Family physician Brian Forrest, M.D. started Access Health Care in 2002 to provide low-cost care and spend more time with his patients. Unlike the large practices he left, where each of the 50 doctors saw between 32 and 40 patients a day, spending at most 15 minutes with each, Forrest now sees no more than 15 patients a day and takes an average 45 minutes with each of them.
Lower Prices, Higher Income
Forrest charges a fee of $45 per visit, posts prices for additional tests so patients know what the bill will be, and even does house calls for an all-inclusive price of $150.
How does he do this? Forrest doesn’t file insurance claims. Patients pay with each visit, so there is no delay caused by the office having to wait for the insurer to decide what it will cover.
That also means Access Health can use fewer office assistants, as they need not work through each insurance plan’s intricacies. That translates into lower overhead costs–which in turn means Forrest can charge less and spend more time with fewer patients.
“By not taking insurance we save about $250,000 per year due to not needing the computer systems and extra personnel that are required to file insurance,” Forrest explained. “That means we are able to have 3,000 fewer patient visits per year to actually net more income.
“That reduced volume lets us spend a lot more time with each patient, and charge them between 50 and 85 percent less than typical offices,” Forrest noted.
Insurers’ Anxieties
It makes mathematical and practical sense, but surprisingly few medical practices function this way.
Forrest blames managed-care contracts with insurers. Non-compete clauses in those contracts forbid doctors from seeing network patients for two years after dropping an insurer.
“I think insurance companies feel threatened by physicians that refuse to file insurance,” Forrest said. “However, if they would actually look at the cost savings that can be realized, they would see that this type of model is actually beneficial for them. When patients in our office submit their own claims to their insurance and get reimbursed, their bill is always substantially less than the insurance company would have had to pay if the claim had been filed by a typical office.
“Some insurance companies have actually realized this themselves and have started encouraging people they insure to see us–with the benefit of a zero co-pay because it is such cost-effective, quality care,” Forrest said.
In that scenario, the patient pays for the entire cost of the visit, submits his or her receipt to the insurer, and gets a check back in the mail for 100 percent of the cost.
Modern Housecalls
Doctors Making Housecalls (DMH), based in Chapel Hill, North Carolina, takes a different route to meeting a different population’s health needs. Whereas 30 percent of Access Health Care’s patients are uninsured, fully 80 percent of those using DMH are insured by Medicare.
DMH files all claims for its patients as an out-of-network provider and charges an $85 trip fee that neither Medicare nor private insurers will cover.
Alan Kronhaus, M.D. founded DMH in 2002 on the recommendation of his wife, Shohreh Taavoni, MD. Taavoni saw patients, while Kronhaus ran the business side. The couple now employs four other physicians in the practice, who see a total of 30 patients a day in the Raleigh-Durham metropolitan area.
Advanced Technology
DMH’s old-world house calls are aided by twenty-first century technology.
Patient records are completely digitized in an Internet-accessible database, so physicians have full access to everything they need while on the road. The physical records are kept in DMH’s home office, which also handles insurance claims and scheduling. Physicians go into the office every seven to 10 days to sign papers, and they attend a monthly staff meeting.
Because the doctors spend most of their time on the road, the practice has no physical limitations.
“The practice’s potential is open-ended, because there are so many compelling applications of the service,” Kronhaus said. “But the best way for other groups to replicate our success is to join forces with us. It would allow us to take advantage of the various economies of scale inherent in the business, and to develop enough market power to perhaps get the attention of the commercial insurers.”
Growing Practice
Within six months of opening, DMH began making regular visits to retirement communities. Patients do not pay the trip fee for these community visits.
Kronhaus would like to offer a similar service to businesses.
The four-year experience of Access Health Care and DMH illustrates the problem with current health insurance, Kronhaus said.
“There are bizarre incentives that lead to misallocation of resources,” Kronhaus said, citing a study published in the December 2005 issue of Annals of Internal Medicine, comparing home care patients with those admitted to the hospital. The home treatment produced similar health results with lower costs. But despite the clear savings, Kronhaus said, “Insurance companies really could care less.”
Ability to Expand
Both Access Health Care and DMH would like to expand their services to serve more patients. Similar practices already exist and more are planned, Kronhaus said, citing the Michigan-based Visiting Physicians Association, which now has locations in six states, and Housecalls Express in Florida.
Forrest adds he has been contacted by a score of doctors statewide, including one whose new clinic will cater to Chinese-Americans.
None of this innovation has required more government mandates. But reducing restrictions on providers and insurers to allow them flexibility to meet the needs of patients could accelerate the trend, Kronhaus and Forrest said.
Joseph Coletti ([email protected]) is a fiscal and health policy analyst for the John Locke Foundation in North Carolina.
For more information …
“Hospital at Home: Feasibility and Outcomes of a Program To Provide Hospital-Level Care at Home for Acutely Ill Older Patients,” by Bruce Leff, MD, et al., published in the December 6, 2005 issue of Annals of Internal Medicine, is available through PolicyBot™, The Heartland Institute’s free online research database. Point your Web browser to http://www.policybot.org and search for document #19772.
