Melissa, thanks for joining us, excited to have you contributing your stories and insights. When you’ve been a professional in an industry for long enough, you’ll experience moments when the entire field takes a U-Turn, an instance where the consensus completely flips upside down or where the “best practices” completely change. If you’ve experienced such a U-Turn over the course of your professional career, we’d love to hear about it.
You would be hard-pressed to find someone who would deny our healthcare system’s current state is broken. Patients face a lack of doctor access resulting in admonitions to go to urgent care when they are sick, limited visit times that are generally filled with prescription writing, and multiple referrals to specialists because their doctors do not have time to delve into any in-depth workup or invest in managing multiple issues. And all this while subject to ever-increasing premiums/copays/coinsurance/deductibles for their medical insurance. It wasn’t always this way. There was a time when a doctor knew his patients personally, had the privilege to spend as much time as needed with them and cared for them when they were sick. It wasn’t that long ago, and I have experienced both as a patient and as a medical provider. I can say with certainty both parties are equally suffering the consequences of third-party medical insurance entities. Decreased reimbursement forces doctors (by way of the administration of the organization they are affiliated with) to increase patient volume, which decreases visit times. The current average face-to-face with a primary care provider is 6 minutes. Requirements to aid in patients being able to utilize their insurance have resulted in a ridiculous amount of metrics and box-checking that consume as much, if not more, time than the patient is allowed face-to-face with their doctor. These metrics could serve as meaningful data for better patient care, but it has been concluded they do not improve patient outcomes to any measurable degree. They have further separated the patient from the doctor and often strong-arm the doctor to adhere to an “allowable protocol” for their patient care. This may include starting every patient on a minuscule dose of medication simply because they have a diagnosis that requires it within an algorithm deemed approved by their insurance company.
It wasn’t always this way. There was a time doctors could make decisions based on what they felt the patient needed, not what insurance required. Doctors could order tests they felt were in the patient’s best interest without fear of insurance rejection, even after supplying the required prior authorization. Doctors knew their patients personally and thus had better insight into their health, resulting in far fewer written prescriptions and more education provided. Things were caught much quicker, and thus much less chronic disease existed. Patients were healthier, happier, and comforted knowing their doctor was available for them when they needed them.
After over 25 years of operating “in the system,” it became evident that something had to be done. My about-face U-turn occurred about 18 months ago when I worked as a local hospitalist amid the pandemic. I was reprimanded for spending too much time with my patients, for the third time. My supervisor stated that “I ran behind schedule and talked too much”. Maybe I do talk too much, but my patients needed every moment (and then some) I invested with them. I could not see a way to be the provider I wanted and needed to be while working within the system’s confines. I realized it had slowly, gradually become unsustainable. Although profit margin is a vital part of any business, it had been kept in check when medical providers had the liberty to care for their patients as they felt best. Once contracted with insurance carriers, providers become handicapped from operating this way. Medical insurance has driven a wedge between the doctor and the patient. Doctors cannot be doctors anymore. They are 100% at the mercy of the insurance company’s requirements and restrictions regarding every decision they make.
Administration costs are the largest element responsible for driving up the cost of healthcare in the US. The healthcare administration sector manages all the nuances of insurance claims, rejections, approvals, prior auths, and so forth. We are paying more and getting less than we ever have.
So I exited stage left. I opted out of medicare (a requirement from the government if you are not accepting their insurance) and began a cash-pay private practice. The model is called DPC, or direct primary care, and is a new movement in the healthcare sector for all the reasons mentioned above. It is a cash-pay membership, where you have access 24/7 to your doctor directly via text, and is all-inclusive for your primary care needs—no additional out-of-pocket expense. We are limiting our patient panel to 500, always to guarantee same-day appointments and extended visit times (30-60 minutes). We do believe insurance has its place. Similar to the other insurance policies we hold. Automobile, homeowners, etc. High deductible, hopefully never use. So most of our patients do carry a policy; however, they don’t tend to require it very often. We believe this is the ideal place for insurance. Not smack dab in the middle of the doctor-patient relationship. More and more providers, specialists, and even surgical centers are adopting this model. Amazingly, patients can take back agency over their health and become a collaborator in decision-making. And you know what? People are healthier and happier when they have open access and a personal connection with their medical provider. And so are their providers.
Melissa, before we move on to more of these sorts of questions, can you take some time to bring our readers up to speed on you and what you do?
We specialize in time, access and connection. We practice the concept of informed consent for our decision-making. We educate our patients and then allow them to decide on the treatment they feel most comfortable with, and barring any obvious reasons we proceed accordingly. We are nontraditional in nearly every sense of the word and would likely be described as outside-the-box providers. We strive to provide a very comfortable environment for every single person. Although we are engaged in keeping up with the most recent scientific developments, we also see great utility in the proven approaches that have stood the test of time. We strongly emphasize treating the whole person, mind, and body, recognizing the two are inseparable. Recently we began offering ketamine infusion therapy at 1/2 the price of the local infusion clinic. This was to remove the cost-prohibitive barrier that prevented some from accessing the treatment. We both have personal experiences with depression and PTSD and had the treatments five years ago. They were life-changing. Mental health has reached epidemic proportions, and current treatment options are failing most. They successfully aid in about 30% remission of symptoms of those treated. Again, we knew we had to look beyond the traditional treatments, science has decades of data showing the problem as well as offering alternative options for treatment. Such as IV ketamine.
Training and knowledge matter of course, but beyond that what do you think matters most in terms of succeeding in your field?
Human connection. Hands down.
How’d you meet your business partner?
Met this guy on Plenty of Fish circa 2009. I knew he was a good catch. I literally asked him to marry me in the initial message I sent him. It said, “will you marry me”. That’s all. He did, but it took a minute, and the rest is history.
- Website: mbodyhealthcare.com
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- Linkedin: Melissa Major
Interview blog with Canvas Rebel: https://canvasrebel.com/meet-melissa-major/