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Local doctors are opting out of insurance-based medicine
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Karen Quincy Loberg / Star staff "Your patient is the focus," Dr. Stanley Frochtzwajg said. "You serve the patient and the insurance intermediary doesn't call the shots." He checks Timothy Wachholz, 9, in Ventura.
STORY TOOLS 
More from County NewsSpend more time caring for patients. Make more money. Leverage insurance companies further out of the picture.
The formula can seem like a cancer cure to doctors battling the malignant one-two punch of cuts in insurance reimbursements and the need to see more patients to earn the same income. Alternatives to insurance-based medicine carry special allure in Ventura County where doctors are fighting Blue Cross over a new fee schedule.
At least two primary care practices already charge patients annual membership fees in a system called concierge care. Other doctors insist people dole out money up front and deal with insurance companies on their own.
More are considering those options, though some in healthcare worry that less reliance on insurance means patients pay more, tilting the best care away from people who aren't rolling in money.
"I wish I had done it a long time ago," said Dr. Edward Portnoy, a Westlake Village internal medicine physician who once had a practice of about 2,800 patients. Now he sees about 380 people but takes home about the same profit, thanks to the $1,800 each patient pays yearly.
He works the same amount of hours but spends roughly twice the time with each patient. He has more time to do intensive physicals and help patients stay healthy, rather than running from one crisis to the next like a war surgeon doing meatball surgery.
"At the end of the day, I feel more like I'm not behind the eight ball," he said.
'For a well-to-do clientele'
At Dr. Stanley Frochtzwajg's family practice in Ventura, patients don't face annual fees but pay at the office for whatever services they receive. A routine office visit is about $80. They're given the paperwork to submit to their insurance companies. One patient said she ends up paying about 30 percent of the bill but is happy with her care and willing to pay for it.
The extra money buys more time with the doctor. And it means Frochtzwajg doesn't need authorizations from Blue Cross or anyone else before he decides what treatment is best for the patient.
"I don't want to be beholden to insurance companies," he said. "I want to be beholden to my patients."
Doctors prefer labels like personalized, preventive care or fee-based practice. Outsiders use different words: "concierge" or "boutique."
"There's not a lot of people who can afford it," said Anthony Wright, executive director of the consumer advocacy group Health Access California. "The reason some people call it boutique medicine is that this is for a well-to-do clientele."
Wright believes the current insurance system is broken as shown by the about 4.9 million Californians who are uninsured. But he doesn't think systems that shift more burden onto the patients are the answer or will evolve into more than an isolated alternative.
"Why would the vast majority of people who have coverage and want coverage, why would they want to pay more money?" he asked, noting patients in some practices also inherit the hassle of negotiating with the insurance companies. "The trend of boutique medicine sends the consumers in the direction of you're on your own. Everyone for themselves."
But Carol Miller of Thousand Oaks thinks the $3,600 she and her husband pay in annual fees to see Portnoy is worth it because it brings peace of mind. The money covers an annual physical and a battery of screenings for everything from Alzheimer's to sleep apnea. The fee also covers follow-up that focuses on preventive care.
There are other perks. People in Portnoy's waiting room find a basket filled with Cliff bars, crunchy peanut butter and chocolate chip bars. They're served tea or Snapple.
They don't have much time in the waiting room because it's usually empty. They go right in to see the doctor.
Patients are given wallet-sized CDs bearing their medical histories. They're promised same-day appointments, sometimes within 45 minutes. If they have problems, they're given the doctor's cell phone number.
"You don't get that with a regular doctor. They don't give out private numbers," Miller said. "I feel like he's more than a doctor. With this kind of practice, they know our name. I call on the phone and they say Hi, Carol, how are you doing today?' "
Portnoy and Paul Block, a Thousand Oaks internist, belong to a national network of about 160 boutique doctors administered by a Florida company called MDVIP. The company is also in discussions with three or four other doctors in Ventura County, said MDVIP President Darin Engelhardt.
Because doctors in the network stress preventive care, patients spend as much as 80 percent less time in the hospital, Engelhardt said.
"Long term, unequivocally, this program reduces healthcare costs," he said.
Frochtzwajg wouldn't join a network like MDVIP because he thinks many of his patients couldn't pay $1,800 in annual fees. His program of asking people to pay instead of insurance companies also means they pay more, but the increase isn't as dramatic.
Shortage of family doctors
Though doctors like Portnoy limit their practices to no more than 600 patients, Frochtzwajg cares for about 2,500 people. That's still less than many other doctors because he can charge his patients more than what insurance companies would pay him. He also saves money on the office staff needed to process insurance claims.
He's not doing anything new. In a 27-year career, Frochtzwajg has never contracted with insurance companies and hopes he never will.
James Glover II / Star staff "I wish I had done it a long time ago," said Dr. Edward Portnoy, a Westlake Village internal medicine physician who once had a practice of about 2,800 patients. Now he sees about 380 people but takes home about the same profit, thanks to the $1,800 each patient pays yearly.
"Your patient is the focus. You serve the patient and the insurance intermediary doesn't call the shots," he said.
The words are attractive in a county where many specialists say they are considering terminating their Blue Cross contracts because of a new fee schedule that threatens their ability to stay in business. Many will keep their other insurance contracts but will ask Blue Cross patients to pay their own way.
The situation of primary care doctors may be more unstable. Though their reimbursements could rise, they often make less than specialists and often have to see more patients, which means less care and longer waits.
"It's not uncommon for patients to bring a copy of War and Peace' when they go for a doctor's appointment," said Engelhardt of MDVIP.
More troubling, there's an emerging shortage. About 14 percent of medical school graduates chose family medicine in 2000, according to the American College of Physicians. Five years later, that number dropped to 8 percent.
Dr. Ted Hole, a Ventura family physician, thinks the one way to survive is for doctors to lessen their reliance on insurance reimbursement. He is considering terminating some of his insurance contracts and asking his patients to pay upfront.
"I think that's the direction that a lot of primary care physicians are going to need to go in," he said. "There's only so much you can do. I don't think you can see 50 patients a day and deliver first-class medical care."
Dr. Bob Gonzalez, medical director at Ventura County Medical Center, worries that less reliance on insurance means fewer people getting healthcare. They won't be able to afford it.
The specter of more doctors downsizing their practices and seeing fewer patients also alarms Gonzalez. It means patients won't be able to find any doctors or could be dumped on an already overburdened doctor.
So yes, he said, more money, less insurance and more time with patients may be good for individual doctors.
"But whether it's good for society or good for patients is the overall question," he said.
Posted by carexpritch on July 23, 2007 at 12:46 a.m. (Suggest removal)
This is nice for rich people.
If a physician sees fewer patients but makes the same or more money, then what happens to those former patients who no longer are seen because they cannot pay?
This enhanced service for rich people and the disgust with insurance companies is just more indication of how sick the system is.
www.onecarenow.org
Posted by uknow1 on July 23, 2007 at 5:49 a.m. (Suggest removal)
Since CMH plays the insurance game to the inth degree, of course Gonzales is "worried" about it.
Privately held medical companies like CMH are a major reason insurance companies are buckling down on benefits. CMH encourages P.P.O. patients to come back to the emergency room instead of advising them to go to an outside physician. Why? So they can bill the heck out of the patient's insurance. They tried to pull the scam on me, however, as I work in the medical industry, I saw the scam as being blatant and wholly unethical. Change is needed all around and these physicians whom are weaning themselves off the staus quo predicament with the insurance companies are truly leading edge physicians.
Posted by Just_wondering on July 23, 2007 at 9:25 a.m. (Suggest removal)
$684,000 does seem like a lot, but don't forget that has to cover office rent, office staff, equipment rental or purchase, malpractice insurance and everything else that comes with owning a business.
Posted by rebel123 on July 23, 2007 at 9:28 a.m. (Suggest removal)
There are some things that just should not be profit driven and forgive me if this sounds "socialist", but health care is one of them. Only the well to do will be able to go to doctors.....even if you have insurance if the doctor is not signed up with the company the most they'll pay is half the fees. So now the doctors are basically striking against the insurance companies and refusing to deal with them. Swell. And for those who can't afford the costs....then what? We're not talking about illegal workers here, we're talking about the average Joe and Joan who work their tails off, are covered by a mediocre group policy at their jobs. My company just switched to BlueCross, which is now being dropped by a ton of Ventura Co. doctors. Something has to be done about the cost of medical care.
Posted by LoveDoggies on July 23, 2007 at 9:38 a.m. (Suggest removal)
Seems like this $1800/yr is for well-care. What happens when you get sick, how much do these boutique doctors charge over and above for taking care of you at that point? It seems like you have to also keep paying for your insurance coverage over and above the $1800 to cover 'everything else'? Rip off.
Posted by jmcgaw3046 on July 23, 2007 at 9:59 a.m. (Suggest removal)
Again better for the rich. The nice thing for these DR is that they get fewer patient since those with the money are the ones who get sick a lot less than the ones who are not rich. The rich have all kinds of things that they can afford that help keep them well, but the person living pay day to pay day,has trouble some times even eating healthy. Most of the food that is health you will find cost more.
Again this is just what M. Moore, SICKO was all about. The rich get good medical care and the poor end up waiting for hours in the emergeny room.
I have one DR I go to that does not take assignment from Medicare, however this is because he does not like them tell him how much to charge. But in the long run, I pay up front and get my money back, the same as if he took assignments, however I have to wait for Medicare to process the claim, which is another subject.
Posted by cslaurie on July 23, 2007 at 10:57 a.m. (Suggest removal)
Thinking back a few years - it is insurance companies that have cost the consummer. They increased payments at the drop of a hat. There is no rhyme or reason to pricing now.
If it wasn't for the insurance companies these doctors love to hate - the doctors would be getting paid with chickens, eggs and crates of brocolli and once in awhile a few nickels from the coffee can.
And remember, about five percent of the population controls 95 percent of the wealth. So there is a finite group of wealthy folks - as soon as this movement catches on there will be competition and the market will set the rates - not physicians.
Posted by AnnaWhaat on July 23, 2007 at 1:06 p.m. (Suggest removal)
I like the idea of spending more time with the doctor. Mine is in and out in a flash !!!! I don't think the price is bad if its unlimited visits if your ill............... BUT what about prescriptions? I have seen prescriptions of mine run well over 200.00 a bottle !!!!!And the shots I once took were over 1,000 a month! So you have a doctor what you can pay ,BUT what about the medicine you need?
Posted by tarahdb on July 23, 2007 at 2:23 p.m. (Suggest removal)
It is incorrect to assume that only the rich can afford to visit a doctor who doesn't take insurance. In fact, only the rich can afford the insurance that allows them to avoid the doctor’s fee. I take home $20,000 after taxes, which is not rich by any stretch of the imagination, but I pay cash at the doctor's office.
Insurance companies try to convince us that we need a low deductible and low copayments because they make a lot of money when people pay $300 premiums every month in order to avoid perfectly manageable doctor fees. Even worse, most so-called insurance leaves you holding the tab for 20-40% of the bill no matter how high the cost of service, and the result is that you aren't insured when you need it most. Most people could pay for a $80 office visit or could eventually pay off a $2000 deductible, but how many can come up with with $40,000 of the $100,000 bill for heart surgery or a month-long hospital stay after a car accident? Doctors care for you, insurance companies make profits by assuming risk and taking more of your money than they pay out.
I may pay $80 for an office visit and $50/month for PPO insurance with a $4000 deductible, but my insurance pays every penny above $4000. It also pays for one checkup every year. The high deductible allows me to have a Health Savings Account which can be used only to pay for health care expenses, enjoys a tax write-off, and earns interest. Considering that regular PPO insurance with a low deductible, 20% “coinsurance” and $30 copayments would cost $200-300 per month, it is more than justified to pick up the tab for an $80 doctor visit. Even the cheapest HMO would be $100/month, plus the hassle of prior authorizations and referrals as well as two copayments (primary care plus specialist) in order to see a specialist.
I am self-employed now, and have joined the ranks of many for whom the choice between expensive insurance or paying cash is a no-brainer. However, even when I was employed by a company I was able to negotiate with them to raise my salary by not taking the crappy HMO that they paid $250/month for – I went elsewhere for cheaper high deductible insurance and used the extra to save for doctor visits.
Also, I agree with cslaurie that the insurance companies are the real problem when it comes to pricing. If a doctor currently sees 100 insurance patients for $50 apiece and 10 non-insurance patients for $80 apiece, the cost for everyone could logically be about $53 apiece if insurance were not involved. Even with the current system, doctors are often willing to negotiate fees or give you a payment plan, particularly at small practices and particularly if you are truly in need of financial assistance (not just fishing for a better deal). With employers and doctors, it often pays to ask.
Posted by AnnaWhaat on July 23, 2007 at 5:10 p.m. (Suggest removal)
Well I have excellent insuracne I only pay 10.00 co-pay and they pay the rest. If I go to the ER its a 50.00 co pay unless I am admitted then I dont have to pay that. They paid 100% of my hospital bill last time over 31,000 and both times I used the ambulance they paid in full.
BUT our Dental plan is terrible !!!!! 1500.00 max a year?? Suppose you need a partial or a couple of crowns? That eats that up really fast. Then your stuck with the rest of all costs.I would love to find a good dental plan !!!!!
Posted by KathrynAsh on July 24, 2007 at 10:26 p.m. (Suggest removal)
I think this is the way too go, especially with children who are unlikely to get extremely ill, but have many small doctor's appointments. Many companies don't cover dependants, and mine charge's people $600 a month to cover their family. Why not spend that money on better care? It beats giving it to the insurance companies.
If people were financially responcible for their own health, they might be more apt to be more healthy in the first place. How much of health costs are caused by preventable things like obsesity and smoking? Let people pay their own way, and leave the government out of health care.
Posted by optisaurus on July 25, 2007 at 7:36 p.m. (Suggest removal)
It is really not so much for rich people. We see less and less of the insurance in our office as well, and our doctor opts out of many plans a year becuase we can not opperate for the money that they pay. We offer a discount for cash customers becuase it takes so much payrol time to fight with insurance companies and to bill patients for things that are not covered that they refuse to pay for. Our doctor does a lot of community service work for those that are in real need. My suggestion is to scale back your cable, scale back the cell and internet fees you pay, buy more fruits and vegetables, and walk around the block every day. You will save some money so you can afford to pay for real health care, and you will be healthier. Make your health care a priority. If the doctor is a good doctor, the patients do find a way to afford them. If more doctors opted out of more plans, insurances would have to reassess their practices.
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