

Physician with a Slick, Web 2.0-ish Method of Practice - karzeem
http://www.jayparkinsonmd.com/

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iamelgringo
It's called a boutique practice. My day job is as an ER nurse (while I finish
my CS degree), and it's totally the way I'd go for my medical care if there
was someone around that did this.

Some doctors with a boutique practice take a retainer fee plus bill insurance.
Sounds like this guy is going the cash only route. I'm sure he'll end up
making more money that way, regardless.

The average GP in NYC probably makes about 120,000 - 150,000. But they have to
carry a 5,000-10,000 patient load while each patient gets 15 minute
appointments. Some docs routinely see over 20 patients a day. This guy is
charging a $500 retainer for two visits a year. That means that if he has 300
patients, he's making what a regular GP makes at an HMO. If each patient has
two visits a year, that means that he can have 2 appointments a day and make
the same amount as an HMO doc. That's his break even point. Anything over
that, and it's gravy. I'm willing to bet that he has a 500 patient load. So,
he's bringing in $250,000 net plus extra visits and appointments. So, by going
cash only, he's probably making twice what an insurance doc would make.

This guy also does house calls only. So, he doesn't have the overhead that
he'd normally have with an office--staff, office rent, equipment, etc... He
doesn't have to hire billing specialists. He outsources all of his X-Ray and
lab work, so no overhead there. And, he has an unofficial network of non-jerk
specialists that he can refer people to that he likes working with.

I'm surprised that this hasn't caught on more than it has.

If you're his patient, look at his appointment schedule. He's giving people a
half-hour to one hour time slots. And, he does a lot of his consultations over
the wire, via IM, video chat and cell phone. He probably doesn't have to see
his patients most of the time, and it's a lot easier for his patients to get
in touch with him. His patients are happier and he has a much better quality
of life.

Brilliant.

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quickpost
Do you think he's getting any kickbacks from his referrals to the specialists?

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iamelgringo
I seriously doubt it. Doctors have always had gentleman's agreements to refer
patients to each other, and then refer the patient back once the specialist is
done.

The only kind of payola that I've ever seen after 14 years in health care are
drug companies purchasing cruises/lovely dinners, etc... for doctors.

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dcurtis
It depends on the type of doctor, and the type of service. For example,
dentists and oral surgeons use referral kickbacks almost 100% of the time.
I've seen xray specialists and open-MRI centers also offer doctors kickbacks.

It's obviously not seen in HMOs and in emergencies or in large hospital
institutions, but in the private medicine arena, where this guy is solely
practicing, it certainly is more common than you make it seem.

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jsjenkins168
Is this guy bypassing managed care completely? Its like a return to the old
way doctors used to practice, house visits and all. But this guy leverages
modern communication to maintain a wider patient base than previously possible
with strictly face-to-face visits. Interesting.

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dcurtis
I wonder what would happen if you got a bunch of new, young, hip doctors and
started the exact same kind of thing in San Francisco. You could have a really
sweet centralized appointment and advice site with always-accessible doctors
ready to chat 24/7, which is covered by the patient retainer fees and/or
insurance.

Healthcare 2.0?

(PS anyone interested in seriously seeing if this is feasible?)

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menloparkbum
sort of exists already. I use these guys:

<http://www.sfoncall.com/index.html>

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lkozma
Sorry, but this is health-care going back to pre-1850 levels with a Web 2.0
interface. If this becomes widespread, it defeats the whole idea of 'pay
according to your means, get treatment according to your needs', social
solidarity, etc.

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edw519
Good. In case you hadn't noticed, most Americans do not agree with that
concept. Maybe they oughta try it in Russia. Oh, wait. Too late.

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gommm
They tried it in france and a lot of european countries and it works rather
well....

But of course, forget what I said, keep on thinking that any concept of fair
social health care is equivalent to totalitarian communism.

As for me, I will go on with my belief that it a government is there to
provide fair and equal access to education and health care and protect an
healthy competitive economy through antitrust laws and simple and efficient
business regulations (unlike france).

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wammin
This is really interesting and refreshing to see a change in the way that
healthcare operates ...

BUT, it seems like this guy is trying to bypass insurance companies
completely. From the FAQ: _... I accept absolutely no health insurance at all
and my fees may not be reimbursed by your insurance company._

We all know that health insurance is a huge confusing nightmare in the U.S.,
but I don't think its advisable get rid of it completely. I suppose if you
don't have insurance, then this doc would be a really good alternative.

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zaidf
Not necessarily.

My surgeon Dad told me once that his practice pockets pennies out of every
dollar they officially bill the patient. Where does the rest go? Between his
own liability insurance, the insurance companies not paying up, and the
privacy/medical records red tape.

This guy's model is actually my Dad's dream: be able to go treat a patient for
30mins, get paid for it(versus fight for hours with the insurance). The actual
bill would be lower too because for most part he only has to charge pennies on
the dollar since there won't be as much red tape.

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icey
This looks really great... until you get cancer.

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falsestprophet
consider this system paired with traditional catastrophic health insurance

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daniel-cussen
On a somewhat unrelated topic, why is health care so pricey in US? Do doctors
willingly quota spots in medical schools?

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kingnothing
It's expensive largely because of the prices of malpractice insurance doctors
have to carry, greedy insurance companies, and a lot of red tape.

I'm not sure what you're asking with the second question, can you rephrase it?

I'm sure some studies are out there, but how much more expensive is medical
care in America compared to Europe and Japan? Sure, we pay out of pocket here,
whereas it's rolled in to taxes over there, but what's the price difference?

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gommm
Here in japan, when I go to the doctor I pay between 5 and 10 dollars +
medecines... The national health care covers 70 % of the bill (so the doctor
would cost between 15 and 30 dollars). The national health care is compulsory
and costs me about 150 dollars a month (since I'm a contractor I pay it in
full, for employees they only pay half and their employers pay the other half)

In france, when I was a student, the doctor cost 20 euros and the national
health care covered 80% (so I paid 4 euros). As a student, the national health
care was included in my tuiton fees that cost around 600 euros for one year.

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kirubakaran
Ah... One appropriate chance for sick==(slick,!healthy) pun and you blew it
karzeem.

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daniel-cussen
Good stuff.

