Robert L. Sharp: A medical revolution

February 7, 2009 

There is a revolt afoot across the land.

Doctors are rebelling against the burden of health care insurance paperwork. They are rebelling against having to deal with upward of 12,000 procedure and drug codes that add expense and time to their practices, keeping them from giving full attention to patients.

This means fewer and fewer doctors are going into general practice, opting instead for specializations, which double their income and insulate themselves, to some degree, from the burden of health insurance paperwork.

This movement is called in some cases "concierge medicine" or "direct care medicine," some of whose doctors belong to Society for Innovative Medical Practice Design (www.simpd.org).

Others follow a model of medical practice also known as an "ideal medical practice" (IMP) Web site www.idealmedicalhome.org, who mostly do not charge annual retainer fees and may or may not accept insurance.

They do, however, have a shared goal of a better patient-physician relationship with a commitment to better accessibility and communication. IMP doctors may be found at www.impmap.com.

Compare your doctor with mine:

Your doctor: you have to wait some time for an appointment. Your doctor spends less than 15 minutes with you before referring you to a specialist who, in turn, takes a long time to see.

My doctor: I can have an appointment the same or next day or whenever is convenient for me. My doctor will spend as much time with me as we both feel is necessary.

Your doctor: You check in with a receptionist who gives you forms to fill out. You stew in the waiting room for some period of time before being ushered into an examination room by a nurse who asks all the same questions you already provided. You wait for another interminable time (without the out-of-date medical journals and golf magazines that were outside).

My doctor: He meets me at the door since he has no nurse, receptionist or other staff, which keeps overheads -- and his charges -- low.

Your doctor: You have no idea what the charge will be (and if you have good insurance, you don't care).

My doctor: He posts his charges on his Web site so you can compare with the competition.

Your doctor: His or her office contains a wall of paper files that are sometimes hard to find and prone to error.

My doctor: He takes down all information on his laptop as we talk (which he takes home with him so he can respond day or night rather than rely on paper files moldering in the office).

Your doctor: The office is covered with little pharmaceutical trinkets, such as pens, coffee cups, pads of paper or candy jars given by extraordinarily well-dressed and attractive young drug reps who leave behind samples of their wares and paper the office with their sales material. They often even bring in lunch for the whole office.

My doctor: He will not accept any goodies or samples from drug reps since he feels it is bribery. See www.nofreelunch.org.

Your doctor: Generates an additional fee by making you come in to see test results; same to obtain a prescription.

My doctor: E-mails or faxes test results to you (available to discuss by telephone) and sends prescriptions directly to the pharmacy.

Your doctor: House calls? You have to be joking.

My doctor: He will make a house call if necessary, even on a Sunday.

Your doctor: Hard to communicate with. Some will share their e-mail address, but that's rare.

My doctor: He answers his own telephone and communicates with you by direct telephone or e-mail.

What's the catch? To keep costs down, my doctor doesn't accept Medicare or Medi-Cal, both of which require a blizzard of paperwork. He does not participate in any HMO plans or Workers Compensation.

He does accept several leading insurance companies' PPO plans, but not those that make him jump through exhausting paperwork or telephone hoops. There is a fee of $120 per calendar year per family.

A unique practice closest to Merced is in Modesto: St. Luke's Family Practice, whose Web site is www.stlukesfp.org. They are a nonprofit that charges "benefactors" an annual fee of about $1,300.

In turn, it takes this money to pay for the health care of "recipients," people who cannot get health insurance and do not qualify for government-sponsored health care either. It has also been called the "Robin Hood model" where money is taken from the more well-to-do to benefit to the less well-to-do.

The closest concierge or "retainer-based medicine"-type doctor to Merced is in Fresno. Han-sen-Smith Family Medicine. Web site: www.hansen-smith.com. Annual fees may be seen on the site.

Robert L. Sharp grew up in Linden (population 1,000) and spent most of the following 30 years as an international banker in Asia, including four years as a Naval officer in that part of the world.

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