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Yes, I couldn’t agree with you, or him, more. I may try that direction, but I live in a somewhat isolated, underserved area with a relatively small population of people who could pay out of pocket. OTOH, I’m the only shrink left in the area, and I get my patients well, and many might be willing to pay to of pocket.

Certainly, in my specialty, it’s an added bonus that people are more likely to really do what’s necessary to get well if they are paying out of pocket, an old truism that fits human nature and is born out in my experience.

I had a practice largely like that years ago, and the whole procedure was very smooth and clean. They paid at the beginning of the visit, and I gave them a letterhead receipt with the date, diagnosis, billing code and fee. It was their responsibility to submit that to their insurance company if they wanted to, and to haggle with them to get reimbursed. Very clean.

The VA has the best EMR out there in my opinion, as it's straightforward and intuitive, designed by physicians. I've also worked on more complex, user-specific EMRs in the civilian sector, and they might be OK for a gamer, but they are needlessly complicated and fragmented. The template issue is huge, as information becomes buried in too much meaningless text, and often the text is contradictory. The Meaningful Use provision is going to be a huge, needless, expensive boondoggle. I was in a CDC-sponsored group trying to form parameters for Meaningful Use regarding cancer patients. The CDC had not even clearly defined an issue of missing cancer data, but now are trying to mandate that all physicians who offer cancer care have to report to the state Central Cancer Registries EACH TIME the patient is seen after their initial diagnosis. State Central Registries are not equipped to handle or process that firehose-torrent of data, and medical practices will have to come up with some type of electronic reporting method in order to comply, or be faced with financial penalties. A lot of the impetus for the Meaningful Use provision is also being pushed by software companies, who are salivating over the extra potential revenue. It is a nightmare, and all the burden is being placed on the physicians.

people are more likely to really do what’s necessary to get well...”

Interesting fact isn’t it. I have been involved in mental health since 1985 and have seen too many professionals, particularly psychiatrists, over the years who never seriously worked with the patient to get them off meds or explore other options. Another of my M.D. clients who is also a psychiatrist is still hanging onto the insurance route. He has several little old lady patients who have been coming to him twice a month for at least ten years that I know of. Their co-pay is quite small and I have decided that it is more of a social outing for them versus a real need to see the doctor.

Certainly people who are bipolar and/or schizophrenics need to be on meds but I do believe that psychotropics are often abused and over prescribed for other diagnosis. Perhaps people with short-term issues would be better served by hitching up their britches and, in addition to praying to God for guidance, get some individual psychotherapy to help them learn to deal with their problem or meds only for a short period of time coupled with psychotherapy.

There just aren’t a whole lot of options out there for doctors right now, especially for those who want to maintain their autonomy, establish a treatment regimen that fits the need of each patient and do place the welfare of their patients above everything else. You sound like a great doc and I do hope your patients appreciate you. Best of luck to you as you wind through the seemingly impossible maze the government has created.