. The annual fee is a private contract between doctor and patient. I will make less money probably because my earnings are based on the doctor’s receipts and he will see less patients every week This is NOT why I am unsure how I feel about this relatively new idea.

My concern is for the 1400-1600 patients in his practice who will not be asked to “rejoin” the practice. Where will they go to find another primary care physician who isn’t already overloaded? Where will the patients who have no insurance go (as I don’t think they have an additional $1500 to pay for an annual fee?) Where will patients who have a Medicaid plan go as fewer and fewer doctors are participating in those plans?

So you can see why I am conflicted. For the 400-600 patients who will have more access to the doctor, this could be a way to decrease what sometimes is a stressful experience. And for the doctor who can and will spend more time with each patient there will also be a decrease in stress on all aspects of the practice. But my conflict continues.

Patients Without Healthcare Insurance

As I complete my fifteenth year as a solo medical billing service,I find this year the most difficult one for patients suddenly without insurance. Over the years I have seen cycles where patients are forced onto Medicaid plans for a period of time but then move back to managed care due to re-employment or they become eligible for Medicare. While I always have some balance bills for patients who “refuse” to pay their portion under the terms of their insurance, this year is different.

There are now stacks of balance bills for patients who are unable to pay. Many of these patients have been seeing the same doctor for years (primary care or a specialist for a chronic condition). Some patients doctor hop to spread the debt around.

Some patients come in with expired insurance and if eligibility is not checked, the patient gets a free ride at least for a while. Some patients might give a check that will be returned for insufficient funds while others may think twice about using a credit card should your office accept that form of payment. Some people will simply ignore the bill because they are overwhelmed with all the other bills, so what is one more?

Now is the time to set policies for patients who have no insurance. Certainly checking eligibility makes sense even in better times. A partial payment can be advised while making the appointment and if you take credit cards, ask the patient if you can expect him/her to use it. Set up a payment plan at the end of the visit and keep one employee or your billing service informed of the arrangement. Make notes in the computer as to what was discussed. Consider a courtesy on a case by case basis especially if you can obtain payment in full at the visit. This saves time, creates loyalty, and a good feeling among the staff who collected the money.

You know your patients best and when they hopefully obtain insurance again, do you want them going to another doctor who might have been more flexible during this rough patch? Is a collection agency really the answer that may take a portion that is larger than the courtesy you may give? Most people want to pay their bills; be clear on what you are billing them for and communicate your policy with your patients

Will US Healthcare Reform Result in Canadian, Mexican or Indian Healthcare?

United States’ healthcare reform is being discussed and debated constantly in America right now, but the discussions appear to be based on many assumptions. Assumptions about what the current “Healthcare Bill” now in Congress actually proposes for one. Someone in the debate will argue that a proposal will turn our healthcare system into the “Canadian’s Healthcare System”, and appear to assume that the listener will automatically understand that outcome to be a bad one. Other countries’ healthcare systems, especially England’s, are mentioned in the same manner.

Since starting this website and blog a short time ago I have received emails from doctors in many countries, which is of course wonderful. As an American doctor who started this website out of frustrations I experienced opening my own practice, I realize I was a bit myopic to assume that private practice issues we face are unique to America. In fact, the issues and the processes are often identical, no matter how a country’s healthcare system is structured. I think it’s safe to say that many things will not change even under healthcare reform because, after all, being an excellent doctor supercedes politics and finances.

Several of the international physicians have kindly submitted articles for inclusion on this website. I hope they represent a trend that will continue as we can all learn from each other. The original tagline for PrivatePractice.MD was “Doctors Helping Doctors” and that’s a sentiment I hope to always encourage. Dr. Lawrence Kindo in India has written several articles. The first is entitled “A Perspective On The Indian Healthcare System” and shares his opinion and overview of the medical system in India. I found it interesting that he believes medical tourism will become a big industry for India, and I had the thought that we American doctors never think about our healthcare system in that way (at least I haven’t). Yet we know that people travel to the US from all over the world for the excellent and advanced medical care available in the US. Dr. Kindo’s other article gives a overview of the training Indian doctors receive. It is entitled “Medical Education In India and the US: A Comparison.” I think you’ll find it an interesting article also.

Dr. Rodrigo Rubio , a Mexican anesthesiologist and MBA student, kindly offered to share his knowledge and insights about private medical practice from a Mexican perspective. He has proposed a series of articles, with the first article talking about the value proposition we physicians bring to our patients. I think you’ll agree that the principles are universal and location- independent.

I encourage everyone to write and share their experiences and perspective.  Please leave comments as well!

Medical Education in India and the US: A Comparison

Medical education in India encompasses allopathic medicine and other indigenous systems of medicine. Allopathic medicine is by far the most favored of all systems because of its wider acceptability and global recognition. This article deals only with allopathic medicine.

Like in the US, medical education in India involves a lengthy and arduous process.
Pre-University Course or HSSLC: It consists of pre-university studies or Higher Secondary School Leaving Certification (HSSLC) in the Basic Sciences with Physics, Chemistry and Biology as its major subjects for 2 years. A prospective medical student should have attained an average of 50 percent of the marks to qualify for medical education. A prospective medical student should apply for various competitive exams to attain a seat at any of the medical colleges or universities across the country. In the US, this stage is termed undergraduate education and consists of 4 years.

The Medical College: A medical college is a medical institution approved by the Medical Council of India (MCI) to train medical students and confer them the MBBS degree, also called Bachelor of Medicine and Bachelor of Surgery. Medical colleges are state-owned, state-aided or private institutions.

Undergraduate Medical Education: Five years of meticulous study of preclinical, paraclinical, and clinical subjects prepare the medical student to appear for four quality assured professional exams through the years of study. The preclinical study consists of one year study of Basic sciences like Human Anatomy, Human Physiology and Human Biochemistry. This prepares the way to a more thorough and in-depth overview of paraclinical subjects of Pathology, Pharmacology, Microbiology and Forensic Medicine for two years. This is accompanied by an introduction to the clinical sciences and learning in the clinical setup. The next one year covers Community Medicine, Ophthalmology and Otorhinolaryngology with clinical insinuation and glimpses of the practices of medical and surgical specialties. The last one year is dedicated to the clinical subjects of Medicine, Surgery, Orthopedics, Obstetrics and Gynecology and Pediatrics with all the sub-specialties. Having cleared the Final Professional examination, a medical graduate is required to complete one year of internship covering various specialties.

Internship Program: It consists of one year of rotating internship in various specialties. Only on completion of the internship is a medical graduate awarded the MBBS degree and a license to practice medicine anywhere in the country as a General Practitioner or Medical Officer. He is also prescribed the title Doctor. Permanent Medical Registration is required either in the Indian Medical Council or State Medical Council to practice. This is in contrast to the 3 to 7 years residency program required to practice in the US.

Post-Graduate Medical Education: This equates to the residency program in the US. Entrance to a Post-graduate degree program is through competitive exams conducted by the concerned college or university. It consists of 3 years of study to achieve an MS or MD degree in any surgical or medical specialty respectively. Following this a Doctor in India can practice in that said specialty as a medical or surgical specialist. There are also post-graduate diploma programs and Diplomate of National Board (DNB) programs for furtherance of medical education. Fellowship programs in various specialties can also be pursued.

Super-Specialty or Sub-Specialty Medical Education: A doctor who has attained a specialty post-graduate degree is qualified to pursue super-specialty or subspecialty education in their field of interest.

A medical graduate in India has the license to practice the broad specialties of Medicine and Surgery but is required to refer patients to a specialist to handle problems that require a particular expertise. Thus, it can be a long journey for the Indian medical graduate before he can settle down, unless he/she is satisfied to practice as a general practitioner.

Dr. Lawrence Kindo

A Perspective on the Indian Healthcare Industry

India devotes only 5.1 percent of its GDP in the health sector. India’s burgeoning healthcare sector has created waves across the world with its enticing medical tourism venture. This and a steadily rising economy have been the two factors that have made the Indian healthcare industry a serious contender to global healthcare leadership. Despite these developments, the health status of millions of its citizens remains below standard. Utter ignorance in the rural areas and the blatant misuse of people’s money by those in power has brought about a vast difference of healthcare status between the rich and the poor.

The Indian healthcare industry is a conundrum. The state-of-the-art healthcare institutions in the public sector cater only to the few that make it to the privileged list. The few mentionable exceptions are just a handful. Most of these so-called centers of healing are very poorly equipped in terms of manpower, medical equipments, and resources.  The input from the government coffers for these institutions is quite less compared to the population it has to cover, but misuse of resources have made an  indelible mark in the Indian public healthcare sector making the scenario worse.  Surprisingly, only 0.9 percent of the country’s GDP is dedicated to the public healthcare which is a gross understatement. There is much to be done to recover the lost glory of these government-owned institutions, and most people are much too disillusioned to try anything new. The healthcare education provided by many of these institutions is also below par and need overhauling.

With regard to the private sector, the monetary aspect is ingrained deeply, and most of these institutions cater to the high and mighty. Exceptions are few and far between where healthcare is provided without this distinction. Charitable institutions worth mentioning are few. About 4.2 percent of India’s GDP lies in the private health sector. This makes healthcare costs reasonably high, driving most of its own citizens to the doors of dilapidated government institutions which merely exist. The investment made by these private institutions is recovered by a steady flow of medical tourists from across the globe. The comparatively lesser cost in these high-end institutions is a boon to the medical tourists who avail the same treatment at a fraction of the cost they would have incurred abroad. An estimate that a mitral valve repair surgery in India would cost only around $ 7000 compared to the $ 200,000 in some of the hospitals abroad is just the tip of the iceberg. This is just one example of the cost-benefit aspect for foreign medical tourists. The healthcare standards in these institutions are comparable to those abroad and hence are a low-cost, affordable option to foreigners. Qualified and experienced specialists in different medical and surgical specialties, excellent nursing and paramedical staff, and affordable charges make these institutions successful and popular.

Medical Tourism Can Provide Much Needed Capital. Having stated these differences, there is hardly a reason why one should not consider options elsewhere when healthcare costs are high. Numerous other countries have made inroads in the medical tourism industry making billions in the process. Medical tourism has rooted itself deeper due to the current depression in the world economy forcing people to look for viable options. India is a rapidly growing economy and would look at medical tourism seriously if it ever thought of making a mark in the global market.

Dr. Lawrence Kindo
India

Doctors are the Cause of the Healthcare Crisis

There’s an awful lot of finger pointing going on, as to whom or what is to blame for our healthcare crisis in the US. In the June 1st, 2009 edition of the New Yorker magazine, physician and best selling author Dr. Atul Gawande makes a case for physicians, and specifically “entrepreneurial” physicians, as the main reason healthcare costs have skyrocketed. Read more

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