06/30/2023    Michael M. Rosenblatt, DPM

Ability to Have a Concierge Practice (Robert Kornfeld, DPM)

Over the years, I have observed Dr. Robert Kornfeld
describe that he jettisoned himself free of
insurance coverage and made a success out of it. He
practiced in New York. Apparently, it worked for
him. I know of MDs and DOs who established
themselves in a so-called holistic practice. I just
never could understand how a highly specialized
practice, say separate from gastroenterology or
cancer care could encompass a holistic medical
treatment style. He does not mention if he
practiced any foot surgery, and how any patients
would be willing to self-pay for that.

Perhaps some of them obtained partial reimbursement
from their insurance. But most insurance panels
have strict rules about how doctors must exist in
their framework. They might require separate
exclusion contracts in order to avoid legal
problems. Or what happens when a patient insists
they bill their insurance, which I'm sure has
occurred to him. He has to have a written policy
for his patients the day they enter his practice on
how he regulates these issues.

Or what happens when an insurance company insists
he supply them with billing data. I assume he
prefers to have "no contact" with them. But in
today's world, that might be impossible. Medicare
has its own regulations regarding complete
exclusion. Anyone choosing his practice style must
become an expert on this in order to avoid charges
against them.

He obviously made it work. But from where I stand
it is rife with legal issues from every turn.
Medicare, for example requires that ANY care that
is not specifically medically necessary is
prohibited from being charged to Government.
Perhaps a patient turns in some of his bills that
could be construed as medically unnecessary under
certain conditions. He perhaps does NOT allow them
to bill Medicare. But how does he police that? Or
does he tell them "Which ones' can be sent in?"

I retired many years ago, so I am not personally
interested in his "system." However, from my
vantage point, it is far more complex than simply
executing an agreement with new patients. Almost
all of them have some form of insurance and expect
them to help pay, even if he collects cash from
them.

Merely stating he "made it work" does not cover the
myriad of legal issues around this type of
practice. "All cash" may mean different things to
different patients.

Dentistry is completely different. They don't
practice under a siege of regulations.
Representative Pete Stark was a magical politician.
Nobody in the history of healthcare has
manufactured more felonies than he did. All that is
necessary is to change the angle of trimming a nail
and it converts into a felony. When you go through
a red light it puts other people at risk. If you
change the angle of your nail clipper 10 degrees,
you have created a felony from which you can go to
jail. It's quite remarkable when you analyze it.

A "holistic practice" still has to march through
this poison.

Michael M. Rosenblatt, DPM, Henderson, NV

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