This New York Times story illustrates some of the reasons why Patients should NOT enter into the “Business of Medicine” without proper Physician guidance.

 

 

Moral of the story? Stop, look, listen, do not jump and do not enter without an experienced guide.  It is a dangerous place that will take lots of your money and eat you up.  Think of it this way: sure you want control, but would you enter an unfamiliar jungle without a guide? 

 

We can give guidance through Veritas Health Care.  But, Physician-Patient Cooperatives must be extremely careful in the ways they select their specialty and subspecialty providers, and the facilities in which the services will be provided.  This is just as important as finding low cost catastrophic insurance coverage for members.

 

Speaking of Guidance, on the primary care front, I did find another interesting model.

 

  http://www.mdvip.com

 

This for profit was started by a physician about 14 years ago.  He sold out to Procter & Gamble a few years ago.  They offer personalized patient care through a network of primary care providers.  In a conversation with the regional corporate guy in charge of “physician development”, I learned that they charge patients $1500 to $2200/ year for personalized primary care services.  Corporate takes $500 to start and the rest goes to the doc.  They limit the number of patients to 600/doc.  According to my calculations, that is a max working pot between $900,000 and $1,320,000.

 

To put this in perspective, during my fourteen year rural family medicine career in Maine, I carried about 3000 – 5000 patients, and my GROSS income (before expenses) never exceeded $220,000, and I had to work in the emergency room of the hospital to enhance my cash flow.  Keep in mind that the cost of running the business (for lack of a better term) was about 55% of the cash flow.  In other words, for every dollar that came in 55 cents was used to pay the expenses (rent, supplies and help).  So, before tax income was generally below $100,000 per year, and that was working all the time.  That is roughly between $15 and $20/hour excluding much of the call pay.

 

I offered prepaid primary care through my practice in the early eighties and had no takers.  That’s right, no takers.  Obstetrics was the only service that people bought routinely on a prepaid basis at $500 for the whole deal, including the delivery and well baby care in the hospital.  Now, if I had 500 prepaid primary care patients at $500 – 1000 per year … do the math … I could have easily enhanced services and spent more time with my family. 

 

No, this is not a litany of complaints.  Before the barrage of third party nonsense and the era of doctor bashing in the mid 1980s, I loved it.  The Joy of Healing was sufficient compensation to make up for the low pay.  But, my experience illustrates the facts.  Very few young docs will take on that sort of burden these days for “Love”.

 

Bottom line?  A hybrid NonProfit Patient-Physician Cooperative Model will work for Patients, Physicians and other providers.  This model is long overdue on a national and international scale.

 

Have a sweet day.

 

MFM

Michael F. Mascia, MD, MPH @IHS ip