In today’s Local Voices, we talk with Dr. James Tinsley of Lighthouse Direct Primary Care in Newport News, Virginia. Tinsley is certified with the American Board of Family Medicine and is fully licensed with the State of Virginia. He charges his patients $75 a month, doesn’t take insurance but suggest patients be covered with a Health Coverage plan in case of a catastrophic event. A resident of Hampton Roads since 2008, Dr. Tinsley agreed to speak with us on the record.
C&BP: Tell me about the Transparent Pricing Rule that you referred to in your email. Why do you believe it’s important?
Dr. Tinsley: Because right now insurance companies are telling everybody that healthcare is expensive. So, everybody has no choice but to believe that and when people come in here, I tell them my price is what things really cost. They’re absolutely disgusted at what these hospitals are charging.
C&BP: The Transparent Pricing Rule was part of an executive order by President Trump. The Center for Medicare Services announced it in November. Sentara has a Transparent Pricing Tool on its website, but it’s hard to find, difficult to use and doesn’t match to prices we’ve seen on one patient’s bill.
Dr. Tinsley: They’re just ignoring the rules because they have the money and power to do so. They think they’re above the law.
I don’t take insurance. I’m better quality because I spend 30 to 60 minutes with my patients. And this is how I can afford to do that. I talked recently with a specialist. His overhead was 70%. I mean, that’s disgusting. That means starting Tuesday afternoon, he’s not making a dime for his family. It’s all going to feed the machine. You know what my overhead is? Fifteen! One five, one five percent. And that’s just from getting rid of insurance. That’s how hungry the beast is.
C&BP: We’ve learned about some very large charges on the bills of some Sentara patients. A $1,500 operating room fee at a clinic, a $6,300 charge for a body scan. Does that surprise you?
Dr. Tinsley: No and here’s why those charges are so large. So, let’s say you’re selling a car that’s worth $500. If you can sell that car for $10,000, would you sell them for $10,000? Well, of course. Because you can sell that car of $500 for $10,000 and you make more money. Well, that’s what this corporate medicine machine is doing. They’re charging $10,000 for a $500 item and they’re getting it because corporate insurance is paying it. And they’re paying it and then they’re turning around to Johnny Paycheck and saying, “Well I’m really sorry. Healthcare is more expensive. So, we’re going to have to charge you more. And they do that every single year. They charge more, they pay more, they charge more and they pay more. I call it the self-licking ice cream cone.”
C&BP: Sentara has its own insurance company. Sentara owns Optima.
Dr. Tinsley: Well, that’s just ridiculous. That’s conflict of interest. How is that legal?
C&BP: How do other medical groups interact with Sentara?
Dr. Tinsley: There are these things in our contracts called non-competes. And this pretty much why I had to leave Richmond. And a non-compete is the section of the contract that says, if you leave that job, you have to move away a certain distance.
For instance, when I worked for TPMG, when I left my job, I had to move away 45 miles from any office they had. That was in my contract. Now, they had offices in West Point and Gloucester and Virginia Beach. I pretty much would’ve had to leave Southeast Virginia.
If you have a wife and children and they’re in school, you’d have to pull them out of school. You have to move; you have to sell your house. If the market is bad, you have to take a loss. So, you’re going to suck it up and you’re going to stay in that job that you hate, because otherwise, you’re going to have to leave the area. And I don’t understand how the state of Virginia allows these places to keep non-competes where they’re saying that there’s a physician shortage.
C&BP: Norfolk, Newport News, Portsmouth have areas with health stats at the level of Mississippi. What are your experiences with taking care of the less fortunate in your area?
Dr. Tinsley: I’ve never turned anybody away in 18 years. And actually, I went broke at TPMG and I never turned anybody away. I went broke there because my empanelment was 55% Medicare. You cannot make a living off Medicare. As a matter of fact, at that time, if you were going to survive as a physician, you had to have less than 15% Medicare in your empanelment, but I never turned anybody away.
And so, doctors turn away Medicare and Medicaid. They’ll say their empanelment is open, but when they get them in the door, they’re not taking Medicare or Medicaid. That’s the realities of healthcare. And I don’t fault them for that because if they go over 15%, they’re going to go broke. Same thing will happen to them. I went broke twice. I went broke once in Richmond because I was 35% Medicare. And I went broke down here when I was 55% Medicare. That’s just the reality.
Here’s another reality: insurance companies cut position pay every year. They add on more administrative duties and they don’t give an equivalent raise. When I started practicing out of residency, we saw 25 patients a day. If you do the math, let’s pull out a calculator. So, 8 hours a day, times 60, 480 minutes divided by 25, that’s 19.2 minutes a patient on average. You follow so far?
C&BP: Mm-hmm (affirmative).
Dr. Tinsley: Today, doctors are seeing anywhere from 30 to 40 patients a day. Let’s split the difference and say 35. 480 minutes divided by 35, that’s 13.7 minutes a patient. That’s where you get the 10-to-15-minute rule. Those are the realities of healthcare.
Back 18 years ago, I made my own schedule. Doctors aren’t making their own schedules anymore. They don’t work for themselves. They’ve got some guy with a two-year business degree doing that. And then coming down, they’re working 10 to 12 hours a day and they have this guy from a down, telling them they’re not working hard enough.
C&BP: Sentara is a tax-exempt non-profit organization. It has accumulated $6 billion in net assets and pays its CEO $8 million a year. Should they pay taxes?
Dr. Tinsley: Absolutely. And correct me if I’m wrong, didn’t they post in 81% increase in profits, first half of 2019? And yet, they go after guys and garnish their wages. I’ve got a big fat bill coming too. Yeah. I got admitted for COVID. I mean, I can’t wait to see that bill.
C&BP: Oh boy. Well, you sound like you’ve recovered.
Dr. Tinsley: Oh yeah, I’ve recovered.
C&BP: Okay, good. I know it’s been a scary time for everyone.
Dr. Tinsley: Well, you know what? They’re not going to cut me any breaks.
Dr. Tinsley: Let me tell you how free market medicine saves people money.
Dr. Tinsley: You know how they say your physical is included?
C&BP: Mm-hmm (affirmative).
Dr. Tinsley: I went and got my physical and with my insurance, the way my insurance works, I pay cash and we get reimbursed, if they reimburse the stuff. I got my itemized bill. The labs, the total labs they did, they charged… now this is Riverside, not Sentara. But Riverside and Bon Secours, they’re just as bad. They really are. I want 50 hospitals out there competing with each other. So, the labs, my total labs, they charged $313. What would you guess I would charge for the same number of labs? $35.20.
C&BP: Your patients must like you.
Dr. Tinsley: That’s what LabCorp charges me. I don’t charge a dime more because I don’t have to, because I make money. It’s like Costco, Costco makes money off their monthly payment, off the monthly admission fee, doesn’t make money off what it sells on the floor. That’s why this works. And they charge $203 for the office visit. That’s almost three months of my service; I’m $75 a month. So, insurance paid out of this whole total, my insurance paid $278.86, Riverside wrote off $177.90. And when they write stuff off, that means the taxpayer picks up the bill. I paid $59.24. The total cost for that visit was $516 for one physical. That’s 6.9 months of my service.
C&BP: That’s good.
Dr. Tinsley: For one physical. I don’t charge extra for the physical. So, somebody getting a physical with me pays $75 a month and then $35.20 cents for the labs. That’s it. And yet, Riverside is charging $516 for that one visit. That’s what they’re charging the insurance company. That’s how this works. They charge $516 because they can charge $516 and get away with it.
I spend 30 to 60 minutes with my patients, and one to two hours at the first visit. I’m a much better doctor at 30 to 60 minutes than I was 10 to 15. So just imagine this, you take your car in to get the brakes fixed, the mechanic spends 10 to 15 minutes fixing the brakes. Would you get in that car and drive away?
C&BP: Not a good idea.
Dr. Tinsley: I don’t think it’s because the insurance, because of the 40 patients a day. Corporate medicine says doctors got to see 40 patients a day in an 8-hour day. And you got 13 minutes of patient. And people accept that, but that’s how it’s got to be done. They’re blaming the doctor for that, but that’s the wrong person to blame. The doctor doesn’t make the schedule. Trust me, the doctors hate that too. I was one of them. But that’s not acceptable. People should not accept that and doctors should not accept that. There’s other ways to do this.
This is direct primary care and this is free-market medicine. I’m getting a $3,000 colonoscopy for $785. A $3,000 MRI for $700. I’m doing it for a girl that came in yesterday. Her insurance company is not letting her get the… they’re going to charge her $2,000 for that MRI, I’m getting it for $700. It was a no-brainer. I’m setting it up for her today. So, in one visit, I’m saving her an entire years’ worth of my service. She’s getting basically my service for free for a whole year.
Not to mention labs. A CBC, which is a lab, costs $72 at Sentara. You can look it up on their website. How much do you think that lab put up on the website. How much do you think that lab costs in my office? Just take a guess. $2. That’s the profit Sentara is making. They’re making $70 on a $2 lab.
Sentara is the biggest bully on the block, but it’s not just Sentara, it’s all of them. I mean, that bill I read from you., that was Riverside. Do you know what Riverside did during COVID? And well, Sentara did too, they cut the number of employees, they cut docs, they cut nurses. And then they say there was a shortage in the hospital. It was artificial.
When I was in the hospital, the nurses were super busy. I didn’t bug them because I was okay. I heard them hustling out there. I said, “Look,” I said, “be honest with me. So y’all at full staff?” She goes, “No.” I said, “Look, I’m going to cut you a break. I can do it,” because if I needed oxygen, I turned my oxygen up. I knew what to do. I didn’t bug the nurses, but they were understaffed. Sentara cut staff to save money, but so did Riverside.
C&BP: Which hospital were you at?
Dr. Tinsley: Sentara [CarePlex Hospital] Hampton. They all did it. And to me, that compromised patient care.
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