Doctor and Nurse "At Your Door"

  1. Interesting Article on Switching Gears on the Dr. Homefront. Why can we not do something like this? Come on Entrepreneurs! Let's hear some feedback:


    Boutique Docs Set Up Shops
    Ocean Springs, Miss., Nov. 22, 2002

    In Knoxville, Tennessee, Dr. Bryan Smith and registered nurse Pam Williams are trying to practice modern medicine -- the old fashioned way.

    Together they are "Doctor at Your Door" -- one of a growing number of boutique medical practices. For an annual fee of $1,100 Smith and Williams will treat you in your home, reports CBS News Correspondent Elizabeth Kaledin.

    They make office calls; they're available 24-7. And there's no voice mail. They forward their landlines to their cell phones when they're out on a call. And they carry a back-up phone in case the first one dies.

    They have no staff, minimal overhead, and most important, they don't accept Medicare -- or insurance.

    "I felt like the insurance companies were practicing medicine," Smith explained.

    Before starting "Doctor at your Door," Smith was ready to quit medicine altogether. He said he was going broke.

    "I would end up hiring two or three people in the back just to work the insurance. And then we would only get back 40 percent of what we billed."

    Doctors across the country are experiencing the same frustrations as Bryan Smith.

    "Physicians will be paid in 2005 less than they made in 1991," said Dr. Donald Palmisano, of the American Medical Association.

    That -- along with a 40 percent increase in overhead means many doctors are looking for a new job.

    "We have a crisis throughout the nation. Twelve states are in crisis right now," Palmisano said.

    One of those states is Mississippi, where escalating costs and falling reimbursements mean more and more doctors are abandoning the state -- and their practices altogether.

    Determined not to hang up his stethoscope, Dr. Todd Coulter is trying an experiment of his own. At his small family practice in Ocean Springs, he has also sworn off insurance and charges $40 dollars cash per visit.

    "When we stopped taking insurance our overhead dropped immediately by $2,800 a month. Just dropped," he told Kaledin.

    Rejecting that third party has allowed Coulter to limit expenses while increasing the quantity and quality of time he gets to spend with his patients.

    "I'm not under a time table. It's not like I'm working for Kaiser Permanent and I've got to see 50 people by lunch time," he said.

    There are no forms to fill out, no waiting for basic care. The patient is happy. And the doctor is staying in business carving out a nice living.

    MMII, CBS Worldwide Inc. All Rights Reserved.


    ======== WOW

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  3. by   2banurse
    Determined not to hang up his stethoscope, Dr. Todd Coulter is trying an experiment of his own. At his small family practice in Ocean Springs, he has also sworn off insurance and charges $40 dollars cash per visit.

    There are no forms to fill out, no waiting for basic care. The patient is happy. And the doctor is staying in business carving out a nice living.

    B. [/B]
    I agree, and what I like about this segment that I copied is that as someone currently not insured, it makes medicine more accessible. It would be a relief for the doctors and patients alike.

    I heard from a friend of mine that the MD we went to quit her practice because of all this insurance BS and she was a great doctor who felt that she was losing touch with her patients because of all the demands of HMOs.

  4. by   jdomep
    I'd do that in a minute...

    Funny though...I was just talking to my mom the other day (she's from Maryville TN) and she said something like "When I was a child Dr. Burchfield (the town's doc) would come over and take care of all of our medical needs and no one had insurance - too bad doctors don't do that anymore..." I will have to email this story to her
  5. by   l.rae
    it's about time the MD's found their cajones and take back the practice of medicine from the clutches of the insurance co.s
  6. by   hoolahan
    Only one question...what happens when you need hospitalization?

    If the doc doesn't accept insurance, he can treat you in the hospital, but can you afford it?? Would the hospitlaization be covered??

    It seems like a good idea, but it needs work. If I end up in the hospital, I want MY doctor treating me, not some hospital-assigned doc!

    If he is so concerned about making some money, and not faulting him for that, but how many pt's can he reasonably carry? 100? 100 x 1100 = 110,000 div by 2 (surely the nurse won't get half)
    He still has to pay malpractice, which is ~ 100,000 a year, so he would need to take way more cases than that to make money.

    I'd be interested in hearing how this works in a few years.
  7. by   LoisJean
    What the Mississippi doc is saying is that his monthly savings will more than cover his requirement for his living needs. He is also saying that because he is no longer hung up with the time consuming paper work, he has more time for more patients- at $40. per pop.

    I surmise that patients who need tests, admittance to a hospital and other covered cares, would get them as usual.

    I don't know about you folks but very few people around my neck of the woods are seen by their family doc in a hospital setting. When I went in some years back for a stay--horrific experience, by the way--I was seen by internists, surgeons, etc- but not my own doc. I went back to her after I got out and more or less 'gave her report'. I think that we see more of this in rural areas perhaps..or where there is only one doc serving a clinic.

    As far as the door to door doc and nurse--well, I'm not certain but I'll bet his nurse is making excellent dough! Look--doc's overhead has just been cut by at least half--HALF!!! And what if nurse is SUB CONTRACTING her services to him as an independent agent? He would not be paying any employer fees; I'd wager that she can foresee an adequate living wage- more than enough for her to pay her own benefits whether she's sub-contracted or not; and, if not yet, than soon, the doc will be realizing a pretty good profit....Why? Because they are offering a unique service based on patient convenience. They will go to the office where you work to examine you, they will go into the home or apartment of those who can't get out easily. $1,100. is very affordable even for low income people. Plus, the $1,100 bucks is a set yearly amount--doc is not going to be seeing all of his cash paying patients every month and so his schedule is open to take on more. He is doing just what lawyers do...accepting a retainer for services even tho they may not be needed on a regular basis. BRILLIANT!

    Both of these doctors have done a wonderful thing--they are using their sense of duty to provide a UNIQUE form of patient care service. People will pay for this. I would pay for this. I would pay $1,100 per year for my doctor to come to me. I'm busy. I have a schedule to keep--it's not simple to drop a day of work to see my doc. Plus I then have to find a day to reschedule.

    Let me say that I think this door to door and cash payment thing is very interesting when viewed from the larger perspective. This is how I set up my business...had to-no other way for reimbursement. People will pay green money for a service that they feel is geared to THEIR needs and not the the other way around.

    Anyway, just a few thoughts here. Keep posting ideas, thoughts and questions--this is really good for my brain!

    Lois Jean
  8. by   hoolahan
    Hhhmmm Lois, you explained that rather well. I guess I am a skeptic.

    You mean when you are in the hospital there you don't see your primary?? I would not like that! I partly picked my primary based on which hosp he works at, b/c there are a few hosp's I would not want to go to, so would not pick a doc who had to treat there.
  9. by   nurse_robin
    I am currently exploring this options, strictly as aprivate practice RN....providing things like enemas, insulin adm and set up, etc....things that Medicare doesn't cover, but patients and families need help with. All on a private pay basis.
  10. by   LoisJean
    Oh, Robin that is just excellent!! Good for you! :hatparty:

    I am convinced that in the very near future the demand for such care is going to be even greater! I see a wonderful opportunity for independent nursing care within the community setting--doing exactly those things you have described. Most importantly though, in my opinion, it opens up a wonderful avenue for you to provide preventive teaching and to act as an advocate for your clients when needed.

    In my experience as the owner of a busy foot care practice, people are happy to pay an out of pocket fee for this service. When we get right down to it, it is these types of services that the general public needs the most. After the home care agencies have pulled out, many people still require assistance with cares.

    As time goes on, and especially now--(the Iraqi War is going to exact a terrible toll on our nation's economic status)-- more in-home health care services are going to be cut and/or the limits on Agency nursing visits will be further shortened. The Independent Nurse can fill those gaps.

    Let me give you an example: Due to my increases in referrals, I opted not to renew a Medicaid Waiver contract last year. It was a good business move on my part. I received a call from the Director of that program a few days ago asking me if I would consider providing monthly medication set-ups for people who did not qualify for the waiver program, but could not afford the out of pocket fee for an Agency nurse to come in on a private duty basis.

    I told the Director that I could certainly do this and gave her my fee amount for that service which she passed on to the folks needing the assistance. So far I have received 6 calls from people who need a nurse to set up meds. Because I pay no middle man I can keep my fees reasonable and still make a profit. This is a very good thing. Good for my business and good for my clients.

    Promise that you'll keep us posted on your business venture!

    Peace and let it begin with me,
    Lois Jean
  11. by   nightingale
    Cutting out the middle man is kep for any business to make a better profit margin.
  12. by   Disablednurse
    Here in Mississippi, we had a scare last month when our docs lost their malpractice insurance. They were treating at their office, but not in the hospital. Fortunately, they were able to find new coverage or I would have been in serious trouble. I already drive an hour away for a decent doctor and if something had happened to the one I see now, I would have been forced to drive further away than that. This malpractice situation and insurance situation is getting rather scary.
  13. by   nurse_robin
    Thanks LoisJean!
    I've read lots of your posts today, and you are my hero!
    I'll keep you all posted.
  14. by   Ted
    Just read the article and this thread. I'm impressed by the article and the people here who have already started a fee for service type of healthcare business.

    The thought of doing away with the insurance companies is very attractive. I can understand why this physician did what he did. My wife does medical transcriptions and billing for a solo-practicing GI physician. She gives testimony to that fact that Medicare reimbursements have droped considerably. A colonoscopy used to fetch around $750 per pop 12 years ago. Now reimbursement for a colonscopy is around $250. I know this physician and he's wearing himself thin to a near nervous breakdown attempting to see as many patients as he can to keep the monies coming in (he's also a bit of a wacko, but that's another topic for another thread for another time). He's losing out. His patients are losing out. Quite frankly, he needs to quit.

    I wonder if a certain yearly fee for service would do this particular physician better than the "traditional" practice of getting paid by the insurance companies? It would be interesting to work out the numbers. Of course, this would mean getting rid of a lot of "middlemen" in his office. . . including my wife (who is studying nursing anyhow. . . ). Beside booking office visits, the three other people who work in his office all have some kind of responsibility with making sure ANY kind of insurance payments are received. There's at least $60,000 in overhead right there that wouldn't be needed if he decided to follow the model suggested by this article!

    Please don't mind me. . . I'm just thinking out loud. . .


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