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Recap: Lawrence doctor chats about unique practice

February 16, 2012

This chat has already taken place. Read the transcript below.

Dr. Ryan Neuhofel

Dr. Ryan Neuhofel will be available Feb. 16 to discuss his new family practice in Lawrence.
Neuhofel is unique in that he doesn’t accept health insurance or third party plans; instead he charges fees for services. He’s even willing to barter.

Moderator:

Thank you Dr. Neu for coming in to answer questions today. I'm health reporter Karrey Britt and will be moderating this chat. We've got quite a few questions so let's go ahead and get started.

amartini2002:

I'm wondering if you will be handing out antibotics and other needed medicine in your office or just handing out a prescription?

Dr. Ryan Neuhofel:

Thanks for having me Karrey.

We currently are NOT dispensing medications from the clinic, but do provide access to a personal Pharmacist (which happens to be my wife) for people who need counseling on medications - regardless of where they received their meds. I have considered doing "point-of-care" acute care meds directly from my clinic, but being just a few steps from a pharmacy in the Medical Arts Building it hasn't been necessary.

charliebryan:

Beyond disarding the conventional approach to being reimbursed for medical services, what other unconventional approaches do you think our community should consider in order to improve the population's health?

Dr. Ryan Neuhofel:

I think the managed-care dominated system has slowed true innovation in the health care in many respects. Everyone believes that utilization of technology needs to improve, but I fear that thus far the "technology incentives" are very much aligned with third-parties interests. Patient-centered technology like we are trying to utilize will be hugely important.

twackerslow:

What type of care can you provide for my younger children ages 18 months, 5 years and 12 years?

Dr. Ryan Neuhofel:

I am trained and board-certified in FAMILY Medicine, so I can certainly care for children of any age. Personally, I love caring for kids and witnessing their growth and development is truly amazing.

cloudbursting:

Are you vegan-friendly? In other words, will you work with vegan patients and respect their ethically-based medical and nutritional choices? Thank you!

Dr. Ryan Neuhofel:

Well . . . my dad is a butcher, so I was raised on mostly on large slabs of grilled meat! But, yes I fully respect anyone's choice of diet and can counsel them on any health-related diet issues.

poolside:

How do your services differ from Health Care Access? Is there more or less you can do?

Dr. Ryan Neuhofel:

I actually have volunteered at HCA since about Dec 2010, so I'm very familiar with their services and think they provide an awesome resource to the community. I differ from them in several ways . . . 1) I am a physician and the only provider at NeuCare. We don't utilize mid-level providers (nurse practitioners, PAs, etc.). 2) We don't have insurance or income 'guidelines' for eligibility to be a patient.

clc1298:

This is amazing...I have been searching for healthcare insurance and continue to be denied due to my health risk. I have heart disease (CAD) with a stent. Will you be serving those of us with these types of health risks and would those lab tests be eligble?

Dr. Ryan Neuhofel:

Thx clc. Unlike health "insurance", we do NOT deny/change our rates OR type/level of service (including labs) for any type of health condition(s).

mkinley:

How did you decide to run your new practice with this fee structure?

Dr. Ryan Neuhofel:

Good question! One that I ask myself all the time! My experiences with the current third-party managed care system were very frustrating from the beginning, so I always knew I wanted to do something "different". Ultimately, I asked myself, "What if we could start with a clean slate? with just myself as a doctor and my patients". I crunched some numbers and found I could provide high-quality, affordable primary care when I could strip away all of the 'unnecessary' paperwork and administrative burden.

Moderator:

Here's a question that came in via email: What kind of patients are you hoping to target?

Dr. Ryan Neuhofel:

Everyone! and anyone! Sadly, the current fragmented system has segregated people in to different 'types' of clinics. In my opinion, that is a bad thing for any community. So my goal is to have a very diverse group of patients - short and tall, young to old, poor to rich, hippies to hipsters . . you get the picture.

clc1298:

Thank you for reviewing my previous question. I apologize for using incorrect wording. What I mean to ask is 'will you be "treating" those of us with high risk health concerns, such as CAD, and will those lab tests be eliglbe? Your practice summary indicates "some lab".

Dr. Ryan Neuhofel:

Sorry for the confusion. Yes, I will treat anything within my scope of practice (including medical management of CAD) which is fairly large. With respect to lab, we do provide SOME 'free' lab as part of our monthly fee - things like fingerstick blood sugar, urinalysis, rapid strep test, urine pregnancy. We also offer affordable, upfront prices for any other labs we do charge for - i.e. price for a lipid (cholesterol) panel is $10. Most our lab is $10/$20/$30.

Jean1183:

Is that a monthly fee AND the fee for service or one or the other?

Dr. Ryan Neuhofel:

Yes, to be a NeuCare patient we require a monthly or "membership" fee - as one of our patient's described it "sort of like a Costco membership for primary care." The membership fee covers . . .
- Short emails & phone calls (<1 min)
-Many FREE lab & diagnostic tests
- Medical equipment lease
- Online personal health record
- Coordination of care
- Pharmacist counseling (remote)
-Some group health programs

But we do charge for visits, labs, procedures. All of our prices are listed on our website at . . .
https://neucare.net/NeuCare/Info_Pricing.html (click on items for more detail)

NewbieGardener:

Dr. Neu:
We are excited about your new practice here. Will your services include general gynecology (preventative exams, etc)? Also, do you recommend catastrophic insurance coverage for your patients? I assume emergency surgery procedures or worse case scenarios will be a concern for those not covered by any form of insurance.
Thanks,
S

Dr. Ryan Neuhofel:

Thx Newbie.
- Re: Gyn. Yes I perform basic gyn care, including Pap Smears,etc.
- Re: insurance. NeuCare is NOT insurance or a substitute for insurance. We are an independent, alternative way to get primary, day-to-day health care. I do encourage (but not require) my patients to have some type of insurance policy in case of an unexpected, expensive health event. For patients and doctors, I believe health insurance is better structured as a financial tool - rather than a pre-paid health overlord.

Moderator:

Here's another question via email: Do you have health insurance?

Dr. Ryan Neuhofel:

Yes. My family (wife and 2 kids) have a high-deductible ("catastrophic") health plan - which I hope to never "have" to use.

EmJones:

Can you provide service on the same day a person joins, or is their a waiting time after joining?

Dr. Ryan Neuhofel:

Typically yes if the clinic is open. We are trying to maintain same-day or next-day visits for all our patients . . even the noobs.

jcstepmom28:

Dr Neuhofel, how do you feel about treating patients with chronic pain conditions? Do you believe in herbal supplements in conjunction with prescription medications?

Dr. Ryan Neuhofel:

I am certainly familiar with chronic pain and view pain management as a key part of comprehensive health care. Re: herbals and prescriptions. I would have to have more information to respond intelligently on that. We do have our controlled-substances policy (and my thoughts on chronic pain and narcotics) on our website at . . . https://neucare.net/NeuCare/Info_Rx_Policies_files/Medication%20Policies.pdf

shaley8160:

Do you have a list of fees for services, and what type of barter system are you interested in pursuing?

Dr. Ryan Neuhofel:

Yes, we list ALL of our fees upfront . . .https://neucare.net/NeuCare/Info_Pricing.html
Re: bartering. I don't have a specific 'system' in place, but am open to bartering for any practical good or service that I would purchase otherwise. I'd much rather be paid in a dozen home-raised chicken eggs than an Aetna "EOB" (explanation of benefit"). :)

chic:

Do you have privileges at LMH?

Dr. Ryan Neuhofel:

Working on it. I am hoping to provide basic inpatient (hosptial) care for my patients if admitted at LMH. I think adult patients is going to be doable, but I'm working on some logistics of caring for children inpatient.

alfordd:

I think your practice would be great for people like me. I work full-time, but as a contractor, I am not offered health insurance. However, since I do work full-time, it would be difficult to make an appointment at your clinic. Do you have any plans for offering more evening/weekend clinics?

Dr. Ryan Neuhofel:

At this time our building closes at 6pm, so we cannot have visits past that time, but that may change in the future. I am planning on starting a Saturday morning clinic (? twice a month) once we get enough patients. Also, I am available 24/7 to all my patients and can even do an after-hours visit (at my clinic or house call) for urgent needs.

Oracle_of_Rhode:

First, I think your model of operation is awesome and compassionate and badly needed in today's broken medical system. Why is it an unconventional approach? Are you taking a monetary hit to provide services in a more humane and easier-to-access way? If not, why do most dr's operate in the conventional manner with insurance cos? Also, do you see kids?

Dr. Ryan Neuhofel:

In historical terms in not all that "unconventional". GPs and primary docs worked directly for their patients until mid-late 1970s. One person described what I'm doing as "Marcus Welby with an iPhone". I don't really know who Marcus Welby is but it must be accurate! Re: money. I am providing a professional service that I was trained (and paid lots) long and hard to do, so I do expect to be compensated for my work - just like anyone else, but I will do perfectly okay financially if my model works out. Don't worry about me :) And yes, I see kids.

EmJones:

If a person wanted to submit a bill from your office to their insurance company so the cost would be applied to a deductible (I have a $3000 deductible plan), is there any reason you know of that it would not be applied to the deductible? An out-of-network deductible, of course.

Dr. Ryan Neuhofel:

Ultimately, your health plan determines what IS and ISN'T an eligible expense. Our monthly fees will not likely be "covered" by any type of health plan. Our visit fees SHOULD be considered an eligible expense.

Moderator:

Dr. Neu — Thanks for taking time out of your busy schedule to participate in this chat. There are quite a few more questions but we're out of time. Maybe you will come back and do another chat? Again, thanks for coming in.

Dr. Ryan Neuhofel:

Absolutely. Good times. Anyone who didn't get their question answered can contact me at anytime. Also, feel free to stop by our clinic anytime we are open to check out my sweet decor (check the the calendar on our home page). Thanks again.

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