For more than a decade now I have found the cash-based model best meets the needs of my clients. My focus is health and wellness. Conventional medicine and third-party payers have very little investment in wellness. Rather they await ominous pathology and then largely dictate for the client the treatment plan they have made available to them, while failing to appreciate the individual or their unique needs and preferences.
Education is not a priority in healthcare, particularly education about wellness. Short clinic visits do not allow for it and an empowered client can challenge the status quo. While coverage to the insurance holder can be an incredible benefit to the card holder, payment to providers rarely covers cost so clinics work to move as many clients through each day as quickly as possible. This diminishes care and prioritizes quick fixes.
Requirements of providers for meeting third-party-payer reimbursement also means practice protocols are developed that ultimately limit consumer choices and keep the clinician behind the desk, consumed by paperwork. Further, outdated payment models and misaligned incentives have conspired to arrest the forward progression of medicine. Functional medicine requires practitioners to invest time with clients - particularly at the onset of the relationship in order to successfully find and address the causes of chronic disease. The current model is designed to motivate and reward providers based on the volume of services delivered above the value of those services, this investment of time, along with the reliance on other lifestyle medicine interventions poorly reimbursed by payers, is often crippling to functional medicine practitioners.
The dominant payment model in the United States, and many other countries, is the fee-for-service system. The common, and escalating, criticism of fee-for-service is that it rewards the quantity of care delivered (within the spectrum of services covered by payers) but not the quality or efficiency of that care. (Blue, 2019)
The really unsettling fact is that fee-for-service actually rewards poor outcomes. Falling short of resolving patients' health problems leaves people dependent on the healthcare system and drives further utilization of the services for which providers are paid. Further, because the fee-for-service model rewards duplication of effort and lack of coordination among providers working in their various organ-system-defined silos (cardiology, endocrinology, dermatology, gastroenterology), it removes any economic pressure for the medical delivery system to reorganize itself to align with a modern understanding of systems biology.
Fee-for-services systems don't value multi-discipline teams wither, which helps offer a more diverse perspective to the client's case in a more coordinated manner. Although most clinicians voice frustration on the onerous administrative, coding and billing, and collection burdens of the current third party payer system, for functional medicine practitioners who devote themselves to approaching health issues by finding and addressing the root cause of dis-ease rather than offering symptom-suppression strategies, this frustration is multiplied even further. The time, services, and personnel which are utilized within functional medicine practices are simply not covered.
Wellness demands an investment in yourself. If third party payers cared about your health, they would pay for preventive care or even wellness care - like a gym membership or mental health therapy before crisis, even genetic testing. Our own government isn't even an advocate of health, as they fail to support breastfeeding women, disallow those injured by vaccines to seek compensation by the manufacturer of the vaccine or the administering clinician, and allow our grocery stores to be consumed by non-food-substances portrayed as nutritious... the assault to Mother Nature and our own environment is yet another atrocity that grossly impacts our health, yet our government largely ignores these violations by large corporations. We are not a nation that prioritizes wellness.
Eden Family Practice does not fit the model currently dominating today's healthcare culture. However, as a licensed healthcare practitioner, these third party payers often do reimburse for Dr. Layne's consultations, do cover her orders for labs and diagnostic screening, and health savings accounts do pay for her educational programs. We will provide those interested a superbill so that you can seek reimbursement.
While many functional medicine practitioners are offering what has been coined concierge medicine, our focus has been to merge some of what works in the more standard conventional system and packaging our functional medicine programs in fixed-priced, bundled episodes of care targeted to specific populations such as the programs found on the forum. These all-inclusive prices and targeted programs for specific populations offers each of us - client and clinician - the freedom to approach your care in the best method for your individual needs.
Keep in mind, not many functional medicine clinicians also maintain primary care services. Our practice values building these relationships along with offering functional medicine consultations, but because functional medicine attracts an increasingly complex patient population, the work involved and the resources these consults demand are far more extensive than the visits typically seen in primary care. This makes utilizing third party payers all the more challenging.