But by setting your own reasonable fees for services, physicians can see 15 to 18 patients per day rather than the 60-patient cattle-call model you might find while practicing under insurers’ thumbs. Plus, you won’t need to bring in a physician’s extender, such as a nurse practitioner or physician’s assistant, to help manage the patient load, nor the extra management staff to deal with endless insurance issues.
A 2009 survey in the journal Health Affairs found that physicians reported spending three hours weekly interacting with insurance plans, while nursing and clerical staff spent even more time. The national time cost to practices in an insurance model was $23 billion to $31 billion annually, approximately $26-$33 billion using 2016 figures.
Today, Good spends the bulk of his practice time in a concierge setting, where patients pay an annual $1,800 fee and in turn, receive a comprehensive annual exam and a host of ancillary services–such as keeping patient’s medical records on a thumb drive for portability, a monthly newsletter, an on-staff healthcare coach for weight control issues, exercise advice and dietary counseling, as well as 24/7 access to Good.
“If I’m home or away, they have access to my cellphone and there’s never a time they cannot reach me,” he says. Good has 94 patients in his part time concierge practice. The typical concierge model has about 600 patients vs. 2,500 or more in an insurance-based practice.
The American College of Physicians has criticized the way doctors are paid by insurance carriers, saying that it has warped the way medicine is practiced, devaluing vital services such as doctor-patient discussions while pumping up rewards for expensive procedures and bigger volumes.
“We used to submit a claim, and two or three weeks later we got reimbursed. Then it became five weeks and six weeks, and then they said they never got that claim even though it was sent electronically,” says Craig Koniver, MD, an insurance-free primary care physician in Charleston, South Carolina, and author of Connected: The New Rules of Medicine.
Koniver says insurers then needed notes to support each visit or procedure, found cause to deny claims repeatedly and eventually his practice was spending inordinate amounts of time chasing down insurance reimbursements. It was time being taken away from patient care.
Good says many of his colleagues have either sold their practices to hospital systems or for-profit corporations, losing their autonomy, or formed concierge practices.