Part 2: The Times They Are A-Changin’

Laddie_Head SquareThe first part of this series focused on change coming as a result of the Affordable Care Act.  This post will discuss one change that has already occurred in my healthcare universe and how I expect it to impact my care.

Late in 2012 I received a notice from my internal medicine clinic that they were switching to a cash-only model starting on April 15, 2013.  The primary reason for the change was stated:  “The present insurance environment reimburses independent clinics less than large, corporate practices.  To continue to provide the high quality care that you have come to expect at our office, we need to change our business model.”

Initially I panicked because I thought I was going to be forced to leave a doctor whom I like and respect.  Doing my homework I learned that my insurance will cover visits to this clinic, but it will be as an out-of-network benefit and I will have to file the claims myself.  The out-of-network provision means that any difference between the billed amount and the charges allowed by my insurance company will be my responsibility.

There are actually 3 options for continuing my relationship with this practice.  The first is a straight fee-for-service plan where office visits are billed based on time and lab/procedure fees are reasonable because they lack the high mark-ups traditionally billed to insurance companies.

The second option is a fee-for-service plan with a $300 annual fee for “Enhanced Primary Care.”  This plan provides access to my doctor through phone, email, texts and online care.

Cash Only DoctorThe third option is a Comprehensive Care plan where everything including office/hospital visits, labs, EKGs, phone consults and emails is covered for a fee of $2500.  This option is basically concierge medicine as shown on the TV show Royal Pains (USA Network) minus the mansions, sports cars, helicopters, and obnoxious brother.

After some thought, I decided that my initial panic was unfounded and that I should not make any changes for the foreseeable future.  One reason is that my current insurance through the high-risk pool in Minnesota will disappear in 2014 when insurance companies can no longer refuse me coverage because of Type 1 diabetes.  It seemed silly to find a new internist in 2013 and risk having to change again in 2014.

A second reason is that in recent years I have only seen my internist once a year for a physical.  Despite being the queen of autoimmune chronic conditions for which I see specialists, I’m pretty healthy otherwise.  I figure that if I have no significant changes in my health status, there is no major financial risk to staying with this practice.  As I choose insurance in the coming years, I will need to be sure that I have coverage for out-of-network physicians even if it is with a higher co-pay than in-network doctors.

A third reason is that I will be on Medicare in less than four years.  Although this clinic will be cash-only for regular insurance, it will continue to accept Medicare.  There is a caveat with this acceptance.  In order to stay in the practice with Medicare, you are required to pay the annual Enhanced Primary Care fee of $300.  I am okay with this fee and understand the necessity for it.  Medicare reimbursement is often ridiculously low or nonexistent for many services.  I realize that my doctors and their staff need to make a living wage in order for the practice to thrive.  Also the telephone consults and online benefits included in that fee will be beneficial.

I have an appointment for my annual physical in three weeks and this will be my first visit under the new cash-only model.  I have selected the fee-for-service option because currently I don’t need the benefits of the Enhanced Primary Care or Comprehensive Care models.

Although I was initially frightened by these changes, I am starting to be more comfortable with the idea of a different financial relationship with my internist.  In many ways I think that this change may end up ensuring that I have better medical care in the coming years.

Each of the five physicians in the practice has a personal statement on their website explaining his view of the transition to a fee-for-service model and his future in medicine.  My doctor ended his statement with the following words:

“The decision to no longer accept insurance is the change we needed to make. It was a very difficult one….  I hope that our sensible pricing system reflecting the service and follow-up provided will be understood as necessary to keep our practice viable. I believe that the new care opportunities for visits and consults, telephone and email, will result in better services and allow us to continue to provide the type of care our patients expect and deserve for many years to come.

 I always knew I wanted to be a doctor. I still do. With the patient as my primary focus. Practicing medicine the way it was meant to be practiced.”

Those of the words of a physician that I am pleased to call “my doctor” and I hope that his decision to take the insurance company out of the equation will be a good decision for both of us.