May 30, 2013

Obamacare Consequences

I don't ever remember having a doctor make a house call.  But I do remember seeing them portrayed on television at the time (right along with pharmacies that delivered whatever the doctor prescribed), so I would conclude that it was still a fairly common practice in the United States at the time.

While I can see the challenges of cost and time affecting a doctor's ability to accommodate office hours and home visits, house calls have always seemed like a really smart idea to me.  Doctor's offices are ground zero for taking home more than you came with, germ wise.  When already ill and immune-compromised people are exposed to other sicknesses, the problems are compounded.  There have been times that I would have gladly paid a little extra to have a doctor come to me.

I have read of these 'boutique' or 'concierge' practices, where patients pay a retainer as a sort of annual fee for guaranteed and expedited access to their doctor.  I like that idea, but think it is probably hard to effectively manage the balance between a number of patients that keeps you in business, versus the number that overwhelms you and results in poor care to those that are supposed to have speedy access.

I think that Dr. Michael Ciampi is on the right track:
Dr. Michael Ciampi took a step this spring that many of his fellow physicians would describe as radical.
The family physician stopped accepting all forms of health insurance. In early 2013, Ciampi sent a letter to his patients informing them that he would no longer accept any kind of health coverage, both private and government-sponsored. Given that he was now asking patients to pay for his services out of pocket, he posted his prices on the practice’s website.
It isn't as if you can't use your health insurance, he is simply reverting to the system so many of us grew up with - filing your own reimbursement claims.  Gasp!  The horror of personal responsibility.  It makes perfect sense that there is immediate cost savings from not needing a bloated office staff devoted to filing insurance claims.

Instead of conforming to insurance company's allowed charges, Dr. Ciampi is able to set his own prices, and work with patients who may struggle financially.  He can spend time with his patients, not worrying about throughput to meet high overhead costs.  He is available for phone consultations. 

Isn't it ironic that reverting to a 1960s business model may set a new standard of care in 2013?

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