Thursday, August 15, 2013

On Doctors and Having the Courage to Practice Independent Direct Care Medicine
Have The Courage To Be Direct.
Title of book, Anthony  K. Tja, Harvard Business Review Press
I shall be direct.  I have just watched a 4 part video recording the proceedings of an August 10 conference on direct pay medicine. I recommend you view it too.
Dave Racer,  a St. Paul, Minnesota based publisher who has written or published 8 books on health reform,  organized the conference in conjunction with the American Association of Physicians and Surgeons.
You can view the 4-part video at You Tube  or by going to   The video features 14 physician speakers – 11 primary care physicians and 3 surgeons – who have plunged into independent direct pay practices.  These practices also go by the names of concierge, direct, retainer,  and cash only practices.  These practices  share one thing in common – they function outside the realm of 3rd parties -  health plans,  Medicare, and Medicaid.  These and other 3rd parties  do not oversee or pay for physician services.
These things struck me about the physician presenters
·         Courage of converting to independent practice without  3rd party financial parachutes.

·         High level of personal happiness.

·         Satisfaction at spending more time with patients.

·         Feeling of renewed closeness to patients.

·         Diversity of approaches  -some retainer, some not.
  •  Refuting  of  notion that doctors care  only for the well-off.

·         Diversity of patient populations – some insured, some not.

·         Lower costs and more convenience for patients.

·         Simplicity of business models

·         Smaller staffs – many with only one assistant.

·         Skepticism in efficacy of  pay-for-performance,  team care,  evidence-based care, affordable care, accountable care, and practice guidelines.

·         Relief at shedding the encumbrances, expenses, and hassles of 3rd party oversight and payment.

·         Less concern and worries about cash flow

·         Freedom of using clinical judgment to serve patient rather than insurers.
None of these things mean that direct pay independent practice is a wave of the future.   These types of practices go against the grain of Obamacare and managed care.   But these types of practices represent a belief among doctors that they should have the freedom to practice what they were trained to do – evaluate and treat patients - rather than to serve as representatives and intermediaries  of 3rd party payers.
Tweet:  Independent direct pay practices appeal to physicians because of more direct, more time, and  personal  relationships with patients.


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