Dr. Christopher Ewin discusses fee-for-care versus the more common business model of primary care.
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Christopher Ewin: I charge about $87 a month. Can you afford that? I work in a charity hospital in Fort Worth. Cigarettes are $5 a pack. They sit there and wait four to five hours to be seen by a different nurse or doctor to take care of multiple chronic problems. And they've waited there and they have gone to McDonalds, they have a McDonalds actually in the hospital and they smoke a pack a day, that's $150 a month for their cigarettes. Here when I can charge you -- and the average charge for this kind of services are about $100 to $150 a month to have personal care. That's huge savings, because third party payers are the problems in primary care. There is so much micro billing and so much coding that it's wasting doctor's time to become data collectors and what we are seeing now is this big push for pay for performance, the AFP, the AMA, the insurers, they want to collect data on outcomes. They have no clue on how good of a physician I am. I think it's the marketplace that should determine it. If I am well-trained and I am Board Certified and I really care about you and I am not keeping up and I am not a child molester and my Board is saying, you're not prescribing drugs, that's what we have a board, Texas State Board of Medical Examiners to make sure that I am a good physician and I am not messing up. But none of these pay for performance is what they are trying to get outcomes data will ever, ever determine on whether I am a good physician or not. The patients and the consumers are the ones that should be doing it. What we are seeing is this big difference where you are paying the insurers and the doctors are getting paid by the insurers. So whom am I working for? Not you. Then I have to hire someone to try and go get paid. To give you an example I have one employee. My old practice, the two doctors there, they have 18 employees. His overhead is 45,000 a month. Doctors are going out of practice and think about this if you're -- let's say you are a college student and the value proposition, even if you're mediocre student we say, you're going to go to four years or competitive college, get into medical school four more years and then do a three to four year residency program. When you get out, you will have $150,000 to $200,000 in debt, no 401(K) plan, no pension plan, you haven't had a social life and huge liability where people will sue you. Then also your social life and also just setting up a business who would want to do that. And the physicians are telling their kids, you don't want to do this. We are miserable. Well, I am happy and I love practicing medicine again. What has to be determined is the patient in their own market and what you have to figure out is what would you pay if you wanted to have my services. Let's say you really dug my chili, there is a huge trust problem in America right now with positions and they can't get in. So I could give you unlimited access to care, a 24X7, you get my cell phone, my home phone, free email, text me with a question that's going to be a great service for you. So the question to you is what would you pay? So how do we fix and simplify the entire problem in the United States? I think everyone needs a medical home, I think you need a physician that you trust at a reasonable price that gives you quality care, not determined by the insurance companies, but determined by a board and you knowing that you have a Board Certified physician trained at a great school. And what you need is a high deductible plan just in case you have a car wreck. If you have a major, major illness and you get $5,000 or $10,000 program and you start putting money away now on your savings by having lower premiums and a high deductible plan, if you have 5,000 or 10,000 in there, then you are covered. It's like a medical IRA. I really like health savings accounts, but if you couple that with a family physician who can take care of 85% of your needs, your Well Woman Exam, you get any kind of skin diseases, so