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Kevin, M.D. “private practice model of medicine is dying”

There was an interesting article written at the AmateurEconomist.com about “Why Doctors Are Not Good Businessmen.”

Hat tip to Kevin, M.D. who commented on this story and said,

“This is why the private practice model of medicine is dying. More practices are being bought by hospitals where the physicians are salaried. This relieves the burden of administrative tasks and supervising ancillary staff, so that the doctor can focus on medicine.”

Rob at VSP says that “[private practice doctors] provide the best care.” Well, if I’ve got the weight of a business on my shoulders, doesn’t that detract from patient care? Additionally, in our field where the private practice doctors sell what they prescribe, can you totally rule out any conflicts of interest which potentially detract from patient care?

Again, independent doctors of optometry in a Wal-Mart setting don’t have the conflict of interest and their administrative duties are much less than private practice.

What’s funny to me is that every CE event I’ve been to always has some talk about why optometrists should start the “medical model” in their practice and watch the money role in. Well, how is adding more third party payers going to help you make more money? Primary care medicine is dying according to Kevin M.D., and yet the roboconsultants are telling us to join more insurance panels. I think getting rid of insurance companies in your practice is the way of the future.

The roboconsultant woos you buy saying that for one case of dry eye you can milk an insurance company for $500-$800 in office visits and procedures. Well, do you do that for every dry eye patient, even the poor self pay patient or the patient with insurance but poor benefits? I would think that doing it just for those with good insurance would be unethical as well as probably insurance fraud.

I think the more your appointment book is filled up, the more you should be able to charge for your services. It’s the old supply and demand of free economics. I think a better system would be for patients to have to front the money to pay the doctor for office visits at the time of service. The patient would have to get reimbursed what they can from their insurance company. Maybe then insurance companies would be forced to have a faster turn around time on processing claims for their patients and be watched more closely for just rubber stamping a denial based on some frivolous billing exercise (or at the least the patient has to worry about it instead of me.) I simply provide the best care for the patient, recommending only the products and services that they need, since now I don’t have to worry about getting paid.

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3 Responses

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  1. PMD says

    I am a consultant, and by your definition not a roboconsultant, because I agree with you. You are dead on in your assessment. The medical model is now being saddled with more patient pay due to high deductible health plans and are needing to put in procedures to collect more up front. You are right, you do have to treat patients the same, and how better to do that with a nice clean and understandable fee schedule that applies to everyone.

  2. mojo says

    you say ” Walmart settings dont have the conflict of interest.” You may be able to sell this BS to new grads, but any dr. who has worked FOR Walmart knows that is just that, BS. i have lost count of the number of times i have been “asked” to “suggest” AR, hi index, PAL, transitions, or whatever Walmart is pushing that month becouse patients ” listen to dr.’s.”
    Why dont you be honest instead of being lap dog for Walmart?

  3. David Langford says

    I am being honest. You must have a different manager than me.

    By the way, I’m pretty sure all patients would be happier if their lenses are the glare-free ones, and if they are presbyopic, most are happier without the line. Also, I recommend to any patient over -4.00 to get 1.67 index, and the patients who get transitions usually bring up the subject of transitions to me.

    Wal-Mart is great. If their sales are good, then they will always be happy with you. If their sales are bad and they are unhappy with the doctor, it’s usually because the doctor is some ugly, ornery, creepy, schmuck who doesn’t recommend the best product for the patient’s best interests.

Written by David Langford, O.D.

David Langford is a graduate of PUCO 2003, worked as a USPHS/IHS optometrist, then as fill-in commercial, then solo private practice, and now works full time as an independent doctor of optometry inside a Wal-Mart Vision Center.

http://optoblog.com

David Langford, O.D. has written 424 posts on optoblog.com

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