Remember when medicine revolved around patient care rather than ICD codes?
While the days of country docs trading chickens for childbirth are long past, the simpler practices of yesteryear are making a strong comeback thanks to a handful of practitioners committed to a ‘new,’ old model of medicine.
Recently, Bernard Health and Fifth Third Bank co-hosted the Fourth Annual Healthcare Reform Seminar featuring Middle Tennessee practitioners who’ve opted out of the insurance game in favor of a direct pay or concierge model of healthcare.
“Our view is that primary care fee-for-services is the wrong business model,” said Alex Tolbert, founder of Nashville-based Bernard Health. “A subscription-based business model is much better for the doctor and the patient, since the driver is the customer in healthcare: the patient.”
According to Tolbert, elimination of the tax benefit that caused employers to have group health plans is pushing employers to adopt strategies that involve individual plans. Tolbert’s company, which facilitates coverage transition for employers and helps employees and individuals evaluate healthcare options, now operates seven retail stores in four cities including Nashville. The non-commissioned staff provides consultation on a range of issues from medical billing, Medicare, or COBRA advice for individuals to HSA and benefits brokerage and advice for employers.
Robert Tomsett, PA, of GracePointe Healthcare in Franklin was one of the panelists at the August seminar. Tomsett’s practice is a direct pay model, offering comprehensive healthcare options for individuals and employers. GracePointe has been voted ‘Best in Primary Care’ by the Toast of Music City Readers’ Choice Awards two years running.
“I saw the nonsense medicine had become with the rat wheel of getting patients in and out, getting reimbursed and keeping patient load up because of the extra cost of just trying to get paid,” Tomsett said. “There was a constant whip cracking, and I was spending so little time with patients and not investing in the relationship part of medicine.”
In 2011, Tomsett was offered the chance to take over an established primary care practice. “My first thought was, ‘heck no,’ but then I started researching direct pay and realized it would get me back to practicing medicine the way I feel called to do medicine,” said Tomsett, a former flight and Green Beret medic. “I wanted to have a relationship with my patients, where they trust me and I trust them.”
The transition wasn’t easy. For three months, Tomsett alerted patients of the change … 75 percent left. And then there was Medicare. Government regulations allow a practitioner to opt out once a quarter, and paperwork must be submitted 30 days before the beginning of the quarter. In the interim, Tomsett couldn’t see Medicare patients unless it was for free.
“I had patients in limbo for 90 days where I could not charge them so I saw them for free and made sure I took care of those who couldn’t stay,” Tomsett said. Patients soon trickled back in, however. He saw 75 his first month and took a 75 percent salary cut that first year. Three years later Tomsett is much closer to his original income thanks primarily to word-of-mouth advertising – GracePointe’s primary source of referrals. Tomsett has also invested in paid advertising, since insurance companies no longer funnel patients his way.
The second biggest challenge, Tomsett said, was educating patients on the new system. “Once patients get it and understand the overall savings, they switch to a high deductible plan and save so much money,” Tomsett said.
Many patients rely on health savings accounts or submit claims for the out-of-network provider. Others are content to pay out-of-pocket, knowing it’s a small price for individualized, no-rush care. GracePointe’s Smart Care Plan also makes Tomsett’s direct pay structure surprisingly affordable.
While the model works well for Tomsett, he admitted it’s not for everyone. “It takes a ton of commitment, and you will work your tail off the first several years,” said Tomsett, who takes vitals, draws blood and empties trashcans on any given day. “You have to have a certain skill set, and if you’re not prepared to do all these things you shouldn’t attempt this.”
But for Tomsett and his patients, it’s a win-win.
“I’m enjoying practicing medicine again,” he said. “When patients come in, I’m getting their hard earned money so I need to earn their business and get back into the service mode of medicine, which is what it should be about.”
Tolbert expects the direct pay model to become increasingly popular in coming years. “The long term trends are that we’ll see more and more providers like Tomsett who say the patient volume Medicare sends isn’t worth it and who chose to get out of network in favor of a subscription-based model,” Tolbert concluded.
RELATED LINKS:
The American Academy of Private Physicians (Concierge Medicine)
