Christmas
is not a very happy season for doctors across the country on the verge of
shutting down their clinics. Many
of these doctors have reached a point where low reimbursement rates no longer
cover the costs of running their practice.
“It’s
ridiculous. Insurance companies
charge patients an atrocious amount for coverage, and then they reimburse so
little of what doctors charge that these doctors actually lose money by having
treated some patients,” said Dr. Vern Cherewatenko, a family doctor in Renton,
Washington. Cherewatenko estimates
his clinic was losing $7 per patient once applying these payments not only
toward the cost of treatment but also to overhead, billing and administration.
According to Cherewatenko, uninsured patients often are stuck making up for the difference. Low reimbursement and increasing costs inflate the price of health care. While doctors charge the same rate to both insurance companies and uninsured patients, insurance companies only reimburse a percentage of the price while self-pay patients must pay the full amount. “This system penalizes the uninsured and makes health care even less affordable to those who have a difficult time affording it in the first place,” said Dr. David MacDonald, who also practices at Cherewatenko’s clinic.
Frustrated
with the bureaucracy of health care and desperate to save their clinic,
Cherewatenko and MacDonald have come up with a new system that allows them to
lower the cost of health care for uninsured patients while increasing their own
profit. Their program, which they
call SimpleCare, simplifies the health care system by eliminating the billing
and much of the administration for self-pay patients.
Instead
of the complex coding system insurance companies require, SimpleCare uses only
three codes – Short, Medium and Long – to signify the length of the visit.
Patients agree to pay in full at the time of their visit in exchange for
the reduced SimpleCare prices, which usually are 30-50% lower than what the
billed costs would be. The doctors get the benefit of up-front payment, zero billing
costs, less paperwork, less risk of miscoding, and less restrictions on
treatment while charging less and earning more on average per SimpleCare
patient. Instead of losing $7 per
patient as before, Cherewatenko and MacDonald estimate they now are making a
profit of $5 per patient.
Doctors
throughout Washington began joining SimpleCare, and now patients can find
doctors of almost every specialty participating in SimpleCare across the
country. Some nationwide labs
and a hospital also have joined the program.
“SimpleCare is really catching on,” said Keri Andrews, the SimpleCare
director of operations, “There’s so much red tape involved in health care
that treating patients doesn’t seem to be very high up on the priority list
anymore. Doctors see SimpleCare as
the means to put patients back on top of that list.”
SimpleCare
is a program of the non-profit American Association of Patients and Providers
(AAPP). For more information about
SimpleCare and how to become a member of the AAPP, go to their website at www.simplecare.com
or call 206-362-1111.
Contact
Information:
Keri
Andrews, Director of Operations
206-362-1111
ext. 119
4033 Talbot Rd S, Ste 570
Renton, WA 98055