What if you could establish a family practice that allowed you to be independent and provide affordable care? A practice that met people’s primary care needs, helped reduce visits to the emergency room, and as a result, the cost of healthcare?
Would you take the chance?
Dr. L Lee Montgomery, owner of Louisiana Family Medicine in Baton Rouge, did just that, gambling on a model he believes will accomplish all of the above and more.
At Montgomery’s practice, patients pay a $29.95 monthly membership fee, then $50 for an office visit and $10 for most labs. There are discounts for families that sign up for memberships. If four or more family members join, office visits fall to $25. Montgomery’s practice does not accept insurance, but it does provide the diagnosis and service codes and the charges necessary for patients to submit claims to their insurers.
“I like this so much because it removes a lot of the burden of the things that aren’t fun about medicine, and you can focus on the joy of taking care of patients,” Montgomery said.
Montgomery, a Vanderbilt University School of Medicine graduate, has worked in both private practice and for institutional employers. He decided to start a cash-only practice after reading a story in Medical Economics magazine about a Tennessee physician’s experience.
The practice model has performed well except in places where everybody has a lot of money and insurance, Montgomery said.
The practice provides care to people that don’t have good access to healthcare, he said. Patients can meet their primary care needs while keeping down their costs, and the cost to the community as a whole.
Patients don’t end up in the emergency room racking up thousands of dollars in charges they can’t pay, Montgomery said.
Dr. Glen Stream, president of the American Academy of Family Physicians, said only a small number of members have turned to the cash-only, primary care practices.
But he believes the number of these types of practices is growing.
According to the AAFP 2010 Practice Profile survey, 3 percent of respondents practiced in what they considered a concierge, boutique or retainer medical practice.
How much the cash-only practices grow depends on the U.S. Supreme Court’s ruling on the Affordable Care Act, Stream said.
If the law is deemed unconstitutional, a lot more people, particularly relatively healthy workers, will see the retainer practice as a solution, Stream said. This patient population typically pays an enormous amount of money for health insurance but doesn’t consume much healthcare.
Physicians also reduce their overhead costs.
Montgomery said in his experience, handling the insurance billing takes 1.5 full-time workers.
In his new practice that cost has been eliminated.
Combining a high-deductible plan with a sort of pay-as-you-go model for basic health needs actually makes a lot of sense for these patients, Stream said.
Montgomery said high-deductible plans, especially those with health savings accounts, make more sense than a low-deductible plan that covers everything.
“You don’t buy car insurance that covers every little nick and scratch. You could but it would be very, very expensive,” he said. “You buy car insurance for when you’re in a wreck and you’ve totaled your car and you need a new car and you can’t afford a new car.”
Montgomery’s practice offers a sensible, affordable complement to high-deductible plans, he said.
Enrollment in high-deductible plans is growing.
In 2011, 16 percent of insured adults were covered by the plans, according to the Employee Benefits Research Institute. In 2005, only 5 percent of insured adults were enrolled in a high-deductible plan.
Montgomery said he has tried to remove all the things that studies have shown inflate healthcare costs.
For example, Montgomery sends patients to imaging centers if X-rays, MRIs, CAT scans or ultrasounds are needed.
That’s because physicians whose offices have X-ray machines typically order more X-rays than a physician who doesn’t have his own machine, he said. The same goes for physician offices with their own labs.
Montgomery said he is also trying to provide some sensible alternatives to the current payment model, where doctors only get paid if the patients come to the office.
There are some things that can be managed over the telephone or by Skype, Montgomery said. But insurers won’t pay for that.
Since Montgomery doesn’t have to worry about collecting from an insurance company, he can offer Skype visits. The charge for a video-chat consultation is $10.
The Skype or telephone consults can’t be used for everything, such as an emergency or diagnosing a new condition, Montgomery said. But these consults can work for a patient who came into the office two weeks ago to adjust a medication and needs a follow-up visit.
Instead of taking half the day off from work, the patient can do a video chat, and Montgomery can see her face when he asks how she’s doing and whether there have been any side effects.
If the patient is happy with the plan of care, Montgomery has accomplished his treatment goal while saving everyone time and money, he said.