Private Pay Health Care

Private Pay is the basis upon which the healthcare financing system began. Patients paid physicians a fee-for-service. In its purest sense, the Private Pay model includes only the physician and patient in the exchange of compensation for medical care provided. Over the years as healthcare financing arrangements have changed, entities paying a fee-for-service includes all payers-public and private. Recently, the healthcare industry has referred to physician practices that do not accept health insurance as cash-only practices or Private Pay offices. Private Pay vastly reduces the traditional overhead expenses by not having to bill and abide by contractual requirements of third party payers. Further, collection rates may be higher with fewer bad debt expenses. Physicians in a pure Private Pay practice may want to continue to see patients with private insurance who are willing to pay cash and submit their own claims. Before charging privately insured patients on a cash basis, the physician should determine that there are no contractual or legal restrictions on doing so. This will necessitate a review of existing contracts and state insurance regulations. Certain states protect enrollee’s in particular private insurance plans from being billed for any sums beyond what the insurance company pays, except for co-pays and deductibles. Opponents of a completely Private Pay practice model would argue that it violates the professional principle of ensuring equal access for all. Individuals with insurance may not be able to afford seeing a physician who does not participate with their health plan due to the added financial responsibilities. Thus, the Private Pay practice is limiting its level of patients’ access to care based on one’s financial means. There are already millions of Americans who cannot afford private health insurance and have Medicaid coverage. Others self-insure due to their financial resources being such that they can pay out-of-pocket for their medical expenses. Physicians who wish to move to a pure Private Pay practice and still take Medicare patients must privately contract with such patients. If still accepting Medicare, it is advisable to follow the Medicare fee schedule as to avoid causing any red flags to be raised. The rules related to treating Medicaid patients on a Private Pay basis will vary from state to state. It is advisable to contact the state Medicaid agency for their terms on charging patients directly.

Benzoyl Peroxide

Benzoyl peroxide cream is a topical bactericidal. Widely available over the counter (OTC), bactericidal products containing benzoyl peroxide treats mild to moderate acne. The patient applies the gel or cream containing benzoyl peroxide twice daily into the pores over the affected region. Bar soaps or washes may also be helpful and vary from 2 to 10 percent in strength. In addition to its therapeutic effect as a keratolytic (a chemical that dissolves the keratin plugging the pores) benzoyl peroxide also prevents new lesions by killing P. acnes. In one study, roughly 70 percent of participants using a 10 percent benzoyl peroxide solution experienced a reduction in acne lesions after six weeks. Unlike antibiotics, benzoyl peroxide has the advantage of being a strong oxidizer (essentially a mild bleach) and thus does not appear to generate bacterial resistance. However, it routinely causes dryness, local irritation and redness. A sensible regimen may include the daily use of low-concentration (2.5 percent) benzoyl peroxide preparations, combined with suitable non-comedogenic moisturizers to help avoid over drying the skin. Patients should exact care when using benzoyl peroxide, as it can very easily bleach any fabric or hair it meets.

Keloids

A keloid is a type of hypertrophic scar. Keloids are made up of type I (and some type III) collagen that results in an overgrowth of tissue at the site of a healed skin injury. Keloids are firm, rubbery lesions or shiny, fibrous nodules and can vary from pink to flesh-colored or red to dark brown in color. A keloid scar is benign, non-contagious and usually accompanied by severe itchiness, sharp pains and changes in texture. In severe cases, it can affect movement of skin. Keloids expand in claw-like growths over normal skin. They have the capability to hurt with a needle-like pain or to itch without warning, although the degree of sensation varies from patient to patient.

Medical Device

A medical device is a product used for medical purposes in patients, in diagnosis, therapy or surgery. Medicinal products achieve their principal action by pharmacological, metabolic or immunological, medical devices act by other means like physical, mechanical, physio-chemical or chemical means. Medical devices are a part of medical technology. Medical devices include a wide range of products varying in complexity and application. The Food and Drug Administration recognizes three classes of medical devices based on the level of control necessary to assure the safety and effectiveness of the devices. Class I devices are subject to the least regulatory control. "General Controls" apply to all Class I, II and III devices. General controls include provisions that relate to adulteration; misbranding; device registration and listing; pre-market notification; banned devices; notification, including repair, replacement, or refund; records and reports; restricted devices; and good manufacturing practices. Class I devices are not intended for use in supporting or sustaining life or to be of substantial importance in preventing impairment to human health, and they may not present a potential unreasonable risk of illness or injury. Most Class I devices are exempt from the pre-market notification and/or good manufacturing practices regulation. Class II devices are those for which general controls alone are insufficient to assure safety and effectiveness, and existing rules provide such assurances. In addition to complying with general controls, Class II devices are also subject to special controls. A few Class II devices are exempt from pre-market notification [10]. Special controls may include particular labeling requirements, mandatory performance standards and post-market surveillance. The FDA holds Class II medical devices to a higher level of assurance than Class I devices, as Class II devices must perform as indicated without causing injury or harm to patient or user. Examples of Class II devices include powered wheelchairs, infusion pumps and surgical drapes. A Class III device is one for which insufficient information exists to assure safety and effectiveness solely through the general or special controls sufficient for Class I or Class II devices. Such a device needs pre-market approval, a scientific review to ensure the safety and effectiveness of the device, and is subject to all the general controls of Class I devices. The FDA classifies Class III devices as those that support or sustain human life and are of substantial importance in preventing impairment of human health, or which present a potential, unreasonable risk of illness or injury. Examples of Class III devices (which currently require a pre-market notification) include implantable pacemaker pulse generators and endosseous implants.