A SLIDING SCALE AND SET FEES — a Concierge Medicine Analysis


By Avitzur, Orly MD, MBA, FAAN

Neurology Today:
doi: 10.1097/01.NT.0000464256.58958.7d

Another Denver neurologist, Allen C. Bowling, MD, PhD, who specializes in multiple sclerosis (MS), has worked in a direct care practice for eight years. (He last chronicled his experience in Neurology Today in 2008. Read the article here: Neurology Today caught up with him seven years later to see how his practice has evolved and if the model was still working. Dr. Bowling has a set fee per visit, which he describes as quite modest, and also sees some patients for free or on a sliding scale.

More Neurologists Transition to Concierge-Type Practices — What They’re Doing to Make it Work ~Neurology Today

Due to the simplicity of his practice structure, which operates without a billing department, the overhead is very low. “Once you eliminate the need to bill insurance companies, the whole structure of the medical practice becomes ridiculously simple,” he said.

“Over the past 20 years, I have worked to develop a new paradigm of MS care that is aimed at optimizing health through the evidence-based integration of conventional medicine with lifestyle and unconventional medicine,” he said. “This approach requires a fund of knowledge and a clinician mindset that most neurologists do not have, yet many people with MS want.” As a result, when he provides this service in a free market setting, some people with MS are willing to pay extra because it is difficult or impossible to find elsewhere, he said. Because some facility fees in his area are in fact greater than Dr. Bowling’s fees and are not covered by some insurers, it can be less expensive for patients to see him out-of-network that it is for them to see certain in-network providers.

cmt selft test 2015Dr. Bowling said that changing to this model was the best decision he has made in his career. “The past eight years have been extremely rewarding; I am able to provide a unique and valuable medical service and get adequately reimbursed,” he said. “I feel just the opposite of burnout.”

Dr. Avitzur, an associate editor of Neurology Today, chair of the AAN Medical Economics and Management Committee, and editor-in-chief of Neurology Now, is a neurologist in private practice in Tarrytown, NY, who holds academic appointments at Yale University School of Medicine and New York Medical College.


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