It's no secret that many patients have had it with their HMOs. But so have a lot of doctors. In Denver, Dr. Senay visited a couple of renegade doctors who call their practice HMNo. Husband-and-wife medical partners Dr. Jonathan Sheldon and Dr. Heather Sowell make house calls, spend plenty of time with their patients, and answer their own phones.
Frustrated by rushed care and the bureaucracy of working within an HMO, Dr. Sheldon and Dr. Sowell started their own family practice, and they do not accept insurance. Just cash or checks.
"We started working directly for our patients instead of for insurance companies," declares Dr. Sheldon. Adds Dr. Sowell, "We went back to the basic principles of medicine, where my primary allegiance is to my patients and not to worrying what an insurance plan thinks about the test I'm ordering or the time I'm spending with a patient."
Two years ago, when they started HMNo, fellow doctors wondered if they could succeed.
"They told us we were nuts," recalls Dr. Sheldon. "They told us, 'It'll never work. You can't do it that way.' And we said, 'It's been done that way for 2,500 years, thank you very much.'"
So far, HMNo is working. They now have 700 patients, some without insurance and some like Casey Frank. He has insurance. He belongs to an HMO but is willing to pay out of pocket for the personalized service he gets with Dr. Sheldon.
But the question remains: How many people will pay? Paul Ginsberg heads Washington's Center for Studying Health System Change.
"I really doubt that this is going to become a dominant trend," he says, "both for the financial barriers and because also I expect to see HMOs making themselves more consumer friendly in the next few years."
In the meantime, for Dr. Sheldon and Dr. Sowell, practicing medicine is about patients, not profits.
"Nobody likes going to the doctor and certainly nobody likes being sick," says Dr. Sheldon. "We save them time. We save them money, and we care for them, and we hope they feel that."
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