High overhead costs, an increasing amount of red tape, unnecessary middlemen, and Obamacare prompted Dr. Michael Ciampi to stop accepting all forms of private and government insurance last April, which has allowed him to cut his prices in half.
Ciampi, who operates a family practice in Portland, Maine, was able to reduce the cost of a regular office visit for an issue of moderate complexity from $160 to $75. And, if a patient has a single straight forward issue such as the flu or an infection, instead of spending hundreds of dollars at the emergency room, Ciampi is able to offer his services for only $50.Part of a growing movement of physicians, Ciampi reverted to a direct pay model (non-concierge) which allows him to work for the patient rather than an insurance company or government bureaucracy that prioritizes treatment plans to save insurers the most money. What insurance companies will or will not allow to be done is no longer relevant.
“Government and private corporations have inserted themselves between doctors and their patients. As regulations and mandates from these third parties proliferate, the overhead of providing care has risen exponentially, while reimbursements have dwindled,” said Ciampi. “Being at the mercy of bureaucrats, politicians, and crony capitalist corporations, as a small business, we did not see any way to remain independent and financially solvent in the current environment.”
One benefit of being a direct pay physician, according to Ciampi, is the freedom from the often terrifying task of complying with the more than 150,000 pages of Medicare regulations. He says there is no way for physicians to comply with all of them and the government knows it.
“If the government calls and tells a practice to do something, or to send money back, they do it out of fear. Most doctors live in fear of a Medicare audit because now honest mistakes now could mean not only civil penalties, but also jail time for criminal offenses. At any time, armed federal agents could enter a Medicare provider's office, shut them down, and seize their computers. The only way not to be subject to this kind of intimidation is to opt out of the system.”
Direct pay physicians are also able to reduce overhead costs because they don't have to employ staff to deal with the excess red tape and paperwork from insurance and government entities.
Moving to a direct pay system frees physicians from government mandated electronic record and billing systems, which Ciampi says allow the provider to justify charging more for each visit and provide the government and insurers with more of the patient's personal information. A trip to Ciampi's office also means patients only visit Ciampi; no physician's assistants or nurse practitioners.
Instead of “playing the game” with insurers and charging far more than he ever expects to receive from them -- “hoping to maximize whatever reimbursement they may choose to provide” -- not accepting insurance frees Ciampi from restrictive contracts and allows him to offer patients a more competitive rate based on free market principles.
Ciampi can now provide services not normally reimbursed by insurance companies, like house calls, and hopes to soon introduce video consultations with established patients.
Photo Source: The Huffington Post