Maine doctor walks away from health insurance

The Bangor Daily News brings the interesting story of Dr. Michael Ciampi, who “took a step this spring that many of his fellow physicians would describe as radical.”

The family physician stopped accepting all forms of health insurance. In early 2013, Ciampi sent a letter to his patients informing them that he would no longer accept any kind of health coverage, both private and government-sponsored. Given that he was now asking patients to pay for his services out of pocket, he posted his prices on the practice???s website.

The change took effect April 1.

???It???s been almost unanimous that patients have expressed understanding at why I???m doing what I???m doing, although I???ve had many people leave the practice because they want to be covered by insurance, which is understandable,??? Ciampi said.

The doctor’s website does indeed provide a menu of services.  For example, at the time of this writing, a brief office visit (one straightforward issue) is $50, while more complex issues requiring longer consultation cost more, all the way up to $150 for a complete physical exam.

Dr. Ciampi admits to losing some patients, but expects his practice to remain financially healthy.  He thinks other doctors may consider following his new business model:

Before the switch, Ciampi had about 2,000 patients. He lost several hundred, he said. Some patients with health coverage, faced with having to seek reimbursement themselves rather than through his office, bristled at the paperwork burden.

But the decision to do away with insurance allows Ciampi to practice medicine the way he sees fit, he said. Insurance companies no longer dictate how much he charges. He can offer discounts to patients struggling with their medical bills. He can make house calls.

???I???m freed up to do what I think is right for the patients,??? Ciampi said. ???If I???m providing them a service that they value, they can pay me, and we cut the insurance out as the middleman and cut out a lot of the expense.???

Ciampi expects more doctors will follow suit. Some may choose to run ???concierge practices??? in which patients pay to keep a doctor on retainer, he said.

Another virtue of the new business model: lower prices thanks to reduced overhead, as both the doctor and his patients spend less time fooling around with paperwork:

Before, Ciampi charged $160 for an office visit with an existing patient facing one or more complicated health problems. Now, he charges $75.

Patients with an earache or strep throat can spend $300 at their local hospital emergency room, or promptly get an appointment at his office and pay $50, he said.

Ciampi collects payment at the end of the visit, freeing him of the time and costs associated with sending bills, he said.

Another Bangor Daily News piece portrays Ciampi as a rebel against Big Medicine’s mergers and consolidations, instead preferring an independent practice with close ties to patients.  He moved his practice into a big health-care system so he wouldn’t have to spend so much time dealing with administrative and financial issues, but he didn’t like it:

???To be fair, hospitals have a lot more services,??? he said. ???You have one-stop shopping where you can see your doctor and you can have your X-rays and your blood tests and advanced images all under one roof.???

Nevertheless, Ciampi said he grew increasingly dismayed by the realities of working under a ???big impersonal system.??? He had less control over his schedule and decisions about care as ???productivity??? took a front seat, he said.

So Ciampi took the practice back, four years later. It???s now located in South Portland and, in a nod to its history, is attached to Ciampi???s home.

???As an independent physician, it???s been very hard to stay in practice,??? Ciampi said, citing ever-changing insurance regulations that increase doctors??? overhead costs, coupled with stagnant reimbursement rates through Medicare.

???That???s really the dilemma that physicians are in right now ??? do you want security or do you want independence???? Ciampi said.

It will be interesting to see if Dr. Ciampi’s approach catches on.  If other doctors are willing to go the same route, they might find customers among those who view the trans-Constitutional tax/penalty cost of escaping from ObamaCare as money well spent.  Pay off your “individual mandate” – perhaps after losing your old plan, because your employer would rather pay his tax/penalty and dump you into the public exchanges – and find a doctor who charges half what those still tangled up in the government/insurance complex are charging.

On the other hand, people have a funny relationship with medical costs.  They don’t view medicine the way they see any other commodity.  It seems more like a penalty charged against those who have the bad luck to get sick.  It’s confusing, and when anything beyond light medication for common ailments is involved, the “consumer” often grows too nervous for astute comparison shopping.  Medicine is an aspect of life that many people don’t really mind losing control of, as long as they believe they’re in good hands.

For all of its absurdities and inefficiencies, the impersonal blend of big medical systems, big insurance companies, and big government provides a distance between patients and doctors that some patients do not consider undesirable.  They also don’t necessarily object to the true cost of medicine remaining hidden, because it’s something they’d rather not think about.  The illusion of “free” care provided by employers, or the government, has its comforts compared to the cold reality of bills pulled from an open wallet, even when paying the most steeply discounted prices.