Monday, June 10, 2013

Doctor quits taking insurance, services become cheaper.

A Maine doctor decided to quit accepting all insurance and require his patients to pay for all services out of their pocket. The doctor discovers his services became much cheaper as he was able to lower his overhead:

SOUTH PORTLAND, Maine — Dr. Michael Ciampi took a step this spring that many of his fellow physicians would describe as radical.

The family physician stopped accepting all forms of health insurance. In early 2013, Ciampi sent a letter to his patients informing them that he would no longer accept any kind of health coverage, both private and government-sponsored. Given that he was now asking patients to pay for his services out of pocket, he posted his prices on the practice’s website.

The change took effect April 1.

It’s been almost unanimous that patients have expressed understanding at why I’m doing what I’m doing, although I’ve had many people leave the practice because they want to be covered by insurance, which is understandable,” Ciampi said.

Before the switch, Ciampi had about 2,000 patients. He lost several hundred, he said. Some patients with health coverage, faced with having to seek reimbursement themselves rather than through his office, bristled at the paperwork burden.

But the decision to do away with insurance allows Ciampi to practice medicine the way he sees fit, he said. Insurance companies no longer dictate how much he charges. He can offer discounts to patients struggling with their medical bills. He can make house calls.

“I’m freed up to do what I think is right for the patients,” Ciampi said. “If I’m providing them a service that they value, they can pay me, and we cut the insurance out as the middleman and cut out a lot of the expense.”

Ciampi expects more doctors will follow suit. Some may choose to run “concierge practices” in which patients pay to keep a doctor on retainer, he said.

Gordon Smith, a spokesman for the Maine Medical Association, wasn’t so sure, saying most patients either want to use the insurance they pay for or need to rely on Medicare and Medicaid.

Even with the loss of some patients, Ciampi expects his practice to perform just as well financially, if not better, than before he ditched insurance. The new approach will likely attract new patients who are self-employed, lack insurance or have high-deductible plans, he said, because Ciampi has slashed his prices.

“I’ve been able to cut my prices in half because my overhead will be so much less,” he said.

Before, Ciampi charged $160 for an office visit with an existing patient facing one or more complicated health problems. Now, he charges $75.

Patients with an earache or strep throat can spend $300 at their local hospital emergency room, or promptly get an appointment at his office and pay $50, he said.

Ciampi collects payment at the end of the visit, freeing him of the time and costs associated with sending bills, he said.

That time is crucial to Ciampi. When his patients come to his office, they see him, not a physician’s assistant or a nurse practitioner, he said

“If more doctors were able to do this, that would be real health care reform,” he said. “That’s when we’d see the cost of medicine truly go down.” Article


Anonymous said...

You ain't seen nothing yet. The number of people who will opt out of buying insurance under Obamacare and pay the penalty is going to be staggering.

Anonymous said...

probably saving gasoline expense by using that horse and buggy as well...I wonder if he'd take a bushel of apples to write me a scrip for some hay fever meds?

bill said...

This is nothing new, nor is it horse and buggy medicine. I knew a doctor in Memphis who was practicing with this model twenty years ago, and had been doing it awhile. He charged $25 per visit and his patients, who were willing to line up and wait for him, were almost exclusively low income. He had streamlined his system so he didn't spend much time with each patient and was able to manage lots of throughput. More primary care will be delivered this way in the future, and it won't be to concierge patients - it will be to the poor.

Anonymous said...

Scoff at barter all you want.

When it all melts down you better hope you have something tangible of worth to trade for something you need.

Anonymous said...

There's a doc in Oxford that's cash only. Just switched over, from what I heard.

I like the cash only model. The problem is Obama doesn't, because his money doesn't. Big hospitals, corporate medicine and the insurance companies don't approve.

Tom Fowlkes, MD said...

I have had a cash-only, walk-in, primary care clinic in Oxford for the past three years. It is working out very well. A typical office visit is $40. The interesting thing is that about 70-80% of my patients actually have health insurance, but they find that they spend less money (and a lot less time) just paying me at the time of service and not filing insurance because there are no more bills coming later. Check out my website:

Kingfish said...

But do you go to eleven?

Anonymous said...

Of course, this concept, which is great if it works for these docs, only works with family physician type visits for strep throat, etc. as soon as you have a significant illness, need a CAT scan, surgery, etc., this pay system doesn't work because regular people can't afford it.

Hence where the law of the land, the Affordable Health Act, comes in to provide health insurance to millions of people who don't have it, as well as many other wonderful things. Do the ObamaCare haters like 1:44 p.m. really want to return to the "good ole days" when insurers just canceled your children's health insurance as soon as they could once they got real sick? I sure don't.

Anonymous said...

There's a doctor in Jackson that started doing this years ago. Most of his patients have insurance and file their own claims.

Tom Fowlkes, MD said...

Unfortunately, I work pretty late most times. Clinic is open 8-5 and 8-1 on Saturdays. I also have an addiction medicine practice to keep me occupied in the evenings and weekends.

Kingfish said...

I think you missed the joke, doc. ;-)

Anonymous said...


Two things. First, you should check out cash only hospitals. There aren't many and shockingly (or not, depending on your level of cynicism) Obamacare outlawed new ones from opening up.

You should also read current events. Some state up North just announced today that rates would almost double under their Obamacare exchange that's coming soon. Which is also true for California, despite what the media and politicians say. Forbes has a very nice breakdown on why.

Next Please - Hurry Along said...

Bill: 'Thoughput' is a term that's mostly bullshit when it comes to the provision of medical services or patient expectations. The utility of 'throughput' is more applicable to retail, manufacturing and craft sales.

Do you really for one minute think any patient on earth would select a doctor whose business model is to run as many as possible through the clinic in a day's time?

Anonymous said...

Cash only, in and out, is a great concept for those wanting a pain patch, pain pill prescription or a note allowing a meth-precursor. Godsend, in fact. Even better if the office has 'streamlined' to the point that those pesky records aren't required. Maybe that's on the horizon too. Don't put it past the Doc-Lobby.

Crazy you say? So was Obamacare five years ago.

Marty DiBergi said...

Bottom line, the Kenyan's promise of $2500 premium decreases was a complete fabrication ... a lie.

Ohio Dept. Of Insurance: Obamacare To Increase Individual-Market Health Premiums By 88 Percent

Democrats continue to try to dismiss the evidence that Obamacare will dramatically increase the cost of insurance for people who buy it on their own. But on Thursday, the Ohio Department of Insurance announced that, based on the rates submitted by insurers to date, the average individual-market health insurance premium in 2014 will come in around $420, “representing an increase of 88 percent” relative to 2013. “We have warned of these increases,” said Lt. Gov. Mary Taylor in a statement. “Consumers will have fewer choices and pay much higher premiums for their health insurance starting in 2014.”
It’s called “rate shock,” but it’s not shocking to people who understand the economics of health insurance. (Ed note: 10:20 PM is clueless.)
What are the drivers of the increase? According to Milliman, the two biggest drivers are (1) risk pool composition changes, such as forcing the young to subsidize the old, and the healthy to subsidize the sick; and (2) Obamacare’s required expansion of insurance benefits, particularly its mandated reductions in deductibles and co-pays.

Stumpy Joe said...

The serial liar telling one of his serial lies.

Anonymous said...

Perhaps we should go to the Australian healthcare system, where everyone gets basic care, stuff like flu, etc. But if you need surgery, you have to have insurance. They have the most effective healthcare system in the world and they rate themselves as THE happiest nation of peoples on earth. There must be something said for that last aprt.

bill said...

Next Please, that may not be the right word but the concept is still the same. Substitute "number of patients that were seen and adequately treated" for throughput.

I think lots of people make health care decisions based on how much money they're going to have to spend for equivalent services. Generic prescription drugs cost less than name band. Store brand painkillers cost less than name brand. Primary care doctors who provide adequate care and charge less will be in higher demand. If you are trying to put the physician's office on an imaginary pedestal separate from other more commercial aspects of health care, well, you're wrong. No doctor can operate without making a profit, and that makes his practice a business.

Anonymous said...

There are hospitals that are doing the same thing. The Surgery Center of Oklahoma has created a consumer driven model, offering 112 surgical procedures at radically reduced costs to their patients. They cut out all the middle management, Insurance and Administrators. It can be done, but the insurance companies and healthcare corporations are going to fight tooth-and-nail to prevent it from happening.

Anonymous said...

Marty D. unabashedly cites to Tea Party darling Lt. Governor/Director of Ohio Ins. Dept. Mary Taylor's hit piece on the Affordable Care Act while betraying his true reasons for hating all things our President accomplishes by calling him "the Kenyan." That's right up there with the Tea Party folks who carry signs showing a monkey with the President's head superimposed on its shoulders. Most racists at least try to use code words for their slurs.

Anonymous said...

It really is quite simple.

Pay $12,000, $15,000, $20,000, etc. annually for insurance -- that you can get at any time, no questions asked and where all preexisting conditions are covered -- or pay the $700 individual/$2,085 family tax penalty?

It is a no brainer. The CBO has already been hoisting up red flags and revising upwards their estimates of total penalty payers because once taxpaying Americans -- especially healthy ones -- figure out the math there will be a veritable tsunami of people opting out.

The Ponzi scheme known as Obamacare is going to collapse under its own weight.

Anonymous said...

But, but, but can you refute the facts 12:14 PM?

Anonymous said...

Hey June 11, 2013 at 12:14 PM. Did you have any problems when stuff like this was being used to denigrate Bush over @ DailyKos?

Next Please - Hurry Along said...

Bill; You can argue for or against throughput or riddle semantics; however, here is what you said:

"He had streamlined his system so he didn't spend much time with each patient and was able to manage lots of throughput."

That doesn't leave me with the impression his interest was in "adequately treating" patients. Does it leave you with that impression? I get an entirely different impression of his business model based on your statement I quoted.

You forgot to say he had no magazine subscriptions and only cleaned the waiting once a week.

bill said...

How did it read when you made the substitution I suggested? Since the thread has reported a number of other doctors who practice using a similar model, it's clear that the doctor I knew wasn't alone. Sorry you got thrown off by my choice of words, but I don't know of any metric used to measure quality that was unfavorable to the physician I knew. I was in his office a number of times and saw nothing but what appeared to be satisfied patients. I was in the hospital business at the time and it would have come before our medical staff committees if he had any quality issues, so I'm assuming he did a good job.

Anonymous said...

You can parse Bill's words 1:03 till the cows come home. What is obvious is that you don't know, personally, any physicians.

Because physicians will find the right balance between the quality of care they want to provide and the quantity of patients they are able to see on a daily basis.

The free marketplace will take care of the rest.

Or, you are a hardcore Obamacare zealot who feels threatened.

Anonymous said...

Bill: I know you love to argue invalid points; but, If you're not the doctor, you're really not at liberty to argue the semantics of his business model.

You can fart in that whirlwind all day long; however, he's a shyster, seeing people quickly, probably without knowing their names, shuffling them off to the payment counter, poor record entry, cash payment, no prollem.... and shouting, "Next Please". RAWHIDE medicine. "Head 'em up. Move 'em out!"

And you think this comports with the training they received?

Anonymous said...

You can fart in that whirlwind all day long; however, he's a shyster, seeing people quickly, probably without knowing their names, shuffling them off to the payment counter, poor record entry, cash payment, no prollem.... and shouting, "Next Please". RAWHIDE medicine. "Head 'em up. Move 'em out!"

Prove it windbag.

Kingfish said...

And the patients don't have to come back and see him if they don't want to. Freedom of choice. You do believe in that or is it just for fetuses or where a guy puts his dick?

KaptKangaroo said...

June 11, 2013 at 6:51 AM

I remember an operations research project focused on throughput in a doctors office. Next please indeed fool. You are wrong.

bill said...

I really don't like to argue invalid points, but I think this thread has also shown that I suffer fools gladly.

Anonymous said...

12:36 p.m., I absolutely denounce comparing Pres. W. Bush to a chimp. I disagreed with a whole lot, but not all, of Pres. Bush's policies, but none of us should belittle and disrespect the man or woman who is our President. They were all duly elected by obtaining at least 270 electoral votes.

To constantly attempt to undermine the legitimacy of Pres. Obama, who won this last time in an electoral college landslide and by 3.5% of the popular vote, is to try to weaken the rule of law that governs our Presidency. That birther nonsense was a cancer on our country.

Reasoned debate of the issues is healthy. Compromise is vital for our Congress to work. Name calling advances nothing but hate.

Intern said...

People who are genuinely concerned about their personal health, monitor their lipids numbers routinely, eat relatively healthy, exercise at least moderately and overindulge rarely....are NOT going to chose a medical practitioner with a stop watch in his hand.

You can speculate til the dogs arrive in Omaha about poor people or some mystery doctor in Columbus or who puts their dicks where (how crude). At the end of the day, (hopefully) a majority of us care about the quality of our healthcare and will make wise choices, including avoiding a doctor who forgot to shave, has the shakes, reeks of yesterday's gin, wears brown shoes with a grey suit and puts on Coke-Bottle spectacles when he fills out a prescription.

Doctors are supposed to be guided by years of training and the oath they take. Not their personal need to increase profit by minimizing care.

Anonymous said...

Not their personal need to increase profit by minimizing care.

100% conjecture on your part.

Anonymous said...

When my doctor stopped accepting insurance in Jackson a few years ago, he stopped accepting new patients and started closing earlier. He spends more time with his patients than most specialists or other doc in the box physicians.

Anonymous said...

"Bill: I know you love to argue invalid points; but, If you're not the doctor, you're really not at liberty to argue the semantics of his business model.

You can fart in that whirlwind all day long; however, he's a shyster, seeing people quickly, probably without knowing their names, shuffling them off to the payment counter, poor record entry, cash payment, no prollem.... and shouting, "Next Please". RAWHIDE medicine. "Head 'em up. Move 'em out!"

So, 6:48 states that a previous poster (Bill) has no standing to comment (positively) because Bill is not the doctor in question, and therefore has no personal knowledge of the doctor's mindset, etc. Then 6:48 goes on to reveal the inner workings of said doctor's mind, presumably due to psychic power that eludes us mere mortals. How 6:48 has knowledge of said doctor's "poor record entry", "without knowing their names", etc, is beyond me.

Anonymous said...

"Not their personal need to increase profit by minimizing care. "

Hey rube -

Trying to squeeze as much waste and inefficiency out of a bloated, broken system is not the same as "minimizing care".

if you can't tell the difference you had best repeat your internship. And your comments about "reeks of yesterday's gin" are possibly slanderous or libelous (I'll leave that distinction to the legal experts here), but will certainly not generate you many referrals when you make these untrue allegations. But you'll find out, undoubtedly the hard way.

bill said...

Fart in a whirlwind? No one can say I don't suffer fools gladly.

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