Self Pay Patients

Self Pay is a type of payment where the patient’s own resources pay for the care. It is contract between the patient and the physician. Individuals pay for care with personal funds, health saving accounts, and other funds. Self-pay is the basis upon which the healthcare financing system began. Patients paid physicians a fee-for-service. In its purest sense, the self-pay model includes only the physician and patient in the exchange of compensation for medical care provided. Over the years as healthcare financing arrangements have changed, entities paying a fee-for-service includes all payers-public and private. Some in the healthcare industry has referred to physician practices that do not accept health insurance as cash-only practices or self-pay patients. Self pay vastly reduces the traditional overhead expenses by not having to bill and abide by contractual requirements of third party payers. Further, collection rates may be higher with fewer bad debt expenses. Physicians in a pure self-pay practice may want to continue to see patients with private insurance who are willing to pay cash and submit their own claims. Before charging privately insured patients on a cash basis, the physician should determine that there are no contractual or legal restrictions on doing so. This will necessitate a review of existing contracts and state insurance regulations. Certain states protect enrollee’s in particular private insurance plans from being billed for any sums beyond what the insurance company pays, except for co-pays and deductibles. Some physicians have found the self-pay model a way to regain meaning in and control over their practices, as well as to reestablish a physician-patient relationship in which there is time to care. Another option to consider in not accepting health insurance is to combine a self-pay model with a retainer practice. This hybrid practice would allow patients who could not afford a monthly retainer fee, to still receive care in their personal medical home and only pay for the medical care provided. For more information on retainer fees, see the discussion paper on retainer practices.

Concierge Medicine

Concierge medicine goes by many names, boutique medicine, retainer medicine, executive health, VIP medicine, and personalized medicine. By any name, concierge medicine is the solution for doctors trying to maintain their integrity and independence in today’s difficult healthcare environment.Concierge medicine is a new style of practice with old roots, in which doctors limit their patient base in order to provide patients with personalized service, high quality care, 24-7 availability, and other amenities. In exchange for this enhanced personal attention, patients pay physicians an annual fee. This concierge fee enables physicians to increase their compensation while managing their workload. In addition to receiving an annual fee, most concierge physicians continue to receive reimbursements from health plans and private pay clients. Concierge medicine is a relationship between a patient and a primary care physician in which the patient pays an annual fee or retainer. This may or may not be in addition to other charges. In exchange for the retainer, doctors provide enhanced care. Other terms in use include boutique medicine, retainer-based medicine, and innovative medical practice design.The practice is also referred to as membership medicine, concierge health care, cash only practice, direct care, direct primary care, and direct practice medicine. While all concierge medicine practices share similarities, they vary widely in their structure, payment requirements, and form of operation. In particular, they differ in the level of service provided and the amount of the fee charged. There are an estimated 5,000 concierge, or membership medicine doctors throughout the U.S. Concierge physicians care for fewer patients than in a conventional practice. All generally claim to be accessible via cell phone or email at any time of day or night or offer some other special service beyond the normal care provided. The annual fees vary widely, from $600 to $5,000 per year for an individual, with the lower annual fees being in addition to the usual fees for each service and the higher annual fees including most services. Some concierge practices do not accept insurance of any kind. These are as cash-only or direct primary care practices. By refusing to deal with insurance companies, these practices can keep overhead and administrative costs low, thereby providing affordable healthcare to patients. They become concierge only if the practice assesses an annual or monthly fee instead of or in addition to a fee for each medical service. Other concierge practices do take insurance, even Medicare, but ask for an annual fee for additional services exclusive of insurance plans. This annual fee is not a substitute for medical insurance, and generally does not cover consultations outside the practice, laboratory procedures, medicines, hospitalizations, or emergency care from other providers.

Medical Device

A medical device is a product used for medical purposes in patients, in diagnosis, therapy or surgery. Medicinal products achieve their principal action by pharmacological, metabolic or immunological, medical devices act by other means like physical, mechanical, physio-chemical or chemical means. Medical devices are a part of medical technology. Medical devices include a wide range of products varying in complexity and application. The Food and Drug Administration recognizes three classes of medical devices based on the level of control necessary to assure the safety and effectiveness of the devices. Class I devices are subject to the least regulatory control. "General Controls" apply to all Class I, II and III devices. General controls include provisions that relate to adulteration; misbranding; device registration and listing; pre-market notification; banned devices; notification, including repair, replacement, or refund; records and reports; restricted devices; and good manufacturing practices. Class I devices are not intended for use in supporting or sustaining life or to be of substantial importance in preventing impairment to human health, and they may not present a potential unreasonable risk of illness or injury. Most Class I devices are exempt from the pre-market notification and/or good manufacturing practices regulation. Class II devices are those for which general controls alone are insufficient to assure safety and effectiveness, and existing rules provide such assurances. In addition to complying with general controls, Class II devices are also subject to special controls. A few Class II devices are exempt from pre-market notification [10]. Special controls may include particular labeling requirements, mandatory performance standards and post-market surveillance. The FDA holds Class II medical devices to a higher level of assurance than Class I devices, as Class II devices must perform as indicated without causing injury or harm to patient or user. Examples of Class II devices include powered wheelchairs, infusion pumps and surgical drapes. A Class III device is one for which insufficient information exists to assure safety and effectiveness solely through the general or special controls sufficient for Class I or Class II devices. Such a device needs pre-market approval, a scientific review to ensure the safety and effectiveness of the device, and is subject to all the general controls of Class I devices. The FDA classifies Class III devices as those that support or sustain human life and are of substantial importance in preventing impairment of human health, or which present a potential, unreasonable risk of illness or injury. Examples of Class III devices (which currently require a pre-market notification) include implantable pacemaker pulse generators and endosseous implants.

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Ophthalmology

Ophthalmology is the branch of medicine, which deals with the anatomy, physiology and diseases of the eye. The term ophthalmologist refers to a specialist in medical and surgical eye problems. Since ophthalmologists perform operations on eyes, they are both surgical and medical specialists. The eye is a fragile organ, requiring extreme care before, during, and after a surgical procedure. An expert eye surgeon must identify the need for specific procedure and be responsible for conducting the procedure safely. Anesthesia is essential for any eye surgery. Local anesthesia is most commonly used. Retrobulbar and peribulbar techniques for infiltrating the local area surrounding the eye muscle cone are to immobilize the extraocular muscles and eliminate pain sensation. Topical anesthesia using lidocaine topical gel is preferred for quick procedures. In topical anesthesia, patient cooperation is a must for a smooth procedure. General anesthesia is for children, traumatic eye injuries, major orbitotomies, and for apprehensive patients. Cardiovascular monitoring is preferable in local anesthesia and is mandatory in general anesthesia. Proper sterile precautions are used to prepare the area for surgery, including use of antiseptics like povidone-iodine. Sterile drapes, gowns and gloves are necessary. A plastic sheet with a receptacle helps collect the fluids during phacoemulsification. An eye speculum is used to keep the eyes wide open. Although the terms laser eye surgery and refractive surgery are used as if they were interchangeable, this is not the case. Lasers may be used to treat nonrefractive conditions, while radial keratotomy is an example of refractive surgery without the use of a laser. A cataract is an opacification or cloudiness of the eye's crystalline lens due to aging, disease, or trauma that typically prevents light from forming a clear image on the retina. If visual loss is significant, surgical removal of the lens with lost optical power is performed and it is usually replaced with a plastic intraocular lens. Due to the high prevalence of cataracts, cataract extraction is the most common eye surgery. Rest after surgery is necessary. LASIK is Laser-Assisted In Situ Keratomileusis. LASIK is a type of refractive surgery, performed by ophthalmologists using a laser. The operation is with the patient awake and mobile; however, the patient is sometimes given a mild sedative (such as Valium) and anesthetic eye drops. LASIK is in three steps. The first step is to create a flap of corneal tissue. The second step is remodeling of the cornea underneath the flap with the laser. Finally, the flap is repositioned.

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