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These Doctors Got Fed Up With Insurance. Now They Treat Their Patients Like Valued Customers.

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One of the most profound changes brought about by the Affordable Care Act is that it drove thousands of independent doctors to throw in the towel and join large hospital networks. This is particularly true of primary care doctors. As the rules involving medical records, billing codes, and prior authorizations have gotten more complex, physicians find they can't survive without joining large health care networks. And they're becoming increasingly demoralized.

Today there's a small but growing movement of doctors who are opting out of the traditional health care system by no longer accepting insurance. This new approach is is called "direct primary care," but it's essentially a throwback to an era before insurance companies were responsible for covering routine services like ear infections or strep cultures.

When companies like Aetna, Blue Cross, and Oxford started signing the checks for even minor health care expense, it had a destructive impact on the doctor-patient relationship. The direct primary care movement is an attempt to reverse the damage.

Dr. Ryan Neuhofel, who's been running his own direct primary care practice in Lawrence, Kansas since 2011, has a page on his website that lists the cost of each procedure, which the patient, not the insurance company, actually pays.

Need an x-ray? That's $25 to 40, along with a monthly subscription fee that runs from $35 for minors to $130 for a family of four.

Most direct primary care practices charge a monthly subscription fee. It allows them to offer other services, like answering patient phone calls, text messages, or even having appointments over Skype—services that our insurance-dominated system doesn't allow for.

"Because I'm membership supported if someone calls me and says, 'hey, I have a rash,' they can send a picture," Neuhofel says.

Removing the interference of third parties changes the dynamic between patients and their doctors.

"We're able to be creative in meeting their needs," Neuhofel says. "[We are] able to give them transparency in pricing, and redesign the entire health care experience around what patients really need."

Direct primary care physicians are able to charge less than traditional practices because the lack of coding and billing means they don't need to hire support staff.

The direct primary care movement is a way of opting out of an industry that's dominated by a cartel of hospital and insurance companies, thus insulating doctors and patients from policies crafted on Capitol Hill.

But there are some changes to the tax code that could speed adoption. The IRS doesn't allow patients to use their tax-deductible Health Savings Accounts to pay direct primary care doctors. In fact, just having a direct primary care subscription disqualifies individuals from contributing to an HSA at all. Dr. Neu and others have been meeting with lawmakers and proposing legislation that would change this.

"We're not living off the reservation just because we're cowboys," Neuhofel says. "We're doing it so we can provide great care, but at the same time we need to figure out how we integrate with the larger health care system."

Shot and produced by Mark McDaniel. Music by Candlegravity, Podington Bear, and Nine Inch Nails. All music is licensed under a Creative Commons Attribution Non-Commercial Share Alike license.

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francisga
18 hours ago
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Lafayette, LA, USA
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London’s sky turns red Monday, but we can’t blame pollution

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DANIEL DAN SORABJI/AFP/Getty Images

Residents of England awoke on Monday morning to a sky that looked very much like a scene from the movie Blade Runner—red and hazy. Fortunately this isn't science fiction—or even pollution. Rather, it's a combination of the rare, powerful ex-hurricane Ophelia's winds and African dust.

The large, extra-tropical cyclone that brought high winds and damaging seas to Ireland on Monday also produced a huge swath of powerful southerly winds that brought Saharan dust from the west coast of Africa all the way north across the Atlantic and western Europe into the United Kingdom.

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francisga
1 day ago
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Lafayette, LA, USA
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Saturday Morning Breakfast Cereal - Gridiron

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Click here to go see the bonus panel!

Hovertext:
I hope no ever measures how many micromurders each of my actions commits.

New comic!
Today's News:

Tomorrow night I fly off for Seattle, and the beginning of the Soonish tour! See you soon(ish), geeks!

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francisga
2 days ago
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Lafayette, LA, USA
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"Nothing More Than Ash And Bone" - NorCal Wildfires Now Deadliest In State's History

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Over five days, the cluster of wildfires that’ve broken out in California’s wine country have claimed at least 31 lives – making this the deadliest week for wildfires in the state’s history. And with the remains of many incinerated homes still too hot to enter, authorities say that number is likely to climb – perhaps significantly – as elderly residents of the afflicted communities were blindsided by the fires’ ferocity, and many were unable to flee in time.

The average age of the 10 victims whose names have been released is 75, state officials said. The youngest was 57.

Whole neighborhoods have been reduced to smoldering rubble. Meanwhile, an army of firefighters have had little success trying to suppress the flames; the largest conflagrations continue to burn virtually unimpeded. Local firefighters, many of whom have worked for days on end with little or no sleep despite their own homes having burned to the ground, are finally being relieved by reinforcements from out of state, CNN reported.

Sonoma County Sheriff Rob Giordano described the grim reality of the body recovery efforts, which he said had only just begun.

"We're moving into a recovery phase," Sonoma County Sheriff Rob Giordano said. "That is the reality part of it."

 

Speaking late Thursday, Giordano said that two more bodies had been recovered as search teams moved into areas where people had been reported missing in the wake of the fires.

 

"We have found bodies almost completely intact, and we have found bodies that were nothing more than ash and bones," Giordano said.

California’s iconic wine country – comprising Sonoma and Napa counties – has been particularly hard hit, as have Mendocino, Yuba, Nevada, Butte and Orange counties. As of late Thursday, 21 fires spanned 300 square miles – up from 8 on Tuesday. Most are still less than 10% contained. So far, more than 3,000 homes and businesses have been destroyed, as NPR reported.

And the unfortunate reality, as one firefighter acknowledged, is that the fires could continue to burn for days, because there’s no end in sight.

"We are not even close to being out of this emergency," said Mark Ghilarducci, director of the state's Office of Emergency Services.

County officials described flying over neighborhoods that had been totally decimated, with not one single structure still standing.

Shirlee Zane, one of the district supervisors for Sonoma County, says she flew over communities that "looked like war zones. They looked like somebody had bombed them."

 

"The air quality is very dangerous right now," she tells NPR. "It's thick, with brown smoke. People cannot really go outside. It's really not safe. You see a lot of people going around with face masks."

Wayne Peterson of Sonoma described the air as "acrid."

 

"I'm wearing the mask because I've been here two or three days now, I live here," Petersen was quoted by The Associated Press as saying. "It's starting to really affect my breathing and lungs so I'm wearing the mask. It's helping."

Santa Rosa, a small city that serves as the county seat for Sonoma County, was particularly hard hit. The LA Times reported that officials said they were stunned by the scale of the destruction. An estimated 2,834 homes were destroyed in the city of Santa Rosa alone, along with about 400,000 square feet of commercial space, Santa Rosa Mayor Chris Coursey said in a news conference Thursday afternoon.

Flames left entire neighborhoods and commercial districts in ruins and – in a disturbingly ironic twist – even gutted the city’s new fire station.

State and local officials expressed hope that the milder winds on Wednesday and Thursday would help fire crews contain the flames. But forecasters are now saying that strong nearly hurricane force winds and hot conditions will return on Friday and Saturday.

Though the cause of the fires has not yet been confirmed, the local utility said that the strong winds knocked trees into power lines, which could’ve sparked fires given the dry conditions.

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francisga
4 days ago
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Lafayette, LA, USA
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State Borders

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A schism between the pro-panhandle and anti-panhandle factions eventually led to war, but both sides spent too much time working on their flag designs to actually do much fighting.
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francisga
4 days ago
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Lafayette, LA, USA
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2 public comments
satadru
2 days ago
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Let's be honest, that Alaskan border would make a whole lot more sense if we had just taken 54° 40' or Fight in another direction.
New York, NY
Covarr
4 days ago
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Something needs to be done about that giant canadian gap between maine and minnesota.
Moses Lake, WA
stefanetal
3 days ago
3 wars and that gap is still there. And we never got to use War Plan Red, even once the UK stopped plans for this eventuality. And at least one of my ancestors faught on the Canadian side against the Fenian raids. https://en.wikipedia.org/wiki/Fenian_raids https://en.wikipedia.org/wiki/War_Plan_Red

Sound of mystery attacks in Cuba released. It’s as obnoxious as you’d expect

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Enlarge / Personnel gather at the US Embassy in Cuba after the US State Department announced it will cut the embassy’s staff by half in the wake of mysterious health problems. (credit: Getty | Sven Creutzmann/Mambo Photo)

On Thursday, the Associated Press released the first audio recording of the sound that some diplomats say they heard during mystery attacks in Havana, Cuba. Those attacks have so far left 22 Americans with a puzzling range of symptoms, from brain injuries to hearing loss.

The sound is high-pitched and grating. You can listen to it here (but beware: it’s unpleasant).

The noise is composed of 20 or more different frequencies, all around about 7,000 Hz and 8,000 Hz. It reportedly came in abrupt pulses of varying lengths.

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francisga
4 days ago
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Lafayette, LA, USA
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