NO FORMS, NO REFERRALS, NO RED TAPE – DOCTORS AND PATIENTS ALIKE JUST SAY NO.
The Issue: Both physicians and patients are becoming more and more dissatisfied with the small amount of time they spend together during a typical medical visit. Adequate time to discuss eating habits, exercise, family or work pressures, etc., and to provide recommendations, is just not available within the managed care system.
The Story: Physicians are dropping out of the third party system, and patients are following them. Doctors are frustrated by the red tape and intrusion of HMOs into the doctor-patient relationship. New models of non-insurance-based care are sprouting. In Tennessee, Dr. Robert Berry has chosen not to accept any third party payments saying that insurers “put doctors and patients at odds with one another.” Says Alan Zend, DO of Edmunds, WA who no longer accepts insurance: “We may be seeing a few fewer patients but we’re giving better care.”
Here in greater Portland, physicians and other practitioners at the True North Health Center in Falmouth routinely see their patients face-to-face for 1 – 1 1/2 hours (that’s 8-10 times longer than the average physician visit in the US). They don’t accept insurance (although patients can choose to submit receipts themselves) but they do make a difference. Says True North patient SD: “Before coming to True North, my health care was a series of quick office visits and prescriptions, none of which helped. Finally, I’m able to spend time with a doctor who asks me a lot of question and who really takes the time to listen. I’m feeling so much better.”
What do True North’s physicians say? Dr. Bethany Hays, women’s health: “I am at True North because I don't want anything to come between me and my patients, not insurance, not business, not time-constraints. I want to be able to hear my patients’ stories, however long that takes, and join with them in creating a journey to health.” Amy Kustra, MD, family medicine: “I choose to work at True North because it allows me to practice medicine in a way that satisfies my heart, soul and mind.” Dr. Miles Simmons, psychiatry: “I am here at True North so that I can collaborate with a wonderful group of smart and talented colleagues, and work within an organizational structure that supports my own values of acceptance, respectful listening and participatory relationships with my patients.”
Says one True North staff member who has observed patient reactions over the 2 years the Center has been in existence: “There were stumbling blocks in the beginning because people didn’t want to step outside of what their insurance would cover. But when they began to understand why TN practitioners chose to practice medicine this way – that they wanted to spend more time with each patient and really get to the root of complex medical problems, they started to change their minds. Most decided their health was worth it and now we see them come out of visits excited about everything they’ve learned and telling their friends.”
Additional Background: The 2001/2002 California Physicians survey was commissioned by Oakland-based California Healthcare Foundation. It was conducted by researchers at UCSF's Center for the Health Professions and elicited responses from 1,033 physicians.
More than 33 percent of specialist physicians in the state have no patients in their practice insured by HMOs, up from 23 percent of specialists without HMO patients in 1998, according to the report. Only 58 percent of patient care physicians in California are accepting new patients with HMO coverage. The rate of physician participation in private HMO plans is approaching the historically low rate of physician participation in Medi-Cal, the state's insurance plan for low-income Californians, the study concluded.
Dr. Kevin Grumbach, a UCSF professor of family and community medicine, said the problem is due to doctors dropping out of HMOs, rather than leaving California.
Story Elements: Interviews with TN practitioners and patients are available.
Contact: Chris Bicknell Marden, Director of Development, 781-6719, cbmarden@truenorthhealthcenter.org
