Medical Practice as a Business

[GRG a/k/a goldenrulegirl]

My primary care doctor dropped me.  By certified mail, return receipt, letter.  I'm not a profitable enough patient for her.  No.  Not today.  But, health is dynamic, not static.  

So, I'm not a fan of running a medical practice strictly as a business.  I understand why she dropped me, but, I don't agree with it.  The practice of medicine is far more than co-pays and re-imbursement rates and kickbacks on expensive lab tests.  Or should be.  

Maybe we need to put an addendum to the Hippocratic Oath.    

Or, at least move lawyers up on the respectability list.  

[gregintenn]

We wouldn't currently have a decent healthcare system were it not profitable.

[GRG a/k/a goldenrulegirl]

See, I think the goal should be to encourage good health through preventative care, not encourage poor choices because there is good care to treat the consequences.

Of course, poop happens even to the healthiest of us. So, don't assume a low-profit patient will always be so.

JMHO. YMMV.

[Miss Tequila]

I'm actually surprised that doesn't happen more often.  I have to assume doctors have a large enough pool of profitable patients to offset those that aren't.  I think that's the problem with HMOs.  A sick person is going to cost a doctor a lot more than they get paid.  That isn't fair to the doctor.  Flip side, a doctor gets paid whether you see him or not.  If there are too many sick patients then the doctor won't make money.

I'm actually surprised any doctors take medicare/Medicaid.  The reimbursements for those to are absolute shit.

[The Walk of the Penguin Mich]

Mar 1, 2016 13:57:19 GMT -5 GRG a/k/a goldenrulegirl said:

See, I think the goal should be to encourage good health through preventative care, not encourage poor choices because there is good care to treat the consequences.

Of course, poop happens even to the healthiest of us. So, don't assume a low-profit patient will always be so.

JMHO. YMMV.

I do understand this logic.  I see my primary care doc yearly, even though I have no problems.  I need prescriptions filled, and occasionally need to see him (like I did as an emergency for the dog bite I had a couple months ago).

However, even though I have no need to see my orthopedist, I do make a yearly appointment to touch base with him.  First of all, while it costs me an office visit and xrays, it keeps me a current patient.  I don't know after how many years, but I think after 3, many drop you from the current patient status and you need to jump through new patient hoops again.  For my orthopod (and for my PCP too), it is WAY easier to get in if you are an established patient vs a new one.  For instance, even though I was an 'emergency', as I was a new patient when I first got in with my orthopod, I had a 6 week wait to see him.  Once I was an established patient and got infected, I got in immediately and he jumped through hoops to see me - even cutting a ski trip short.  

[mollyanna58]

My long term doctor changed to concierge service a few years ago.  I could have stayed with her if I was willing to pay $2,100.00 annually for one super-duper exam and unlimited phone and email service.  Any sick visits would have additional charges.

I understand why she had to make a change; she would answer emails at 4:00am and 11:00pm.  However, I decided it wasn't up to me to support her in the manner she wanted to be accustomed to.

[alabamagal]

I know this is a personal question, and we are not supposed to give out too much info on the internet.....

But I'm curious.  Is it because you are too healthy?

[zibazinski]

Mar 1, 2016 14:05:58 GMT -5 Miss Tequila said:

I'm actually surprised that doesn't happen more often.  I have to assume doctors have a large enough pool of profitable patients to offset those that aren't.  I think that's the problem with HMOs.  A sick person is going to cost a doctor a lot more than they get paid.  That isn't fair to the doctor.  Flip side, a doctor gets paid whether you see him or not.  If there are too many sick patients then the doctor won't make money.

I'm actually surprised any doctors take medicare/Medicaid.  The reimbursements for those to are absolute shit.

The only ones that I know that take Medicare had patients that aged into it

[phil5185]

I'm not a profitable enough patient for her. No. Not today. But, health is dynamic, not static.

So, I'm not a fan of running a medical practice strictly as a business. I understand why she dropped me, but, I don't agree with it.

Not sure that I get it - you don't provide much revenue - but do you cost her anything?  Eg, does her insurance increase appreciably based on number of patients?

[kittensaver]

Mar 1, 2016 15:56:48 GMT -5 zibazinski said:

Mar 1, 2016 14:05:58 GMT -5 Miss Tequila said:

I'm actually surprised that doesn't happen more often.  I have to assume doctors have a large enough pool of profitable patients to offset those that aren't.  I think that's the problem with HMOs.  A sick person is going to cost a doctor a lot more than they get paid.  That isn't fair to the doctor.  Flip side, a doctor gets paid whether you see him or not.  If there are too many sick patients then the doctor won't make money.

I'm actually surprised any doctors take medicare/Medicaid.  The reimbursements for those to are absolute shit.

The only ones that I know that take Medicare had patients that aged into it

Or who work for HMO's . . . .

[CCL]

Mar 1, 2016 16:05:17 GMT -5 phil5185 said:

I'm not a profitable enough patient for her. No. Not today. But, health is dynamic, not static.

So, I'm not a fan of running a medical practice strictly as a business. I understand why she dropped me, but, I don't agree with it.

Not sure that I get it - you don't provide much revenue - but do you cost her anything?  Eg, does her insurance increase appreciably based on number of patients?

I'm wondering the same thing. Why would she have reason to drop you? How do you hurt her bottom line if she seldom sees you?

[Deleted]

Mar 1, 2016 16:05:17 GMT -5 phil5185 said:

I'm not a profitable enough patient for her. No. Not today. But, health is dynamic, not static.

So, I'm not a fan of running a medical practice strictly as a business. I understand why she dropped me, but, I don't agree with it.

Not sure that I get it - you don't provide much revenue - but do you cost her anything?  Eg, does her insurance increase appreciably based on number of patients?

My primary care physician quietly dropped me, and I don't blame him.  He had closed his practice to new patients, and I hadn't been there in several years.  The ob/gyn did my yearly.  The school provides most of my vaccines at no charge.  If I got sick or stepped on a nail, I went to an urgent care clinic.  Medicine has changed since the days when I would take a day off from work and sit in his office for hours, hoping to be worked in.

He did let me make an appointment, even though the practice was closed, for something.  I forget what.  He retired the next year, though.

I still find it hard to go to the primary care physician for "nothing."  But everyone expects you to have one.  I do, but he's really my husband's pcp.  He wants me to have a check-up every six months, which is silly since I also go to the gyn.  So I skipped the winter one.

ETA:  They probably don't want to practice medicine on someone they never see.  There is a certain amount of liability.  If you don't come regularly, they are operating (pun there) in the dark.

We'll see if he notices in the summer.

[GRG a/k/a goldenrulegirl]

Mar 1, 2016 15:49:52 GMT -5 alabamagal said:

I know this is a personal question, and we are not supposed to give out too much info on the internet.....

But I'm curious.  Is it because you are too healthy?

Apparently, so. I swing by once a year for a check-up, get a couple minor prescriptions renewed, and I'm on my way. She gets paid for that visit, but I don't come back again for another year. It's not an HMO -- it's a Point of Service plan. She only gets paid when I see her, so I'm not the guaranteed income a healthy HMO patient would be.

[adela76]

Mar 1, 2016 13:39:11 GMT -5 GRG a/k/a goldenrulegirl said:

My primary care doctor dropped me.  By certified mail, return receipt, letter.  I'm not a profitable enough patient for her.  No.  Not today.  But, health is dynamic, not static.  

So, I'm not a fan of running a medical practice strictly as a business.  I understand why she dropped me, but, I don't agree with it.  The practice of medicine is far more than co-pays and re-imbursement rates and kickbacks on expensive lab tests.  Or should be.  

Maybe we need to put an addendum to the Hippocratic Oath.    

Or, at least move lawyers up on the respectability list.  

I'm not saying you aren't reading between the lines correctly, but I'm curious: what did the actual letter say?  

[Shooby]

  You are "too healthy"?  That doesnt' seem like a reason to drop you.  That doesn't make sense.   Doctors want a lot of healthy patients.  They get paid for those exams and can move them through quickly.  Did your insurance change or something?  Or did the doctor join a different group that maybe doens't accept your insurance?

[NancysSummerSip]

Mar 1, 2016 14:40:11 GMT -5 mollyanna58 said:

My long term doctor changed to concierge service a few years ago.  I could have stayed with her if I was willing to pay $2,100.00 annually for one super-duper exam and unlimited phone and email service.  Any sick visits would have additional charges.

I understand why she had to make a change; she would answer emails at 4:00am and 11:00pm.  However, I decided it wasn't up to me to support her in the manner she wanted to be accustomed to.

Same thing happened to me. I had my doctor for 15 years. And I was dropped with only two weeks' notice. But karma got my now ex-doc. He filed for bankruptcy, so I guess that concierge thing didn't work out all that well. Either that, or he spent his incoming imaginary riches on his two ex-wives.

FWIW, my ex-doc also stopped taking all insurance when he went to the concierge service. He just did not want to be bothered with the paperwork stuff, his nurse told me on my final visit. OK, I get that. It's a pain from my end of it, too. But he's not the only one who ever dealt with it. And as a patient, I did not create the paper problem by staying healthy and only coming in to see you once or twice a year.

[tskeeter]

Mar 1, 2016 16:05:17 GMT -5 phil5185 said:

I'm not a profitable enough patient for her. No. Not today. But, health is dynamic, not static.

So, I'm not a fan of running a medical practice strictly as a business. I understand why she dropped me, but, I don't agree with it.

Not sure that I get it - you don't provide much revenue - but do you cost her anything?  Eg, does her insurance increase appreciably based on number of patients?

Apparently the Doc has been reading too much Harvard Business Review.  Sounds like whatever time is devoted to the OP could be spent caring for patients who yield more income.  (You have a limited number of appointments available, so you make sure you fill those appointments with the most profitable patients).  In the business world, this is referred to as product/customer rationalization.

[CCL]

That doesn't really make sense to me either. When my doc spends more time with us it's because we need more care and he charges accordingly. If we are in for something simple there's no need to spend much time with us. Of course, I know nothing of Harvard Business Review, so maybe I'm missing something.

[tskeeter]

Mar 2, 2016 22:47:38 GMT -5 CCL said:

That doesn't really make sense to me either. When my doc spends more time with us it's because we need more care and he charges accordingly. If we are in for something simple there's no need to spend much time with us. Of course, I know nothing of Harvard Business Review, so maybe I'm missing something.

Depending on the services that the practice is able to provide, such as blood draws, lab work ups, X-rays, therapy, etc., a patient who requires lots of additional services is much more profitable than one who requires only a see lightning/hear thunder exam once every year or two.

[CCL]

Mar 2, 2016 22:58:09 GMT -5 tskeeter said:

Mar 2, 2016 22:47:38 GMT -5 CCL said:

That doesn't really make sense to me either. When my doc spends more time with us it's because we need more care and he charges accordingly. If we are in for something simple there's no need to spend much time with us. Of course, I know nothing of Harvard Business Review, so maybe I'm missing something.

Depending on the services that the practice is able to provide, such as blood draws, lab work ups, X-rays, therapy, etc., a patient who requires lots of additional services is much more profitable than one who requires only a see lightning/hear thunder exam once every year or two.

Hmmm...my doc doesn't do any of that in his office. He sends us elsewhere.

[Phoenix84]

Mar 1, 2016 13:39:11 GMT -5 GRG a/k/a goldenrulegirl said:

My primary care doctor dropped me.  By certified mail, return receipt, letter.  I'm not a profitable enough patient for her.  No.  Not today.  But, health is dynamic, not static.  

So, I'm not a fan of running a medical practice strictly as a business.  I understand why she dropped me, but, I don't agree with it.  The practice of medicine is far more than co-pays and re-imbursement rates and kickbacks on expensive lab tests.  Or should be.  

Maybe we need to put an addendum to the Hippocratic Oath.    

Or, at least move lawyers up on the respectability list.  

So what makes a patient not profitable?  Going to the doctor all the time, or not going to the doctor enough?

I hardly ever go to the doctor, is this something I should be worried about?

On the other hand though, if I'm not going to the doctor, they aren't spending their time on me, but they're there when I need them.

[Phoenix84]

Mar 2, 2016 7:19:02 GMT -5 Shooby said:

  You are "too healthy"?  That doesnt' seem like a reason to drop you.  That doesn't make sense.   Doctors want a lot of healthy patients.  They get paid for those exams and can move them through quickly.  Did your insurance change or something?  Or did the doctor join a different group that maybe doens't accept your insurance?

That's what I thought.  I thought doctors would want a lot of healthy patients to cycle through quickly with minimal work.  I fit that bill, and so does GRG from the sound of it.

[beergut]

Mar 1, 2016 14:40:11 GMT -5 mollyanna58 said:

My long term doctor changed to concierge service a few years ago.  I could have stayed with her if I was willing to pay $2,100.00 annually for one super-duper exam and unlimited phone and email service.  Any sick visits would have additional charges.

I understand why she had to make a change; she would answer emails at 4:00am and 11:00pm.  However, I decided it wasn't up to me to support her in the manner she wanted to be accustomed to.

I think concierge service would be worth it if you are a young parent and have a young family, having a doc constantly on-call would be worth the one-time fee just so you have peace of mind with your kids. $2100 for just one exam and unlimited phone/email is pretty steep, though. 

[Deleted]

Mar 2, 2016 23:41:18 GMT -5 Phoenix84 said:

That's what I thought.  I thought doctors would want a lot of healthy patients to cycle through quickly with minimal work.  I fit that bill, and so does GRG from the sound of it.

I'm sure there are bean counters and analytics somewhere in this. Maybe the revenue on the OP's once a year visit is less than they could get for someone with chronic issues who has more work done per visit. Sometimes generally healthy people ask for advice or prescriptions over the phone on occasion (e.g. They get a stubborn case of poison ivy) and the doc gets nothing from that unless they charge for phone calls, so that's a resource drain with no added revenue.

[tskeeter]

One thing we haven't considered is that GRG's Doc is dropping her because the reimbursements from her insurance carrier are less than other carriers, or because her carrier is so hard to deal with that it just isn't worth it.  Blaming lack of profitability could be a way to make the notification yet avoid backlash from an insurance carrier.

[Anne_in_VA]

Mar 3, 2016 11:23:27 GMT -5 tskeeter said:

One thing we haven't considered is that GRG's Doc is dropping her because the reimbursements from her insurance carrier are less than other carriers, or because her carrier is so hard to deal with that it just isn't worth it.  Blaming lack of profitability could be a way to make the notification yet avoid backlash from an insurance carrier.

That may very well be.  Our PCP has sent out a letter saying they will no longer accept new patients with Blue Cross insurance due to low reimbursement rates.  I have that insurance and I can foresee them dropping us if we continue to have that insurance.  Both DH and I have been going to the same docs for a long time and if we get dropped I think it will be hard to find a new doctor.

[weltschmerz]

Mar 1, 2016 13:39:11 GMT -5 GRG a/k/a goldenrulegirl said:

My primary care doctor dropped me.  By certified mail, return receipt, letter.  I'm not a profitable enough patient for her.  No.  Not today.  But, health is dynamic, not static.  

So, I'm not a fan of running a medical practice strictly as a business.  I understand why she dropped me, but, I don't agree with it.  The practice of medicine is far more than co-pays and re-imbursement rates and kickbacks on expensive lab tests.  Or should be.  

Maybe we need to put an addendum to the Hippocratic Oath.    

Or, at least move lawyers up on the respectability list.  

That's crazy! I don't know how you guys put up with the system you have.

[Sam_2.0]

Mar 3, 2016 12:43:38 GMT -5 weltschmerz said:

Mar 1, 2016 13:39:11 GMT -5 GRG a/k/a goldenrulegirl said:

My primary care doctor dropped me.  By certified mail, return receipt, letter.  I'm not a profitable enough patient for her.  No.  Not today.  But, health is dynamic, not static.  

So, I'm not a fan of running a medical practice strictly as a business.  I understand why she dropped me, but, I don't agree with it.  The practice of medicine is far more than co-pays and re-imbursement rates and kickbacks on expensive lab tests.  Or should be.  

Maybe we need to put an addendum to the Hippocratic Oath.    

Or, at least move lawyers up on the respectability list.  

That's crazy! I don't know how you guys put up with the system you have.

Well, those of us that wanted a system closer to yours got called communists, so.......

[The Walk of the Penguin Mich]

Mar 3, 2016 12:43:38 GMT -5 weltschmerz said:

Mar 1, 2016 13:39:11 GMT -5 GRG a/k/a goldenrulegirl said:

My primary care doctor dropped me.  By certified mail, return receipt, letter.  I'm not a profitable enough patient for her.  No.  Not today.  But, health is dynamic, not static.  

So, I'm not a fan of running a medical practice strictly as a business.  I understand why she dropped me, but, I don't agree with it.  The practice of medicine is far more than co-pays and re-imbursement rates and kickbacks on expensive lab tests.  Or should be.  

Maybe we need to put an addendum to the Hippocratic Oath.    

Or, at least move lawyers up on the respectability list.  

That's crazy! I don't know how you guys put up with the system you have.

After hearing about some of the nightmares my Canadian friend has had, likewise.

She has had 3 surgeries (2 under emergency conditions), which had there not been a 6 month wait, they could have done her repairs properly rather than getting a patch job that failed twice.

[weltschmerz]

Well, yeah. Everything goes PERFECTLY with surgeries in the US. No fvck-ups, no mistakes.