**The following is another installment in an SW101 exclusive series entitled Medicine In America (MIA), covered by our crack journalist team scattered around the globe.**
TULSA, OK – “Just in case I screw something up,” Dr. Jason Hines says, smiling, as he helps an elderly man sign a form and pay for his “procedure insurance.”
Dr. Hines, owner of New Day Family Medicine, a small group practice here, is one of a growing number of primary care doctors who are getting creative as they struggle to increase falling reimbursements.
“I got the idea from my very own Family Medicine Academy,” Hines says excitedly, holding up a postcard with bold, red letters emblazoned across the top reading LAST CHANCE! “They’ve been trying to get me to buy their life insurance policies for about 2 years. This is the 14th ‘last chance’ notification I’ve gotten.
“Then it struck me! Even the AAFP is getting in on insurance, why can’t I? I mean, we can’t all be lawyers and dentists, right? Gotta make the bucks somehow. ”
Dr. Hines’ fledgling business-within-a-business had a rough start. “Nobody saw a need for it,” he said.
Debbie Lawrence, one of the first patients to sign on, described her initial doubts. “It seemed a little strange, you know? I’ve already got insurance for my car, my house, for medical bills. I even usually get that extra insurance for rented DVD’s. But then, as the doctor described the procedure of removing a mole on my back, I saw this slight tremor…and then he read me the consent form! Boy, it just seemed like the safest thing to do.”
“I had to figure out some way to promote things.” Hines explained. “The postcard idea was already taken by the AAFP, so I wanted to do something more creative.”
His solution was to enroll in an acting class at the local community college.
“Watch this!” He said excitedly. “I’ll just reach for this piece of paper, aaaaannd NOW, I’ll have this nearly-imperceptible tremor just before I pick it up. See that? We really worked on the subtle-but-obvious thing in class.”
Then he modified his legally-mandated consent form process. “So, they make you blah, blah, blah about the risks and benefits of every procedure, right? Well, I just figured I should capitalize on that.”
His consent form reads:
My signature is proof that I consent to the forthcoming procedure. Procedures are dangerous. Most are not proven to actually improve anyone’s health. I understand that I risk serious pain, including but not limited to severe disfigurement such that my children and spouse might recognize me only by mannerisms.
Often, procedures of this kind result in lasting nerve damage, potentially to the genital area. I understand and fully consent to an ambivalent and uninspired sex life from this point forward.
Bleeding is usually something that can be stopped. If not, I am willing and happy to slowly dwindle into a shivering unconscious blackness from which I may never emerge.
I also agree to not underestimate the risk of infection. I realize that flesh-eating bacteria exist everywhere, at all times, and are constantly attempting to gain access to my body. I understand that should infection occur, I may wake up with parts of my body unexpectedly reduced to nothing more than exposed skeleton held together by rotting fascia.
“That’s the mellow one,” Hines’ states matter-of-factly. “I use it for wart removal and immunizations.”
After the slow start, business now is booming. Dr. Hines calculated his acting class cost – “110 bucks a unit for a 3 unit class” – at $330, which he claimed on his income taxes as a business expense. He sells insurance for any procedure in his office, usually at a cost of $25 to $350 per procedure. “I’m thinking of adding waiting room insurance – you know, in case the roof collapses – but we haven’t worked that angle yet.”
What has been developed is the “Cabo” insurance package, which includes a special waiting room with palm fronds, seltzer water, a chaise lounge and soft music. Aside from guaranteeing the procedure to be safe and “up to standards”, the patient also receives a massage at the conclusion. “Sometimes, we’ll give their dog a massage also.” He said charitably. “After signing my consent form, people are pretty keyed up. I usually just throw the dog in for a reduced fee.”
The AAFP did not return calls for comment, but did release this statement,
The AAFP does not condone the practice of selling non-medical products within the environment of medicine. We believe in assisting our doctors as they provide the best care possible for the entire family. Just look at the success of primary care medicine in America over the past 30 years for evidence of our presence in Washington.
Although the insurance business does offer unbelievable profit margins and investment returns of nearly 50%, we strongly believe that individual doctors do not have the expertise to get into the business. Individual family doctors should leave the big business and real financial gains to organizations that are qualified to actually make money.
Finally, although we typically keep information about doctors confidential, it should be mentioned that Dr. Hines appears appears to have let his board certification lapse. He is soon to be rejected from our community as a “fellow” if he doesn’t pay his dues by cash, check or debit/credit.
“They can say whatever they want.” Replies Hines. “I got the idea from them. The AAFP opened my eyes to the fact that there’s lots of ways to make money on the medical field, as long as you don’t waste much time actually practicing medicine. I can’t believe it took me so long to figure it out. I’m just glad I got in on the gig now, when the para-medical business is still in it’s Golden Age.”