Have you noticed how medical care has changed lately and how it continues to change right under our noses?  These changes are bad for patient care. 

First of all, do you want more interference in the relationship between you and your doctor? Ask yourself that question! The three players so far interfering in your relationship between you and your doctor are as follows:

1. The first ones to interfere were insurance companies, and they have done nothing but drive the cost of healthcare through the roof.  We all are now paying the consequences.

2. Second came the government, regulating every aspect of medicine you can think of.

3. The latest players wanting to interfere in the relationship between doctors and their patients are the hospitals. They want more and more control over the doctors and the one who will suffer is you—the patient. The sooner they make your doctor get you out of the hospital ready or not, the more money they make.  

The story of your friendly corner drug store pharmacist.

 A cautionary tale can be found by looking at friendly pharmacists of the past at their corner drugstore. Unfortunately, they have mostly disappeared!  Now, 90% of pharmacists work for one of the big chains, like CVS, Walgreens, Wall-Mart, Publix etc. When you as a doctor call one of these chains, you either get an answering machine, or, if you get lucky after pushing all the buttons on your phone, an employee will answer and put you on hold for sometimes as long as 30 minutes before you can actually talk to the pharmacist that you are looking for. Why is that? Because the pharmacist does not care anymore; they are not running their own business. They have given in to impersonal corporate America, where they simply punch a clock in the morning and another one in the afternoon. The personal relationship with the customer has been destroyed. They also don't care if the doctor  waits on the phone for thirty minutes before he can call in your refill. This lack of caring on the pharmacist part will have an effect on how long you have to wait for your prescription. The doctor may be busy with patients and may have to hang up and call the pharmacy later or transmitted electronically and when you get to the pharmacy your prescription may not be ready. Or worse yet, the doctor may require you to come to his office to pick up the new prescription because he can afford to waste that much time on the phone or the computer.  This is a good example as to why, if you dislike how big pharmacy chains operate and do business, you should support the few remaining local independent pharmacists!

What is happening to your friendly independent doctor? 

We are now seeing the same thing happening to the medical profession. Your friendly doctor that you have relied upon for years is being forced to join corporate America. They are getting bought out by hospitals with the help of the government and insurance companies. For example some insurance companies in Saint Augustine Florida are not letting independent doctors be participating providers of certain plans created specifically for certain Hospitals Acountable Care Organization (ACO) participating physicians. This ACO is like a little club in which the Hospital has 51% of the votes in any decision taken by the group. What does this do? The hospital has complete control of these physicians that belong to the ACO. What is this insurance program called? Florida Health Plans. Physicians that do not belong to the ACO or drop out of it are not allowed by the insurance company to be participating provider. And they are pushing this insurance hard. Just ask around to the people that work at these hospitals. Look at the Bill Boards put out there by "so called independent insurance agents ". I myself have not been allowed by the insurance company to be a provider of this plan because I want to remain independent serving my patients. Another physician I know was dropped from the insurance plan because he dropped out of the ACO. 

Now ask yourself how does this affect you the patient? To start with it affects you in two ways. First if your friendly physician is not in that group (ACO) and you have an insurance that is only good for ACO doctors you have to change doctor unless you pay out of pocket because the insurance will not pay your friendly doctor. Second, those doctors that participate will have their hands tied and will only be able to do or order the test approve by the insurance company or the hospital otherwise they don't pay. Result is that your relationship with your long time physician is also lost.

 You are already experiencing it, and most of you do not like it. You get admitted to the hospital and your doctor does not see you. You get somebody, sometimes a doctor you don't even know and sometimes a nurse practitioner or physician assistant that works for the hospital and is controlled by the hospital. This person works under a whole different set of incentives. They really do not care about how you perceive them and don’t care about keeping you and your family as a longtime patient. They don’t know you personally, either. You have simply become a number in their daily routine—somebody that they have to deal with before it’s time for them to clock out and the next shift to begin.

When we see more and more physicians becoming employees of a hospital or when physicians enter into some kind of contract by which they are controlled by the hospital, medical care, and, in the end, the medical profession as we know it is on its way to the funeral home! You will be left with a few independent practitioners like myself and some others that really love what they do for their patients and do not want the interference.  

Sadly, some physicians will sell their souls to the hospitals for money and will become active participants helping the hospital to achieve their goals of controlling all other physicians. These physicians that sell themselves are what I call hospital boys! Physicians will lose their independence just like the pharmacists have, if they allow the trend to continue. 

The writing is on the wall when you hear or see in the press or social media  statements such as wanting to evolve into a "health system with a focus on provider integration”. That is a loaded statement. While it appears innocent, that is essentially shorthand for wanting to control doctors, and wanting to have them, as the saying goes, “by the short hairs”. Nothing less.

The hospitals’ main goal of integration is not better care for you! Their main focus is to work with big insurance companies, make a buck off the physicians, give you less care and increase the profits of the hospital that is paying that CEO a multi-million dollar salary and great retirement benefits for the big chiefs. They all retire with what I call a golden parachute. "Wealth Extraction" is call by some.  

Check around. Google it and see the hospital and insurance companies CEOs’ salaries. Where this happens, in order for them to have those great salaries and benefits, somebody has to suffer and that somebody is the patient. How do you lose? By losing your personal physician, by paying higher insurance premiums, by paying higher deductibles and copays, and by getting less care. Yes, less care! When your doctor wants to order needed MRI or CT scans to make an accurate diagnosis, there will be delays at your expense, sometimes suffering in pain. In the process, you suffer as a patient but they, the hospital and insurance company CEOs simply don’t care. They have to protect their bottom line! 

Here is a link to an interesting article to look up:

https://www.nakedcapitalism.com/2017/06/follow-money-non-profit-hospital-ceos-quietly-collect-millions-us-health-care-reform-battle-rages.html

What is in store for you if we let it continue?

If both you and I let this trend continue, be ready to wait in long lines at medical clinics, like you do for example at Wal-Mart when the store is packed and there are only five out of thirty checkout registers open. The hospital and insurance company CEOs won’t care; the only thing important to them is their bottom line. And remember, by that time, the doctor is on the clock for x number of hours a day till he clocks out, he is not going to care if you need to return the next day, and he will not be available for you when he’s off the clock. You are not his patient anymore. You are the patient of “Corporate America Medical Care”. He is out of there, when his time is up!

Possible solutions to the problem we find ourselves in! 

Now, you may ask yourself, how can this trend be stopped? It’s not easy, but there are a few things you as patients and we as physicians can do. It all starts with supporting each other. On the physician side, we have to understand the financial constraints of patients and adjust our rates to a point that are affordable to the patients and work with them with good intentions to help them meet their healthcare needs. Some patients out there are paying over $400.00 a month on an insurance policy and even then still have a $3000.00 yearly deductible. Still others have a really cheap policy and think they have great coverage, only to discover reality when the time comes to go to the doctor and nothing is covered or have to jump hoops to get anything done.

Remember the more intermediaries there are, the less you get. That is why a direct physician-patient relationship without control from any third party is so important and is the best. On the other hand, patients have to realize that nothing is free in this world we live in and physicians have expenses to meet running an office and all that it entails and also taxes to pay.

You have to be realistic. If you treat your health like a priority, just  like you do having the latest technology such as an iPhone and a big screen TV, with all the additional expenses both entail monthly, you should be able to pay a reasonable doctor’s office fee and most outpatient procedures.

Here is one way many people are managing the insurance/healthcare crisis: by buying insurance only for catastrophic coverage and then paying for the other outpatient doctors’ office care out of pocket, like you do at the vet with your dog or at the dentist. Remember what really gets expensive quickly is if you get admitted to the hospital after an accident or major illness and catastrophic coverage would take care of most of that.

Many doctors’ offices, realizing the problem patients are facing getting trapped between the big insurance companies and the hospital conglomerates, have come up with real solutions for these patients while still at the same time providing top of the line personalized care like the old days.

Issues many patients may be facing include no insurance, high deductibles, a desire for better care than what the insurance company provides, high co-pays, delaying tactics by their insurance companies, access to specialist care made difficult by their insurance company or primary care doctor running an HMO, having an insurance that not many offices accept etc., etc., etc. Many of us independent physicians understand these issues and have come up with very affordable cash flat rates to help those patients. Similar to what dentists and veterinarians do when their clients have no insurance.

So trying to work under the above scenario, this is what I have come up with. If you as a patient need our services and have no insurance or a bad insurance or insurances we don’t accept, please call our office in St. Augustine, Florida at 904-824-0955. We have developed affordable flat cash rates to work with you and your situation.