A Philosophy on Medical Economics

By Richard Faiola, MD

Nobody likes to spend their money, and doctors, in particular, do not like to charge people for our services. Both, however, are necessary if Heritage Family Medicine or any other business is to remain open. What follows is a quite personal note of how we have arrived at our fees and our financial policies.

Real world experience

After 21 years of practice, most of them in leadership of a medium size multi-specialty group and additional short term experience in academic medicine, a government run clinic, a church mission clinic, a US Army clinic and several other practice venues in 4 states and 4 countries, I (Dr. Richard Faiola, the founding physician of Heritage Family Medicine), have formed some fairly firm opinions about how health care ought to be delivered.

No compromise with quality

First, there can be no compromise with quality. Heritage Family Medicine hopes to grow, but it will employ only the most competent, skilled, compassionate practitioners available. Nothing short of an absolute dedication to the welfare of our patients is sufficient. Clock watching number counters will not be welcome at any level. The needs of our patients come first. Period.

Prudent use of patient resources

Patient needs also include the prudent use of their dollars. More tests, more visits, more consultant referrals, or use of the newest TV-advertised drug is NOT necessarily better medicine. Their practitioners of Heritage Family Medicine will seek at all times to be prudent in the expenditure of medical resources. When a particular test or procedure might prove especially costly versus an expected very small likelihood of changing either treatment or outcome a patient should expect to be so advised and share in the decision whether to proceed. As we live in a litigious society a patient may be asked to verify in writing that informed decision. We believe a commitment to a conservative practice style will save patients at least 20% in over-all costs - our own and referred services.

Costs of "first dollar coverage"

A great contributor to excess costs in medical care in "first dollar coverage." When patients believe "somebody else" is paying their bills they may have little interest in reducing expenditures -- and it is easier for the doctor to just "order everything." We do not wish to practice that way. It has driven up costs so high that 46 million Americans have no health insurance.

That same "first dollar coverage" heaps a tremendous burden of expense on both the insurance company and the doctor's office. Full time clerical people process relatively small bills - at both ends. Those bills need justification, tracking, payment, accounting and auditing. All those employees need training, policies, scheduling, management, grievance procedures, etc., -- and salaries.

Increasing numbers of people and several insurance companies are turning to high deductible or catastrophic coverage plans. As most insurers will accept bills up to 12 months after the service, there is little point clogging up the system with those bills if the patient knows they will not be covered. Others, of course, simply have no insurance.

A better way - a discount for immediate payment

If for whatever reason a patient does not require a bill to be submitted to a third party, HFM will give a substantial discount for cash, check, credit card payment. All patients will, of course, receive a record of their care and a receipt for any payment made.

An even better option - a low cost retainer fee

Each enrollee through DirectcareMD pays a flat monthly fee of $20.00 - 60.00 (depending on the number and age of family members enrolled) for all of the primary care services their participating physician can deliver in his or her office. For an additional $30.00 per month ($15.00 per child under 18), basic in-office laboratory and x-ray services are included (if available).

Physicians in turn pledge to provide appointments for enrollees on the same or next business day (if patient is ill) and to be available (or provide "coverage") for telephone or email consultation continuously. There are no co-pays.

You might recognize the convenience and predictability of this retainer arrangement to be similar to the maintenance agreement many businesses have on their copy machine or a s homeowners have for their lawn maintenance - but in this case, you protect your most important asset: your health. Learn more at

We will welcome insurance

Heritage Family Medicine participates fully in most insurance programs, PPOs, etc. We recognize that despite their inefficiencies, the insurance companies have played an important role in preserving and encouraging the health of their members. We will work within their guidelines while promoting optimal health for our patients.

An efficient practice

Heritage Family Medicine has been designed from the ground up to be the most efficient setting in which to deliver the highest quality primary care. Our unique architecture and careful use of technology such as computer based records saves steps for both doctors and nurses. HFM will be innovative in our use of the web for consultations, prescription refills, and appointment making.

Lower medication costs

Heritage Family Medicine strives to practice "Evidence Based Medicine" - that is, we wish to have strong scientific evidence for the choices we make on behalf of our patients. In many situations, that means no using the newest, most expensive medications unless a clear advantage has been demonstrated. Further, Heritage Family Medicine intends to develop its own supply of the most commonly used generic medications that we can provide our patients (only) at a more convenience and usually lower cost than any other reliable source.

Total effect: about 50% savings

A discount for immediate payment, a prudent approach to medical expenditures and access to directcareMD make Heritage Family Medicine the ideal practice for those with Health Savings Accounts, Medical Reimbursement Arrangements, "Cafeteria" Plans and those with no insurance or high-deductible insurance. We estimate that over time, the average family may save 50% on the cost of their primary medical care.


There are only a small number of patients who habitually drive up costs by seeking telephone or email consultations or requests for refill prescriptions when a re-check office visit is what is required. Similarly, there are only a small number who do not pay their bills. HFM seeks mechanisms by which those that require extraordinary service fund those efforts and we vigorously enforce our financial policies, thus keeping our regular charges lower for all patients.