A California group practice model of eschewing insurance may take seed nationwide. Read a DOTmed News interview with Kent Holtorf, MD, the Holtorf Medical Group, Torrance, CA.

As the health care reform debate intensifies in Washington and across the country, the President has focused like a laser beam on health insurance. Insurance is the crux of the matter, driving up costs rather than containing them, according to Kent Holtorf, MD, of the Holtorf Medical Group, Torrance, CA. The group practice of six doctors, with another location in San Francisco, specializes in complex endocrine dysfunction. Many patients receive their primary care at the practice. But quite apart from their clinical model is their radical approach to payment -- the group does not accept insurance. Dr. Holtorf wants to take this approach to medicine nationwide with centers across the country.

DOTmed News (DM): Tell us about how you went "off-grid"--you don't accept health insurance at your practice?

Kent Holtorf, MD (KH): We went away from the insurance model about 10 years ago. You don't use insurance for services that you use on a routine basis, it just doesn't work. Insurance is for emergencies.

We found, in family practice, that we were just working for the insurance company. Doctors are no longer doctors now, they are "providers." Instead of doing what's right for the patient they work for the insurance company. So we wanted to get back to doing what's right for the patient.

DM: What's wrong with the way insurance works in health care?

KH: With insurance, the patient pays their premium. They want everything they can get. Then the doctor tries to bill as much as they can and see as many patients as they can. They know they are going to get denied a lot of the service by the insurance company. The insurance company just tries to deny everything and no one is working together to do the best medicine--what's most cost effective. So we said, what is the most effective way to sit down and be with the patient?

DM: So do you favor medical savings accounts?

KH: Medical savings accounts are great except one fatal flaw: There is no one negotiating rates. So what we did is we sat down and negotiated rates with all the labs and services and it works very well.

The reason medical savings accounts didn't take off was the lab charges five times as much [as a negotiated cash rate]; the hospital charges ten times as much. The doctors charge three times as much.

DM: Do patients pay out of pocket?

KH: Patients pay out of pocket, but we give them a superbill that they can submit for reimbursement.

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