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Coulter running a cash-only practice to keep health care costs down

Ocean Springs physician garners national attention

OCEAN SPRINGS — Dr. H. Todd Coulter, who practices family medicine at Midway Family Care, a walk-in clinic, started out just trying to stay in business. His innovations designed to make health care more affordable for patients while keeping his practice financially solvent has received national attention.

On a recent spot on the “CBS Evening News,” Coulter was interviewed about his efforts to provide low-cost medical treatment by operating on a cash only basis charging patients a flat rate of $40 for a visit and foregoing the hassles of dealing with insurance companies. The news piece concluded by saying, “The patient is happy and the doctor is staying in business — just what the doctor ordered for a system badly in need of healing.”

“Our goal is to provide readily available, easily accessible, quality medical care at an affordable price,” says Coulter, who is immediate past chairman of the Young Physicians Section of the American Medical Association and a spokesperson for the American Association of Physicians and Surgeons. “Over a year and a half ago we began a program where we disengaged from insurance because of financial reasons. To have a solvent medical practice, we couldn’t continue taking insurance.”

Coulter said in some regards health care insurance can seem like a pyramid scheme. Physicians often get as little as 40% of their costs reimbursed by the insurance companies because of what doctors’ call the insurance industry’s four d’s strategy: Claims are downcoded, devalued, denied and payment delayed.

“The only ones getting rich are the insurance companies,” Coulter said. “Patients and physicians are the ones who are left to struggle for an existence. I didn’t realize what I was doing was so novel. In fact, what we are doing is beginning to revolutionize the health care industry. Our overhead dropped initially by $2,800 per month because we are no longer paying for software maintenance programs and electronic medical records. We don’t have to create records for billing purposes, but just for clinical purposes. We were doing a lot of dictating at $3 per page. That is what it cost us that to substantiate the billing. Now I don’t have to do that because the only ones involved in the transaction are myself and my patient.”

Coulter first got attention for his innovative way of providing health care when he was interviewed by the Kentucky newspaper, the Lexington Herald. After that article appeared he got a call from CBS News, which then followed up with a three-hour interview on Nov. 7.

Coulter decided to operate on a cash-only basis, offering a Bridge Account medical discount program where members are obligated to pay only $40 cash for office visits, with discounts on all services, tests and procedures. Patients with health insurance are provided with all the information they need to apply for reimbursement. But many patients don’t have health insurance, and the normal cost for seeing a physician can be a disincentive for obtaining health care.

“We wanted to create an environment in which there was no financial disincentive to seek care,” said Coulter, an African-American who received his medical training at the University of Illinois College of Medicine, Chicago. “We want people to feel they can afford to come see us. The way we came up with the idea of $40 office visits is I drive a 1995 Chevy Ford Van. It costs $44 to fill up my gas tank. If I take my family of six to Master Grill or Waffle House, I will spend about $40. I picked a value that the average person here on the Mississippi Gulf Coast could afford.

“We have to be a little more equitable in the way we administer health care. We have to be equitable in our dealings with patients. I put myself in their shoes. Everybody doesn’t have a lot of money. So you make it so people can afford it. We wanted to disengage from the disincentives to get medical care. You don’t have to have insurance to come here. You don’t have to have a referral. You don’t have to have an appointment.”

Coulter said he has been surprised at the attention his innovations have received.

“The people outside the great state of Mississippi are looking at what is being done at the practice right here in South Mississippi,” Coulter said. “Realistically, I didn’t realize I was doing something so different. I had to change the way I was doing business if I was going to stay in business. I’m a better physician because of this. And financially it is much more palatable.”

Coulter came to the Coast eight years ago after being recruited by Singing River Hospital in Pascagoula to start an internal medicine practice. Coulter is an internist by training. But he found that what is needed most in the area is more basic primary health physicians who are available and accessible. “We need more Indians, not more chiefs,” Coulter said.

While his gross income is far lower than before he began offering the Bridge Account, his bottom line is better. He says he is making a credible living, supporting his growing family and saving enough for retirement. And he is doing so with no accounts receivable, no headaches fighting with insurance companies and no disputes with patients over the bill.

“No one walks out of this office owing me money,” Coulter said. “I don’t have to worry about sending threatening letters to patients.”

Patients accustomed to long waits at the doctor’s office are pleasantly surprised at Midway Family Clinic. The waiting room is small and doesn’t need to be larger because patients are seen quickly.

“This is about customer service,” Coulter said. “We are totally customer- service oriented. Your time is very valuable. Time is money both for the patients and the physician. We should not have people waiting that long. There is no doubt about that.”

Coulter says the only fly in the ointment is he is disappointed in the lack of response from the business community to the program. With costs for health care insurance escalating at a rate that greatly concerns most business leaders, Coulter believes businesses could save money by contracting with a physician like him for primary health care and then providing catastrophic illness coverage for more serious problems.

One problem may be skepticism that this model can work.

“There are those who think it can’t be true,” Coulter said. “There has to be a catch. There has to be a gimmick. But there is always a physician here from 8 a.m. to 7 p.m. Monday through Friday. You don’t see a packed room. Everyone gets his or her time. I’ve always wondered why certain businesses will pay $2,000 a month for health insurance that most employees don’t take advantage of, but they don’t negotiate with providers like me. There is no reason to pay for levels of service the employees are not utilizing. I believe business leaders need to start linking up with people like me to start turning things around.”

Coulter’s patients also benefit from lower costs for services such as X-rays and EKGs. He charges $40 for X-rays and $20 for an EKG. Coulter does the EKG in his office and reads it himself. But the average hospital charges over $100 for an EKG, and that is in addition to what the physician charges to read it.

Coulter recommends that business leaders spend more time listening to health care providers instead of insurance actuaries. He said one of the biggest problems is the business leaders don’t talk to the doctors.

Contact MBJ contributing writer Becky Gillette at mullein@datasync.com</a.

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