ABOUT FACE
Upper St. Clair dermatologist offers a different business model
Dermatologist Ashley Kittridge opened her Upper St. Clair practice this week with the promise of offering a different sort of clinical business model: No insurance needed or wanted, and patients will be seen within a week of making an appointment.
That last part may be the hardest to pull off.
This is not a concierge/subscription service like those popping up in family practice settings. Fees, which are posted at www.kittridgedermatology.com, are based on the length of the appointment and the complexity of care.
Without the insurance component, Dr. Kittridge said, patients can expect those fees will be lower. “Any time you have a middle man, the fees are higher.”
Dermatologist W. Patrick Davey of Lexington, Ky., who formerly chaired the practice management committee for the American Academy of Dermatology, said “maybe 1 percent” of dermatology practices nationwide have adopted the no-insurance directcare model.
But he thinks it could be a coming trend as the administrative burden of dealing with insurance claims continues to grow, and doctors decide they don’t want to “get stuck in that morass of insurance companies.”
One veteran of this business model is Oregon Coast Dermatology, which Dr. Kittridge said was a model for her practice.
Coos Bay, Ore.-based dermatologist Kathleen Brown converted to direct care seven years ago, echoing Dr. Davey’s observation about frustration from dealing with insurance claims. “It was like swimming through hardening concrete,” she said in a recent phone interview.
By refusing insurance, she said she has been able to limit her practice to one parttime and two full-time staff members, about half the size she might need if they were processing claims, which “actually gets in the way of care,” Dr. Brown said.
“I let people know it’s basically a choice. If it doesn’t work for them, they do have other choices.”
Dr. Kittridge says she was inspired by a journal article written by Dr. Brown after three years in a traditional multi-provider practice in Robinson. While not directly involved in patient billing there, she said she would frequently hear from upset patients.
“A number of times it was, ‘How could I get this bill?’” said Dr. Kittridge, who is board-certified in dermatology.
Many health insurance plans will fully cover office visits to a primary care physician, she explained. “So when they go see a specialist, and they get a bill, it’s a little bit of a surprise.”
And not a pleasant surprise, as the trend toward high-deductible insurance plans means patients could be on the hook for thousands of dollars out-ofpocket.
More than that, she said the traditional practice model made it increasingly difficult for her to spend enough time with patients. Where she would see 40 patients day in her previous job, she intends to see no more than 16 patients each day at her new practice.
While that approach obviously reduces revenue (”I’m sure I’ll take home a smaller paycheck”), she believes that will be largely offset by not having to deal with the administrative work and other costs that go with processing insurance claims.
She expects patients will like it, too, as her streamlined operation allows her to keep her fees lower, a savings for those without insurance or who are enrolled in a plan that carries a high yearly deductible. As one example, she said a routine full-body skin check at her practice will cost $150, including simple procedures such as a biopsy, where a traditional model might charge possibly $100 more for each biopsy.
The other big draw for patients may be the prospect of seeing a doctor within one week, as Kittridge Dermatology promises, as waits of several weeks, or even a few months, can be typical for a new patient seeking an appointment with a dermatologist.
Kittridge Dermatology had 100 appointments already scheduled when it opened its doors Monday, and as the practice picks up, Dr. Kittridge plans to set aside a half-day each week for walk-ins.
If that open-door arrangement endangers the appointment-in-a-week promise, she says she will bring on another dermatologist to keep up with the increased volume.
“If my patients are happier then I’m happier. That’s what this is about.”
“If my patients are happier then I’m happier. That’s what this is about.” — Dr. Ashley Kittridge, Dermatologist