Taking the Bait of Third Parties

One of the biggest fears I have is that DPC will get so popular that insurance companies will want to work with us and by working with us I mean control us.  Read this editorial and then read our conversation

  1.  I agree with this dude 100%. I pray that none of us take the bait and get hooked into Medicare, Medicaid or the insurance companies and start this same bad dream all over again. This is my opinion and I am open for debate here. Not all of you may agree so let’s hear it. If there were rules in the DPCU then I would dream that it would say NO PARTNERSHIPS with the government or insurers. Thoughts?
  2. We should and need to be beholden to our patients and ourselves, NOT a 3rd party with conflicting interests. Wendy and I are working on developing contracts with local employers to provide care to their employees and families but we’re sensitive to the need to make sure the contracts stipulate our relationship is with the individual patients. We can all appreciate why Medicare/Medicaid and insurances see this as attractive, but until they have the same alignment of incentives as we have with our patients (btw, they never will) we need to avoid any direct relationship otherwise we risk everything all over again. While direct primary care is simple at it’s core, it’s NOT easy to make it work, and having risked so much, we simply cannot hand anything back to the forces that are ruining the current US healthcare system.
  3. I met w an insurance CEO last week. i explicitly told him that the only way we can work together is if doctors are allowed to practice medicine and not be employed by the insurer. he seemed to get it….for now
  4. insurance companies and govt are never going to go away completely so i think we need to find ways to work with them and not for them for DPC to ever really go mainstream. i do think there are ways to not sell out of what our objective is but be reasonable w our approach. we actually have the control if more docs unite. without us insurers are screwed and we need to show them that en masse
  5. we have to hold true to the basic tenet of working for our patients and not being beholden to outside influences . . . to me, that’s why we’re in this!
  6. Im sorry, but wtf?!!! If any DPCers are interested in contracting with the insurance companies then get out of DPC.
  7. here is a difference between INDEPENDENT practice and DPC. And I think we could do a better job saying this. People can design whatever care model they want. I think there’s an exuberance among system employed physicians when they realize they can go on their own and be their own boss. DPC is not the only way to do it however. And if you bill a patient cash once it does not make you a DPC doctor. As we all mentor others we may want to consider how clear we are with this message. There’s been a lot of discussion about hybrid type DPC situations. I don’t think a hybrid situation is DPC. I know that offends some and Nexterra has made a good go of it … But the doctors I know who want to do DPC but still maintain some insurance relationship have a far more complicated situation and, strangely, seem to not fundamentally understand DPC. . . As far as I’m concerned people on the underground can do as they please but the majority of existing insurance opportunities would render the practice model not true DPC
  8. Agree 3rd party paying risks them controlling/ruining DPC. Agree that those who are new to DPC may see 3rd party involvement as less risky and this could undermine the DPC movement. Possible exception to this-Liberty Direct (I know docs on here have different opinions). 10 of my 60 pts have LD and so far so good-LD has not attempted to be involved with my care at all. Still would be best to have pts pay directly in my opinion. Other involvement risks mal-aligned incentives.
  9. Bottom line is that monthly payment from patient to doctor = DPC. Monthly payment from insurance company to doctor = capitation. Didn’t work before. Won’t work now.
  10. It is tough to turn down money. They is how Medicare got accepted in the 60s. The dentists turned it down. Then the HMOs suckered us in as well. We lose every time because we are greedy. Will you turn down 400 patients at $60 per month if an insurance offers it to you? Remember, though, everything comes with strings attached. Soon they add qualifiers, metrics, hoops, etc and then you are fucked (no offense to anyone who doesn’t like that term or likes getting fucked by insurance companies). Slippery slope indeed. Say NO now.
  11. We must remember that if someone is bringing you patients, whether it is an insurance company or employer, they can take them away as well. I talk to employers because I want to grow my practice, and adding 20-50+ patients at a pop is great for the bottom line, but on the flip side, if the employer ends a contract, the vast majority of those patients go away, even if you (and the employer) make it clear that they can stay if they are willing to pay their own freight. I had this happen on a small scale. I had a dozen employees of a company whose membership was paid by the employer. The employer changed insurance to one which was not as DPC friendly and stopped paying. While all patients were happy with the service, only two were willing to reach into their own pockets. Too bad because the insurance they got was shitty and they still would have been better off staying with me. They were so conditioned that they could not see the big picture.
  12. EXACTLY my issue with employers as well. I want people to 100% free without any strings or nudging to buy in to our services. I invest a ton of time and energy on developing a great relationship with new patients. Obviously, individuals and families can and do leave our care for a variety of reasons, but the employer entanglement makes that much more likely to happen in my experience.

    The insane part is that people would NEVER put up with this type of BS in other areas of their life — groceries, hair stylist, etc. But, sadly people have become accustom to changing PCPs frequently because of such matters.

  13. It is better to have 600 individual bosses because if two or three fire you, it affects less than 1% of your income. If you have 6 bosses (i.e. 6 employers with 100 patients each) and 2-3 fire you, you just lost one third to half of your income.