07/05/2026
Been awhile since I posted on this page. We have two businesses. (Devoted Family Medicine and Devoted DPC Direct Primary Care) after I set up this page as I never really thought I could physically move enough to open a practice.
It's been two years, and this is what I learned: Trust but verify and if you think things are going off the rails, they probably are. We had an EHR company and biller AND credentialling assistant (all referred by EHR system), and their product was unusable, the billing was unusable and the credentialling was not done. I did call the companies to verify that he indeed tried but bever followed up. All the while lying to me about how close we getting to everything being done. did not do his job...So we lost 3 solid months to credential on my own and got help from family to complete that job. and lost at least 3 more months before an insurance check beside Medicare came in.
When someone says they can do a job, be sure they actually manage that job, and don't let it run amuck and MAKE VERY sure that you as the business owner have superadmin privileges on every account before it is set up.
If someone working for you, tells you they know what they are doing, then defies what you tell them about the simplest things, know for sure, they don't respect you as having authority over your business and get rid of them. Even if they seem nice and even if in your heart of hearts believe they are simply inept and mean no actual harm. They can do a lot of harm. The clean up can be hours or weeks.
I also learned once I was on the Insurance pathway, that I could no longer (by contract) offer any type of sliding scale or assistance even to a cash payer. I also learned that people who don't pay before their appointments skip out quickly and will disappear. It's theft and it hurts. They don't actually meet their deductible because they don't pay it and the insurance company doesn't care about that.
I also learned that we are gradually losing our biggest hope of a healthy and decent quality of life if we don't accept a different approach to our healthcare that takes more than 7 minutes to correct and we might have to pay out of pocket to get that but if procedures are discounted, the program pretty much will pay for itself It just won't meet the deductible most people won't meet anyway.
is only getting half of that and you have a situation where in order to make the office work, patients really do have to be in and out in 15 minutes. Particularly, the doctor only has about 7 minutes with insurance payouts.
This is not my idea of healthcare. This is more like inspecting a leaky lawn sprinkler from afar and turning off that sprinkler zone and hoping the area will get enough water from the rest of the sprinkler system. Not enough time to actually walk to the sprinkler region, figure it out, and fix the problem. I just can't do that type of healthcare to people with all that I have been through in my own life and my children's health has been affected by this as well.
So what to do?.. and then I got a scam call that was useful. I man tried to tell me that they wanted an interview for podcast... About Direct Primary Care. I put him off to call back and even made the call. (I wanted to see what his schtick was going to be...) In the meantime, I did a crash course in Direct Primary Care. Just in case, you know ... (but yeah, the guy wanted $20K to do the podcast with his so called famous person he was not really affiliated with.. Since then, I have actually been featured in a community Impact newsletter which was real.
In my crash course, this is what I learned: I could form a new company, provide cash prices to those people or also allow them to get a subscription to a plan that allows free visits! Oh how I wish patients didn't have to worry about a big bill to make sure their kidneys and diabetes were ok. Certain patients need the extra care and don't come and so they will get worse and I don't want that to happen. If residency didn't teach me anything else, it taught me that health neglect can kill people by the time they were mid 50's So much for retirement.
I was personally passed around for 7 minute visits for years. I stopped complaining. I put up with things and I chalked it up to OLD, even when I was 30...then it was anxiety. My doctors were happy to agree. I tried to get help from 4 neurologists after I am sure I had the disease that disabled me. Had I known about the condition 10 years before, I would have known to stretch and I would have never did the exercise that did me in and I would not have gotten a certain treatments that in fact was a co-factor in the gravity of the collapse of my health.
So, to preserve my integrity, I let everyone know what has happened. We still take insured patients if they cannot afford the subscription plan but we have to limit their time and just do our best. We encourage our patients to keep the insurance, but get the catastrophic plan it has morphed into for hospital visits and with the saved money from not expecting your insurance to take care of you (which they really don't anyway) you can get real doctor visits that are comprehensive, well thought out and perhaps have time to say the thing that helps us put your puzzled condition into a spiral upward to better health instead of a spiral down. The subscription is low, the labs are so low that most of the time, the cost of one declined lab I want but your insurance company doesn't, can cover two sets of labs from me and others are so high that they are a years worth or more than I would charge for labs.
In addition, I learned that there are alternative treatments that have emerged that actually help. There are more options that ever before and really, we could all use some help in finding out which of these options actually do something and what doesn't I fear for the unwitting patient who sees a self proclaimed specialist who has no license to practice and sends them to a doctor labs or imaging but misses serious clues to cancerous conditions. I have watched this in real life. I was disabled in the year where a health condition disrupted every one's life. The aftermath is distrust, and it's understandable. I have it too. I didn't realize how anxious people had become since that point.
So today, I treat a minimal number of patients per day due to my health condition but I am there available to speak with Mary Decker my Nurse Practioner or the patient, and will likely be getting another Physician Assistant or Nurse Practitioner or perhaps that doctor who already realizes how crazy staying in the rats nest of insurance and corporate provides can be and want out. As long as they also don't mind working to help the patients with our "give the patient time to talk and be sure to listen and take them seriously". We want to bring back the real family doctor.
We are ultimately transitioning to Direct Primary Care. Mary Decker is still seeing most of the patients under insurance but I am getting close to hitting a critical mass for Direct Primary Care patients that would be the number I can see without hurting myself.
I learned how the insurance companies are essentially trying to force out competition. More importantly, I learned who the competition is: Me. They don't own me, they do have at least once interest in the pharmaceutical, hospitals, clinics, imaging centers, labs, pharmacies and many other type locations. As a physician, this verges on severely unethical but couched in the insurance company with the "sister companies" they have so many place to hide profit that they can now come back to you after declining the care you paid out of pocket last year and tell you that they have to increase your premium and deductible, or get sneaky - promise you "approved" healthcare and then make the acquisition of the approved doctors, the medications, the imaging and labs difficult In come cases, the surprise comes when they decline to pay for it, instead leaving you with a big bill that doesn't come off of your deductible.
But wait there's more: you can pay the premium every month for this very priviledge of waiting on the phone for 3 hours, making additional appointments with your doctor for the next "one problem" they can help (maybe) with and finally, someday, 6-10 visits later each costing you about 3 hours of time maybe 1/2 day wages, not to mention the increased deterioration of your health. maybe then the doctor will hear just the right words.... and you will get help.
I listen, I review, I stabilize and then I get to work to improve your quality of life. It does take a few visits if you have multiple problems but if you have multiple problems, your situation is likely more serious than you think. It's not always age. Eventually it is but not suddenly and not when you are 30-50 years old. Some people are more spry at 85 than some I have seen at 57. We all have the same environmental toxins thrown at use everyday. We have been is difficult situations where we had no choice but to eat what was before us. Not everyone is sick. So let's fix it!
