One Size Does Not Fit All In Healthcare
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Healthcare has changed over the decades in many ways. We’ve all been through the roller coaster of changing insurances, often from PPO to HMO, and back to PPO, learning that the $10 co-pay isn’t all it’s cracked up to be. Access, quality and cost of care are all major components in healthcare’s changing landscape. The number of primary care providers has declined while the demand continues to rise. This imbalance has left both doctors and patients redefining what’s important to them. A positive result in all this is the opportunity to choose which level care and service are most important to you and to your family.
The Insurance Model
For many, the insurance model works. It’s not perfect, but it meets many of the basic needs of the patient. The cost for an individual visit is generally paid in part or whole by the insurance company unless such services fall to the deductible. In this model, patients work their schedule around the availability of their healthcare provider.
A patient’s choice of provider is also limited by the insurance plan. Patients share the doctor and office staff with an unlimited number of other people. Calls are returned at the leisure of the staff, and if the patient wants to talk to the doctor, it may or may not be an option unless there is a face-to-face appointment scheduled. This disconnect isn’t because doctors don’t like patients, it’s simply a numbers game.
Insurance-based practices have to increase volume in order to pay the bills. Since insurance reimbursement fluctuates, and billing doesn’t necessarily match receipts, doctors have to over accommodate for lost revenue. Keep in mind that the physician’s business office, the portion of the staff that chases after insurance payments, is often their highest cost center. Services and testing offered in this model are often dictated by what insurance will cover, rather than what is in the best overall interest of the patient.
Fee-for-Service
People wishing to get off the HMO treadmill (as we call it in medicine), will often move to a fee for service model. This type of model isn’t new; it’s actually centuries old. Doctors used to be paid in cash or livestock at the time of service. A fee-for-service medical practice may be open to the public but there are few patients.
The offices are generally more comfortable and the staff and doctors spend more time in the room because they don’t have the expense of a costly billing department. Some fee-for-service practices give the option to upgrade for more access and preference. Fee-for-service practices may also offer testing that is outside of insurance dictates. The focus of this model is generally more wellness driven. While not required, some fee-for-service practices will give coded receipts for individuals to obtain possible reimbursement from their insurance company.
Luxury Medicine or Concierge
When you pay to join a private club, you pay for the experience, the expertise and the exceptional perks that come along with membership. The same holds true in luxury medicine. True luxury medicine practices are rare, but they all include a concierge type model. In concierge medicine, the patient is given a higher level of priority.
The physician’s time is scheduled around the patient’s availability with same day or next day visits and patients often have direct access to the physician via their cell phone. Patients at this level only share their doctor and staff with a limited number of other people. The office is much like a five-star country club in both the aesthetics and the attention to detail by the staff and physicians.
The perks and packages include extensive testing that yields a personalized game plan for better health. The focus of this model is on health, wellness and longevity. The goal is to optimize health. Services offered in luxury medicine are generally cutting edge and highly experienced physicians spend numerous hours on continuing education. Some luxury practices will provide coded receipts when applicable, but keep in mind that not all services and tests will qualify for insurance reimbursement. This is the Ritz of healthcare and once patients experience it, they rarely go back.
Bio: Judy Gaman, MS, BSHS is the CEO of Executive Medicine of Texas. She is a graduate of George Washington University and currently attends Harvard Extension School. You can hear her on the KRLD 1080 on Sundays at 4 p.m., along with Drs. Mark Anderson and Walter Gaman, as they host the nationally syndicated Staying Young Show. You can learn more about the Luxury Medicine programs at Executive Medicine of Texas by visiting EMTexas.com
