Insurance-free doctor prefers quality over quantity

DULUTH, GA [January 3, 2013] — Until recently, Robert Devillier had never heard of having a membership with a doctor.

But if he continues his recent health improvement, Devillier might not need to return to a traditional doctor.

The Stone Mountain handyman, who doesn’t have insurance, said he is a diabetic with high blood pressure and a heart attack in his medical history. Before this fall, Devillier hadn’t visited a doctor in 10 years, he said, and the only reason he showed up at Dr. Ravin Talati’s office was the payment setup.

“It would a great program for the doctors to get into that way of practice, especially the way the things are going now,” Devillier said. “I couldn’t afford to go to doctors, and pay $120 a visit. It benefits me. Thirty-five dollars a month, I can afford that.”

Talati doesn’t accept insurance, and charges $35 per month, $15 per visit for “members,” and has discounted rates for lab work. A chest X-ray is $45, flu vaccine $20 and an adult physical is $99. But what Talati also stresses is he only books one patient per 45 minutes, another contrast to a traditional doctor’s office. Talati said he can handle 95 percent of primary care needs, and about the only things he can’t do himself are surgeries and MRIs.

His goal is to reach 500 patients, and then bring in another doctor; Talati said he can maintain this kind of practice because of low overhead costs, and two employees: himself and a receptionist.

“This model is beginning to really pick up, especially in primary care,” Talati said. “It’s actually called direct pay. The whole idea is to get rid of the middle man. Before, traditionally, you would have the patient, the doctor and the insurance agency. So we said let’s get rid of that insurance agency and put the medical decisions and the health back into the hands of the patient and the physician. Nobody knows you better than your personal physician.”

Talati joined the medical profession after he earned a business degree from Texas Tech University, worked for a company manufacturing apps, then for an accounting firm before his father became sick.

At 26, after he watched his father undergo a heart transplant where he was in a hospital for 14 months, and eventually led to a two-year “ordeal,” Talati became inspired by the doctors that helped his father.

“It fascinated me,” he said recently, six years after he made his career-changing decision. “I thought it was just fantastic that these guys could do what they do. A lot of respect for them. They helped me, my Dad, that way, so I felt like I could give back that way.”

Talati previously worked in Youngstown, Ohio, but moved to Gwinnett when his wife enrolled in a doctoral program at the University of Georgia. He’s worked in emergency rooms and a traditional practice, and currently works 12 shifts per month at ERs in north Georgia to offset bills.

The popularity of direct pay practices is rising, Talati said, including companies like IBM converting their employee benefits package to make them accessible.

In 2007, Procter and Gamble acquired a large minority stake in company called “MDVIP,” where members pay $1,800 per year, and doctors are limited to 600 patients.

Talati said these setups have far less paperwork than a traditional one. Talati said he used to work exclusively on paperwork from 6 p.m. to 8:30 p.m. each day.

“It got very frustrating very quick,” he said. “That’s time away from your family, that’s time away from you making revenue to make money to sustain, and keep your practice open.”

Doctors in traditional practices are aware of the rising popularity, Talati said, but are waiting to see long term results, and if they can be supported.

“I think a lot of them are still waiting to see how successful these practices become,” Talati said. “They’re still a little scared, that if this doesn’t work, what’s going to happen?”

The appeal to be a primary care doctor is to help people of all ages in the family, Talati said. Because as a youngster his own doctor had a personal relationship, Talati also wants to administer healthcare to newborns, grandparents and everyone in between.

To develop that relationship, Talati said he needs more time than the seven and a half minutes that insurance companies allow per patient.

“It’s an unwritten rule, seven and a half minutes per patient,” he said. “There’s only so much you can do in seven and a half minutes. We wanted to get away from the idea of you waiting in the waiting room for two hours, and then seeing the doctor for five minutes, or seeing a (physician’s assistant) or nurse practitioner. When you go to a doctor’s office, I feel like you should see a physician.”

For patients like Devillier, Talati said he couldn’t explain and treat diabetes in that short amount of time, which is why many doctors write a lot of referrals.

“As far as working with you and taking the time, it’s not like rushing you in and rushing you out,” Devillier said. “He wants to take the time with the patient. I like that.”

Talati said referrals aren’t necessary for something he can do himself. But because doctors are pressured by insurance companies to see “50 or 60” patients each day, doctors become “a referring machine.”

“Get a physical, diagnose you, treat you. Go to an endocronologist,” he said. “I wanted to change that. I want to sit down and treat you, because we can. We’re MDs. We’re capable of treating diabetes, I don’t need to throw you to a referral. I have time to sit down with you and treat you.”

Talati doesn’t suggest not having insurance at all. For his own family, Talati said he has a high deductible insurance plan, and recommends similar plans for his patients in case they are in a car wreck, or need an emergency appendectomy, for example.

Devillier said his blood sugar has dropped at least 200 points, and Talati did it in an affordable way.

“He’s willing to try and get your medicine cheaper,” Devillier said. “Just like some of the medicines he wanted me to get on, I couldn’t afford, (they were) $200 to $300. We worked together for something that’s reasonable. It’s a little more work on my part. He works with you on that, and he’s willing to call the drug stores and talk to them. He’s very sincere.”


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