Physician with a Slick, Web 2.0-ish Method of Practice

http://www.jayparkinsonmd.com/

by karzeem • 19 years ago

56 25 19 years ago

Is this guy bypassing managed care completely? Its like a return to the old way doctors used to practice, house visits and all. But this guy leverages modern communication to maintain a wider patient base than previously possible with strictly face-to-face visits. Interesting.

daniel-cussen2• 19 years ago

Good stuff.

wammin• 19 years ago

This is really interesting and refreshing to see a change in the way that healthcare operates ...

BUT, it seems like this guy is trying to bypass insurance companies completely. From the FAQ: ... I accept absolutely no health insurance at all and my fees may not be reimbursed by your insurance company.

We all know that health insurance is a huge confusing nightmare in the U.S., but I don't think its advisable get rid of it completely. I suppose if you don't have insurance, then this doc would be a really good alternative.

edw5192• 19 years ago

So the only ones who make money are those who actually provide value. What a concept.

zaidf• 19 years ago

Not necessarily.

My surgeon Dad told me once that his practice pockets pennies out of every dollar they officially bill the patient. Where does the rest go? Between his own liability insurance, the insurance companies not paying up, and the privacy/medical records red tape.

This guy's model is actually my Dad's dream: be able to go treat a patient for 30mins, get paid for it(versus fight for hours with the insurance). The actual bill would be lower too because for most part he only has to charge pennies on the dollar since there won't be as much red tape.

karzeem• 19 years ago

This guy could accept insurance, but given the way he practices, I'd imagine it would be a bureaucratic nightmare.

His intent doesn't seem to be to subvert the insurance system so much as to serve the large niche of people, especially in NYC, who are relatively young, need a good GP, and don't have insurance (or good insurance).

iamelgringo3• 19 years ago

It's called a boutique practice. My day job is as an ER nurse (while I finish my CS degree), and it's totally the way I'd go for my medical care if there was someone around that did this.

Some doctors with a boutique practice take a retainer fee plus bill insurance. Sounds like this guy is going the cash only route. I'm sure he'll end up making more money that way, regardless.

The average GP in NYC probably makes about 120,000 - 150,000. But they have to carry a 5,000-10,000 patient load while each patient gets 15 minute appointments. Some docs routinely see over 20 patients a day. This guy is charging a $500 retainer for two visits a year. That means that if he has 300 patients, he's making what a regular GP makes at an HMO. If each patient has two visits a year, that means that he can have 2 appointments a day and make the same amount as an HMO doc. That's his break even point. Anything over that, and it's gravy. I'm willing to bet that he has a 500 patient load. So, he's bringing in $250,000 net plus extra visits and appointments. So, by going cash only, he's probably making twice what an insurance doc would make.

This guy also does house calls only. So, he doesn't have the overhead that he'd normally have with an office--staff, office rent, equipment, etc... He doesn't have to hire billing specialists. He outsources all of his X-Ray and lab work, so no overhead there. And, he has an unofficial network of non-jerk specialists that he can refer people to that he likes working with.

I'm surprised that this hasn't caught on more than it has.

If you're his patient, look at his appointment schedule. He's giving people a half-hour to one hour time slots. And, he does a lot of his consultations over the wire, via IM, video chat and cell phone. He probably doesn't have to see his patients most of the time, and it's a lot easier for his patients to get in touch with him. His patients are happier and he has a much better quality of life.

Brilliant.

quickpost• 19 years ago

Do you think he's getting any kickbacks from his referrals to the specialists?

dcurtis3• 19 years ago

Of course. That's how the game is played.

iamelgringo3• 19 years ago

I seriously doubt it. Doctors have always had gentleman's agreements to refer patients to each other, and then refer the patient back once the specialist is done.

The only kind of payola that I've ever seen after 14 years in health care are drug companies purchasing cruises/lovely dinners, etc... for doctors.

dcurtis3• 19 years ago

I wonder what would happen if you got a bunch of new, young, hip doctors and started the exact same kind of thing in San Francisco. You could have a really sweet centralized appointment and advice site with always-accessible doctors ready to chat 24/7, which is covered by the patient retainer fees and/or insurance.

Healthcare 2.0?

(PS anyone interested in seriously seeing if this is feasible?)

menloparkbum• 19 years ago

sort of exists already. I use these guys:

http://www.sfoncall.com/index.html

lkozma• 19 years ago

Sorry, but this is health-care going back to pre-1850 levels with a Web 2.0 interface. If this becomes widespread, it defeats the whole idea of 'pay according to your means, get treatment according to your needs', social solidarity, etc.

edw5192• 19 years ago

Good. In case you hadn't noticed, most Americans do not agree with that concept. Maybe they oughta try it in Russia. Oh, wait. Too late.

gommm2• 19 years ago

They tried it in france and a lot of european countries and it works rather well....

But of course, forget what I said, keep on thinking that any concept of fair social health care is equivalent to totalitarian communism.

As for me, I will go on with my belief that it a government is there to provide fair and equal access to education and health care and protect an healthy competitive economy through antitrust laws and simple and efficient business regulations (unlike france).

iamelgringo3• 19 years ago

You're right. It completely creates a multi-tiered health care system. Those who can pay more get better care, and those who can't get worse care. But that system already exists. It's just off the record and off the books. You'll see more and more of this as the health care system worsens.

People who are wealthy have better insurance and congregate in wealthy neighborhoods. So, doctors and hospitals in that area are better funded and provide a higher quality of care. The brightest doctors compete for jobs in these areas, because they know that they will have more insured patients and get paid more over the course of their career. If you want the best doctors in a city, go to a clinic/specialist in the richest neighborhood.

Low income areas have a high concentration of low/no health insurance patients. So, the health care system in those areas tends to be underfunded and the doctors often get paid less. So, you'll see less competition for doctor jobs in those areas as well.

Everybody has access to Emergency Rooms regardless of the ability to pay, that's mandated by law. But, in low income areas, the Emergency Room generally looses money for the hospital, so it's underfunded and understaffed. In the wealthy areas, patients have insurance and can pay so the ER makes money for the hospital and is staffed accordingly.

Here in California if you have no or low insurance, good luck seeing a specialist unless it's a life or limb threatening Emergency. It's next to impossible to see an orthopedist or a dermatologist in LA unless you have great insurance or pay up front with plastic.

If you don't have health insurance, you get referred to the county health system which is generally terribly overburdened. ER's at County hospitals can routinely have a 12-24 hour waiting time. That is, if you break a leg, and go to a county ER in California, chances are, you'll sit in the waiting room for half a day before getting anything for pain.

What this guy is doing is simply calling a spade a spade, but at least he is advertising his rates, and he helps his uninsured customers know where to go for low cost services like X-Rays and Specialist referrals, and he tells them how much it's going to cost his patients.

icey• 19 years ago

This looks really great... until you get cancer.

falsestprophet• 19 years ago

consider this system paired with traditional catastrophic health insurance

kirubakaran• 19 years ago

Ah... One appropriate chance for sick==(slick,!healthy) pun and you blew it karzeem.

daniel-cussen2• 19 years ago

On a somewhat unrelated topic, why is health care so pricey in US? Do doctors willingly quota spots in medical schools?

rms• 19 years ago

It's a conspiracy between the insane government and psychopathic corporations.

kingnothing• 19 years ago

It's expensive largely because of the prices of malpractice insurance doctors have to carry, greedy insurance companies, and a lot of red tape.

I'm not sure what you're asking with the second question, can you rephrase it?

I'm sure some studies are out there, but how much more expensive is medical care in America compared to Europe and Japan? Sure, we pay out of pocket here, whereas it's rolled in to taxes over there, but what's the price difference?

gommm2• 19 years ago

Here in japan, when I go to the doctor I pay between 5 and 10 dollars + medecines... The national health care covers 70 % of the bill (so the doctor would cost between 15 and 30 dollars). The national health care is compulsory and costs me about 150 dollars a month (since I'm a contractor I pay it in full, for employees they only pay half and their employers pay the other half)

In france, when I was a student, the doctor cost 20 euros and the national health care covered 80% (so I paid 4 euros). As a student, the national health care was included in my tuiton fees that cost around 600 euros for one year.

mhb• 19 years ago

Why (or why not) US health care is so expensive: http://news.ycombinator.com/item?id=63646

Physician with a Slick, Web 2.0-ish Method of Practice

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