value added fee

[Guest guest]

This is a very interesting variation on the membership fee

concept. The voluntary fee based on a perception of extra

value.

The extra fee makes me uncomfortable on the grounds that the US spends

more on health care (by a LOT) than any other country in the world,

without any particular advantage in terms of outcomes.

It makes me more uncomfortable when employers pass on increasing amounts

of the burden to their employees, resulting in financial hardship for an

increasing number.

Wal-Mart has taken the ultimate approach: $4000 annual deductible, they

don't cover pediatric immunizations, and have other truly repugnant

policies.

The implication is that primary care is without value: " We'll cover

you if you get so sick you have to see a specialist or go to the

hospital. "

More from the people seeking out care is a tough sell and will exclude

more from care, exacerbating the downward spiral of our health care

system.

On the other hand, primary care is not where the exorbitant health care

dollars are being spent. If we offer same day access, see people on

time, and provide phenomenal evidence-based care based on the " Care

Model " (see Planned Care on my web site

www.idealhealthnetwork.com)

then we ought to get something extra for it.

Some insurers are beginning to notice.

I'm working with a Medicaid HMO in Rochester NY, redesigning office

practices serving inner-city vulnerable population in the North

East. The HMO is willing and indeed eager to pay the primary care

folks for doing the work you guys are doing. We'll test this out in

the next year and go public with it as soon as we have some

data.

My goal is to create a compelling data set and story so that we can all

be paid for the good work that results in the better outcomes.

In the meanwhile, I want you folks to succeed! If you need to do

something along the lines of an extra fee to close the financial gap in

the meantime, do so. Be open with your patients about the problems

and your attempts to fix them. Keep the fee as low as

possible. Give special allowance to those who need your level of

care but can't afford it. Carry your share of the load, but don't

presume to take on more than you can carry or you'll get

crushed.

The software world has precedent here - the idea of share ware

( " Send me $10 if you like the program. " )

Some on this listserv have opened practices with similar fees. It

would be great to hear from them about their experiences.

Does the extra fee get in the way of contracting with insurers?

Is it repugnant to patients?

Have you taken your share of vulnerable populations?

Gordon