Brian,
I totally agree in principle with your cash only and pay in full at time of service model, as long as we have the present broken system in place. Get these SOB's out of our offices and off our backs. But many of us are in areas where the next practice or doc is willing to cut our throats instead of stand together. I think opt out works best in well to do areas or those where there really arn't very many other choice such as rural ones. Even those few patients that we have become personally friendly with, don't want to go where their insurance isn't taken. God forbid they should have to deal with their own carrier 6-12 times a year the way we do now thousands of times a year for each and everyone of them. We would need to opt out as a group action and right now organizing such a thing is a violation of the crazy and misguided FTC's idea of "free-trade". We all cost exactly the same thing.... Oh Right; I forgot, that's free trade...
This is why, I still believe that the only way to break this strangle hold is for all docs, especially PCP's is to organize and unionize and to pressure for those rights to be recognized and protected by federal law, all plans even the gov't ones. Only as a joint action, with all docs leaving en mass as you put it so well (just like the carriers) can anything meaningful occur.
I'm an old stagehand who like docs and construction workers we frequently worked in many different places for many different employers, sometimes even on the same day. Theater set up that day, Met Opera or Soap Opera turn around at night. The employers used to and still do try to pull the old "private contractor" bit on us. But they call most of the shots and control our access to the work. A private contractor really can show up when he or she pleases, perform the work as they see fit as long as the deadlines are met. But the carriers and my old employers dictate way too many terms and conditions. Doctors, like stagehands are really "freelance" labor, not private contractors. That is the difference in terms all docs need to us. "I'm a freelance laborer, not a private contractor." Unless and until they drop all formularies, step therapies, and limits on what treatments you can choose, call requirements and a host of other things, you, by the definitions of the Dept of Labor are an enployee, not a private contractor. Worse yet, remember, every time they control your choices like this, the carrier is practicing medicine without a license. And yet somehow, King George saw fit to give only them a free pass on malpractice.
And as a relative new comer to this game, I also agree with Leslie that there were a lot of stupid, coopted, or mal-intented docs and societies that allowed things to get to the point that they are now. The docs of the 80's and 90's should be supporting the starving and stressed out docs of the 21st centry that they laid down this awful ground work for. Those of us today you are drowning in the wake they left behind. How did anyone get so stupid as to actually beleive that these greedy SOB's have anyone's best interest in mind, besides their own greedy selves? I just want to take the docs who work for the carriers as "advisors", committee chairmen, and "Medical Directors" and put them all in stockades for patients and docs to flail and mock in public. I know who my enemy and my master is....
I think that some how this issue of joint action has to be brought to a national spot light and quickly, while the iron is hot. Folks are talking about healthcare reform and we better get in there or they will do it without us. They will be mislead by those who don't have the patients' or the docs' best interest in mind, and PCP's will again have lots of busy work to do, with little or nothing to show for it. How dare any sane person support a system that has PCP's seeing more than 15-20 patients a day max??? Drive-by office visits averaging 7.5 minutes each!!! And then the insult of P4P because quality sucks so bad with those drive-by visits. It's my old Henry Ford thing. Crank up the assembly line so fast for your own short sighted greed and then get punitive on the assembly line workers because quality has gone to hell. You should have thought about that before you cranked up the assembly line speed so fast, right?
Now I've got a question for you and opting out. One of the other very large expenses in healthcare is vaccines. How do you bill and charge for such things? Kids get so many of these very expensive shots that we on our end have little control over price or access for. We even have carriers that are trying to use the terrible AWP thing as means of paying us less than it actually costs us to purchase the darn things on the open market. And don't patients still need referals for their managed care plans if and when they need a higher level of care? How do you and them get around all of that garbage? CAT Scans, MRI's, ortho, gastro, endo, oncology and all the others??? Without a referal isn't the patient SOL basically? I was thinking if we are not in a plan, can we still perform a prior auth or referal, charge for the service of doing such, so as to finally compensate us for all this extra busy work and get the patient the documentation they need to move to the next level? Obviously this charge would be paid for by the patient. $25-$50 so we can afford to have a staff member do all of them. But would most of the plans accept paperwork from an out of network PCP??? It would be glorious.
How come everybody else on everyside of this business, like software vendors, device manufacturers, big pharma, insurance companies, they all have a real free market; and we on our side of the system have been shoved in to this upside down, inside out, out of balance "free market"??? Couldn't you almost imagine hearing John Cleese explaining modern American healthcare from the Ministry of Uncontrolled Stupidity and Greed????
Good Night and Good Luck
Paul
