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South Portland Doctor Gives up on Insurance System
07/01/2013   Reported By: Patty B. Wight

On April 1, South Portland primary care doctor Mike Ciampi stopped accepting insurance. Now, Ciampi charges less per visit, and can spend more time with each patient. But the decision does come at a price: Patients now must pay out of pocket or file their own insurance claims, and some have left Ciampi's practice as a result. Patty Wight brings us the first of two stories about health pracitioners working outside the insurance system.

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Dr. Mike Ciampi

Dr. Mike Ciampi, in his South Portland office.

"Good morning, Dr. Ciampi's office. We're actually not taking insurance anymore," Ann Burr tells a caller. "You're welcome."

As the sole support staff at Dr. Mike Ciampi's office, Burr is a jack-of-all trades. Both medical assistant and secretary, Burr spends a lot of time on the phone - but not nearly as much as she used to when also dealing with insurance claim issues.

"Hit one, hit two. Say this, I don't understand. All operators are busy," she recalls. "It was just a chaotic chasing - chasing money, chasing 'What's wrong with this claim? How can I fix it?'"

Now that problem is gone. When a patient's visit is complete, they pay on the spot. End of transaction. "I feel a lot more liberated," Ciamp says, "because I don't feel like I have to play games with the insurance companies."

Dr. Ciampi has been practicing in the Portland area for 14 years, and over the past year, had been ponderign dropping out of the insurance payment system. The Affordable Care Act, he says, ultimately pushed him over the edge.

"Twenty-thousand pages of new regulations, on top of the 150,000 pages of regulations that Medicare has," he says. "So we just realized there's no way as a small business we can ever hope to comply with all those regulations. We'd have to hire dozens of people. And frankly, we just couldn't do that and stay in business."

And on top of all that, were the insurance company requirements. Ciampi says there were times that he'd prescribe a medication, only to be told the patient had to try other medications first before the insurance company would cover it.

Then, there was the issue of his charges and reimbursements. "It's a complete shell game," he says.

Ciampi says doctors have to sign contracts with insurance companies that guarantee discounts on services and procedures. The same contracts prohibit doctors from charging anyone else less for the same procedure.

"So let's say ,for example, when I was taking insurance I did something that I felt was worth $150. The insurance company might say, 'That's great that you think that's worth $150. We think it's worth $100. Oh, and by the way, according to our contract, we're giving ourselves a 25 percent discount, so here's $75.' The part that really annoyed me was that, if someone came in that didn't have insurance, I had to charge them $150 according to the contract."

To make enough money on patient visits, Ciampi says he needed to increase volume, and therefore reduce time with each patient to 10 or 15 minutes - though he says some doctors spend just 5 or 6 minutes. "There's no way you can really know what's going on with a patient in that amount of time," he says.

By taking insurance companies out of the picture, Ciampi has cut or eliminated certain administrative costs and charges half of what he used to, and can spend twice as much time on a visit. A half-hour diabetic appointment, for example, costs $75.

But Ciampi says he thinks it is possible to earn the same salary as before and run his practice the way he wants. Still, there is a cost to this new model. "We've had a lot of patients leave us because our system won't work for them," Ciampi says.

Between 200 and 300 patients - or about 10 percent of his practice - have left. Patients can submit their own insurance claims, but Ciampi says some insurance companies won't reimburse receipts for his appointments, or his referrals to specialists.

Despite the loss, Ciampi says he has gained a few dozen new patients - many of whom haven't seen a doctor in years because they either have a high deductible or no insurance at all. Ciampi says he feels liberated. And nervous.

"Very. People say that I'm very brave. And I always say there's a fine line between that and being fool-hardy," Ciampi says. "So how this works in the long run remains to be seen. But there are doctors across the country that are doing it, and I haven'theard from one who regrets what I'm doing now."

And colleagues are watching Ciampi's experiment. He says he's heard from other doctors who tell him that if he's still in business in a year, they'll follow suit. He thinks health care would be better for it if consumers used insurance for catastrophic events, but payed out of pocket for the rest. When patients know what they're paying for, competition will go up, costs will go down, and, he says, care will be better.

Editor's Note: Tomorrow, a visit to a physician's practice that hasn't accepted insurance for more than 10 years - and is still around to tell the tale.

Photo:  Patty Wight


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