Tuesday, April 07, 2009

Doctor's Charges

We were expecting a bill from our doctor. What we received on 1 April 2009 was much worse. It was a letter.

Dear Valued Patient, it began. The adjective was the first false note. Just what made me a "valued" patient? What kind of letter uses the salutation to pay a compliment? How much is this going to cost me?

As you know I love practicing medicine and enjoy being your physician, the letter continued.

Actually, I did not know either of these things.

A little over a decade ago, we chose Dr. Arthur King to be our physician because he was within walking distance of our home. This became particularly important in recent years when we gave up having a car.

I have not seen him in over a year. As I am without health insurance, there is little point. The lab work for a decent physical is more than I can afford.

We procured a high-deductible policy for my wife recently. It was for a diagnostic examination for a condition that could prove serious – but thankfully so far has not been – that we expected a bill.

Therefore, we cannot claim the close relationship that our doctor seemed to think we had. His office staff has been cordial and understanding. He has been professional and never prescribed snake oil. Nevertheless, the last sentence of his overly flattering first paragraph sent a chill.

Unfortunately, the current system does not allow me to provide your care in the way I know you deserve.

Then came the pitch. He was going embark on a new method of medical practice "that enables the patient-physician relationship to be a true partnership." The services under this "new" system were described in bulleted short phrases.

Opposite "Higher quality care experience" was "Total care coordination with specialists and other providers," "Test result consultation," "Post-specialist visit explanations," and "Assistance with insurance filings."

The verbiage was pretty, but the first three points simply describe standard operating procedure when a general practitioner makes a referral to a specialist. The last is how a doctor gets his money.

Opposite "Incredible access at your convenience" was the truly incredible claim of "24/7 access to me via cell phone, email, or office phone." Notice that this is not access to "service," but to Dr. King himself. The FAQ sheet, which accompanied this letter, was equally unambiguous on this point, offering "Direct access to your physician any time of the day or night."

Only God is accessible 24/7. Mere mortals do not have this power. Leaving aside the fact that even doctors must eat, sleep, and take days off, there is the conflict of dealing with a patient in the examining room when the cell phone goes off. "More about your colonoscopy later, Fred, I have to take this call."

There was one new item that followed "Incredible access" – "House calls as needed" (italics in original). There was no statement about who would determine the need or how need would be determined, making this an empty though enticing promise.

All the puffery and empty promises of this letter came down to this. Dr. King claims to have 4,000 patients. Under the new ModernMed practice he can have no more than 500. Of those 500 patients, the first 300 to sign up will be offered the introductory monthly rate of $75 a month. The unfortunate remaining 200 patients will be charged the normal rate of $125 a month. Given the terms offered, everyone will be paying $125 or more a month in the years to come just to be a patient of Dr. King.

That is right, friends, this retainer fee does not cover office visits or tests or anything else. It is a simple retainer fee, promoted with pompous and incredible claims. There is nothing offered under this new system that is not either standard operating procedure of a good general practitioner or available elsewhere for less or nothing.

The advantage is all with the doctor. He dumps 3500 patients. He dumps some who have come to him regularly for any number of reasons. He dumps some who come only under the compulsion of dire illness. He keeps only those who can pay for the privilege to call him their doctor. He receives over a half million dollars annually under the introductory rate, three-quarters of a million in the next year, and undoubtedly, a million and more in the years to come, in addition to any fees charged for the actual practice of medicine.

At $125 a month, his patients will pay an annual $1500 in addition to their health insurance premiums, deductibles, and office visit co-pays. They will receive for this sum nothing beyond what is expected of the general practice of medicine.

What is being promoted here is "a new revolutionary model of medical practice." What we have is medical extortion.