To Cure Insurance Woes, Doctors Try Prepaid Plans - Some Say Fee System Cuts Costs, Boosts Care; Dr. Wood's Legal Battle

[Guest guest]

To wrap up the direct pay subscription discussion...stumbled on another example while researching the Medicare annual wellness and annual fee examples.

 

http://online.wsj.com/article/SB119300947082066420.html

 

To Cure Insurance Woes, Doctors Try Prepaid Plans

Some Say Fee System Cuts Costs, Boosts Care; Dr. Wood's Legal Battle

WHEELING, W.Va. -- Vic Wood's walk-in clinic here sees patients six days a week and logs roughly 15,000 visits a year. Its sparsely furnished waiting room is packed much of the 11-hour day with people seeking care for conditions ranging from sore throats to chest pains.

Despite the booming business, Dr. Wood and his staff -- another doctor and four physician assistants -- have battled strong head winds to keep the clinic going. Rising administrative costs and flat insurance-reimbursement rates make it tough to cover basic expenses. One in five patients lacks insurance; others are saddled with sky-high deductibles. Last year, Dr. Wood even cut his annual salary by half to help keep the clinic afloat.

In an attempt to turn the tide, Dr. Wood is trying a new approach -- one that he hopes will one day sustain his practice.

For a monthly fee of $83 per individual or $125 for a family, the clinic provides unlimited primary and urgent care. Those who enroll in the prepaid plan get office visits, lab work, X-rays and as many generic drugs as the clinic can provide.

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Dr. Wood runs some acute care clinics http://doctorsurgentcare.com and a Primary Care Clinic http://www.primarycareone.com/ .

Pilot ProgramDoctors Urgent Care is offering a clinic-based health care pilot through a program administered by the West Virginia Health Care Authority. As part of this program, we may submit certain medical data to the state so that they may assess the progress of the program. No information that would identify specific patients will be submitted to the state.

http://doctorsurgentcare.com/primarycareone.php

Primary Care One

Visit PrimaryCareOne.com for more details of Primary Care One.

Single: $83.00 / monthlyFamily: $125.00 / monthly

Primary Care One at Doctors Urgent Care is a Clinic-Based health care program that allows you to pay for your preventive, primary and urgent care provided with one low monthly payment. There are no claim forms, copayments or prior-authorizations.

Pre-existing conditions accepted Workers’ compensation cases accepted- initial visit only

Personal Benefits

Truly Affordable Health Care For Individuals and FamiliesAt last, health care that individuals and families can afford. Primary Care One is a clinic-based health care program that allows you to pay for your preventive, primary and urgent care provided by Doctors Urgent Care in Wheeling with one low monthly payment. There are no claim forms, copayments or pre-authorizations.

Business Benefits

Truly Affordable Health Care For Business And Employees At last, small and mid-sized businesses can offer employees a health care benefit that is affordable for families and individuals. Primary Care One is a clinic-based health care program that allows you to pay for your preventive, primary and urgent care provided by Doctors Urgent Care in Wheeling with one low monthly payment. There are no claim forms, copayments or pre-authorizations

 Payment Plans

At signup, two months payments are due and a one year contract is signed. Monthly payments thereafter are done automatically through auto-debit from a checking account or billing to an authorized credit card.

Cancellation of your contract requires a 30-day notice. Your participation will stop at the end of the 30-day notice. You may still receive services at our clinic by paying the cost of each service at the time it is rendered as is the case with any walk in patient.

If you are participating as an employee of an employer group and the contract is cancelled due to employer nonpayment we will provide you the opportunity to participate as an individual or as a family.

Services Provided

The following is a description of services that will be provided to you as part of your participation in the Primary Care One Program:

Primary care medical services such as treatment for minor illness, cold or flu; Medical services for the treatment of illnesses such as diabetes, asthma and cardiovascular ailments that do not require the follow-up of a specialist; Post-surgery, follow-up care as is medically appropriate; Preventive services such as an annual physical, and routine blood and lab tests; Lab services and X-rays provided on location at Doctors Urgent Care, including: chest X-rays, strep test, EKG, cholesterol test, blood sugar, pregnancy test, PSA and more; Minor urgent care treatment for: sprains, minor lacerations, first and second degree burns; Office procedures such as: I & D abscess and cyst, hemorrhoid treatment, nail removal, cryotherapy, pap smear tests, digital rectal examinations; Injectables including: B-12, Benadryl, Claforan, Dexamethasone, Lincocin, Nubain, Phenergan, Rocephin, Tetanus, Toradol, Valium and adult flu and pneumonia vaccinations; Gynecological care that does not require the follow-up of a specialist; Mental health treatment for minor depression; Health and disease counseling to help improve your health status and better manage your health; 24-hour, call-in number for your use if a medical condition presents itself after hours; Limited generic drugs:* Some drugs have zero copayment. Others have a $10.00 copayment.

 

08/19/10Area Program Offers Affordable Option for Access to Health Care 03/26/10Health Care Legislation Paves Way for Direct Primary Care Medical Homes to Compete in Ins. Exchanges 03/13/09The Center for Health Transformation List Primary Care One in Best Practice Compendium 04/20/09President Obama, ask the patient what they need! 12/10/07To Cure Insurance Woes, Doctors Try Prepaid Plans (Taken from Wall Street Journal) 05/19/09Crisis in healthcare: Does Vic Wood have the answer? 04/20/07Clinic-Based Health Care Makes Its National Debut 04/16/07Press Conference Announced for April 16th

 

Part of article... http://www.doctorsurgentcare.com/publications.php?id=88

 

Crisis in healthcare: Does Vic Wood have the answer?05/19/09

NIHCM Foundation Health Care Journalism Award-Winning Article for Trade Publication Category Publish date: Dec 15, 2006 By: Lowes

Story taken from Medical Economics - memag.com

Prepaid primary care means predictable costs Wood isn’t the first in West Virginia to charge a retainer for medical care. Coal mining companies used to deduct a few dollars each month from a miner’s wages to pay the company doctor. And two federally qualified health centers offer similar programs. One called Valley Health, for example, guarantees up to $3,000 worth of care—everything from office visits to medications—to uninsured working people in Cabell County, WV, for $72 a month, an amount usually split between employer and employee. With average monthly expenses per enrollee at $80, the program nearly pays for itself, says health center administrator Lanie Masilamani. Surprisingly, only about 80 people are participating.

" We have no idea why the number is so low, " says Masilamani, whose program was approved by the state legislature. " Our best guess is that people think it’s too good to be true. And healthy people in their 20s may not see the value in it. "

Wood says he seized on the idea of prepaid primary care for the uninsured in 2003 when he read a magazine article about concierge medicine. He knew he couldn’t charge a yearly retainer of $5,000 in hard-luck Wheeling as some concierge doctors do in affluent suburbia. But what was the lowest amount he could charge and still earn a reasonable profit? To answer that question, Wood had to estimate how much care a typical patient would need.

" I didn’t look at how many visits a patient averaged each year. Instead, I looked at the total number of services—labs, X-rays, and procedures as well as visits. I estimated that the average adult needed about 20 services a year. And I estimated that $1,000 a year would cover them. "

This math translates into Wood’s retainer fee of $83 a month for an individual. A family pays only $42 more. Enrollees are entitled to unlimited office visits; any service the clinic provides, including labs and X-rays; and healthy-lifestyle counseling. Wood throws free injectable medications, crutches, and splints into the deal. He treats sick children, too, but refers them elsewhere for immunizations.

Wood made the plan available to his staff, then advertised it to the community, envisioning that small businesses might even purchase it for their employees. His first taker was a self-employed music teacher named Yuncke. It was good timing for Yuncke, who was diagnosed with high cholesterol.

" Between the lab work and the Lipitor samples, I’m definitely getting more than my money’s worth, " says Yuncke. " I feel like I’m cheating Vic. " In all, 50 people other than employees have signed up for prepaid care so far. " Two thirds are individuals, " says Wood. " The average age is 37. They’re typically employed, so they make too much money to quality for Medicaid. "

Is he breaking even on them? So far, says Wood, the demand for services seems to be staying within his original estimates. =======================

http://www.doctorsurgentcare.com/uploads/03-26-10_3j_HealthCareLegislation2010.pdf

 

Health Care Legislation Paves Way for Direct Primary Care Medical Homes to Compete in Insurance Exchanges

Flat-Fee Health Care Option Provides Patients and Small Businesses Lower-Cost Alternative to Traditional Insurance Plans

SEATTLE, WA--(Marketwire - March 23, 2010) - A relatively little-known provision in H.R. 3590, the Patient Protection and Affordable Care Act, signed into law by the President today, creates an affordable new choice for individuals and businesses by allowing flat-fee direct primary care practices, commonly referred to as " medical homes, " to compete within the state-based insurance exchanges where many Americans and small businesses will be able to shop for health coverage beginning in 2014.

This provision enables Americans to elect a more affordable health care option to traditional insurance plans -- an alternative in which patients and/or employers pay a flat monthly fee directly to a primary care provider for all primary and preventive care, chronic disease management and care coordination throughout the entire health care system. Under the new law, a flat-fee direct primary care medical home membership can be bundled with a new, lower-cost " wrap-around " insurance plan that covers unpredictable and expensive services outside its scope, such as specialist care, hospital stays or emergency room visits.

Direct primary care practices already exist in more than one-third of U.S. states, offeringaffordable health care alternatives to more than 50,000 Americans, according to the Direct Primary Care Coalition (

www.dpcare.org).

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Locke, MD