Wednesday, March 5, 2014

President Obama – Concierge Medicine Salesman

"ObamaCare helps the concierge medicine movement.  President Obama is the direct care salesman of the year.  ObamaCare will  drive people right to our door. "

Josh  Umbehr, MD,  Concierge Medicine Practitioner, in  Medinnovation and Health Reform blog interview

Recently I interviewed Dr. Josh Umbehr,  a concierge physician in Wichita,  Kansas,  He is one of three physicians in a thriving  direct pay practice.  The practice is based on the premise that patients will willingly pay  monthly fees  for an insurance-free practice  for convenient  personal  24/7 cell phone  access to physicians  who offer unlimited time for a one-on-one relationship with a physicians,  same day appointments, free procedures, biopsies,  lesion removals,  lab,  and other tests,  wholesale prices for generic drugs,  and reductions of  premiums from  health insurers  with  an overall savings in their health care expenses. 

As part of that interview, Umbehr made the statement that President Obama is concierge medicine’s salesman of the year.    Umbehr’s statement rested on his belief  that ObamaCare was driving up costs of premiums and deductibles, causing millions of  patients to lose their health plans,  and creating uncertainty, anxiety,  and confusion among patients about present and futre access to doctors.  
Umbehr  expressed great satisfaction  over the fact that he had not had to code during his 3 ½ years in practice.  This and other factors allowed him and his two partners to have a staff of  two registered nurses, one half-time, while similar  traditional practices may require a staff of 20 or so members.

 Coding  for 3rd party payers, either  private insurers  or government programs.  like  Medicare or Medicaid,  drives up costs.  Doctors have to hire staff to properly code to be paid.   Their staffs may grow to 5 or 6 just to enter the data for the codes,  to select the right code,  to document the code, and to hassle with the payer about the validity of the code.

As ICD-9 coding now stands,   doctors have to pick and choose among 1700 codes  to find the right one.    This will change in October 2014 when new ICD-10 codes, which will number 150,000,  will be introduced.    This can be a logistical nightmare among physicians, causing them to hire new staff, and resulting in decreased productivity with  lower reimbursement revenues because of the lower payment rates.

According to a 2008 study,  the total cost of the ICD-10 implementation would be $83,290 for a small practice (3 physicians and 2 administrative staffers), $285,195 for a medium practice (10 providers, 1 professional coder, and 6 administrative staffers), and $2.7 million for a large practice (100 providers, 10 full-time coding staffers, and 54 medical records staffers).  Code costs will be higher in 2014, may require an electronic health record system to cope with,  and  will  lead inexorably to  higher costs.

The new coding system ,  which President Obama and CMS endorses,  is yet another example why Obama is  a salesperson in disguise for direct concierge care and for physicians fleeing from government sponsored health plans.

Tweet:    ObamaCare, besides  creating higher premiums and deductible,  is backing an complicated new ICD-10 coding system, in the process,  driving doctors into concierge direct pay practices.


1.       Grace-Marie Turner,  “New Rule Creates Avalanche of Time Wasting Paperwork for Doctors : Is There a Code for That?“ Investors Business Daily,  March 4, 2014.

2.      Stephen Hayes,  “Coding Chaos:  another Nightmare for Doctors, Courtesy of the Federal Government,  The Weekly Standard,  March 10, 2014.

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