From the Streets of New York: A Tale of Three Medical Offices

Direct Pay = Relaxed and Happy Doctors

I had an 11 AM appointment at Dr, Kristina Janson’s Office this week but I was a little early so I made two stops beforehand to a few FairCareMDs. This story is about that morning and the view we see every day at FairCareMD.

Office 1: The Problem Doctors and Patients Face

First I saw my old friend Dr. Hussman. He showed me the effect of Medicare’s payment reduction on his MRI reimbursment rates. In this case the normal rate of 656 was cut down to 424 for an MRI. While that is terrible for his business, it isn’t as bad as what a Third Party Administrator (TPA) pays after they take their 45% cut of the payment from Medicare. With a huge overhead and one of the best MRI facilities in the country, he asked what we could do. So we went in to his profile and reduced his list prices to just above what he will accept. Not so low that Medicare will accuse him of undercutting their rates, but reasonable. So the $1,250 MRI in his profile is now $675. Nice Price Cut Dr Hussman! That should help!

Office 2: The Insurance-Based Practice

And then I stopped by another friend’s office. He wasn’t in but two of his partners and twelve of their staff were. There were also a good 25 people in the waiting room, which resembled a bus station. After waiting 15 minutes I spoke to the office manager and explained FairCareMD to her. Her office was like a mountain range of papers, she had just fired one of her twenty total staff members, and was spending her day calling insurance companies. A patient was called to an exam room and wandered, confusedly, into her office. While the doctors there are good ones, doing the math they must see at least 50 patients a day each. They take Medicare, Medicaid, and are in network with every other insurance plan. My friend, one of the owners, says they are barely turning a profit – and believe it or not I hear this all the time from practices like his. I have visited over 3,000 medical offices in the past six months and this is all too common. Meanwhile, chaos is barely constrained and few people feel cared for. After passing on my message to the very nice, but clearly too busy, office manager, I hurried to my 11 o’clock.

Office 3: The Direct Pay Office

Since I am the only person I know who can arrive an hour early and still manage to be late, the first thing I did when I arrived at Dr. Kristina Janson’s office was apologize. Nick, behind the counter, was forgiving and happy to see me in his newly empty waiting room. I heard about his bed & breakfast upstate and were chatting about his practice when a gentleman who brought back warm memories of my grandfather came in with his attendant. While walking between two exam rooms Dr. Janson detoured to the waiting room to say how pleased she was to see him and gave him a hug (yes, an actual hug!) and asked how he was doing. It was like seeing two long lost friends meet again. The warmth was real and the conversation was not just medical but covered the whole biopsychosocial spectrum they talk about in medical school and what you and I think of as ‘chatting about life.’

After the medical mill I had just jogged over from, being in a direct-pay practice that is run beautifully by happy and wonderful people was like culture shock. What is the difference? Let’s take a look at the numbers:

A Tale of Two Offices
Description	Insurance	Direct-Pay
Doctors	4	3
Staff	20 19	1
Staff per Doctor	4.9	0.33

Patients per day	50	15

Office Visit Cost/ Paid	300 / 47-300	200 / 200

Doctor State	Harried	Relaxed

Patient State	Confused	Cared for

When you look at it this way it makes sense. In order to give great care the Direct-pay practice needs far fewer staff members and can pay them better, retaining only the best. They also don’t have to have inflated prices for people paying directly (even though the list price in the insurance practice is $300, they are rarely paid anywhere near that amount by Medicaid or many insurance companies.) Finally, and most importantly, the doctor has time to spend with you, not just to see you but to SEE you and get to know you – and this is what puts the care back in to healthcare.

The Moral of the Story: Direct Care is Better Care and You Have A Choice

Every doctor visit and every day in your practice you have a choice. It is your health and your practice. It may seem like a radical change to go out of network or take direct pay patients but it does not have to be. Not every revolution needs a guillotine. Change can be gradual and evolutionary rather than radical and immediate.

Patients: Try a FairCareMD and see the difference! Better yet, ask your doctor about direct pay and learn how he or she truly feels. Your doctor went into medicine because she or he cared enough to devote their lives to healing and helping but the current model is not conducive to caring interactions like Dr. Janson’s. Insurance companies, TPAs, and the government add so much cost to delivering care that the people who actually give the care get only about 14% of every healthcare dollar spent. Not fair at all, in my opinion.

Doctors: List your services with a fair price. Give a great description so people can see what they will get for their money. Take great care of that first FairCareMD patient because most of them leave reviews. That one review, if positive, will turn into two patients. When you have five reviews and a steady flow of direct pay patients maybe you can fire your least favorite insurance company – and won’t that be nice! When you have a hundred, maybe you can be relaxed and happy and enjoy your work again. Try it, what do you have to lose?

How to get started?

Patients: Just go to the home page and search for what you need. If you don’t find it tell us what you want and one of our amazing patient advocates we will get great prices from great doctors for you.

Doctors: Start here with one offer and a free profile. Oh, and Dr. Janson says it is OK to copy her sign when you are ready for it – no royalties or anything – I told you she was nice!