Pediatrician Terence McAllister and his spouse, administrative director Leann DiDomenico McAllister, MBA, are co-owners of Performance Pediatrics, a pediatric micropractice based in Plymouth, Mass. Physicians Practice recently spoke with the McAllisters on their experiences and thoughts on the rising cost of healthcare as part of our reporting on the Great American Physician Survey.
Physicians Practice: Are you feeling the effects of high-deductible health plans (HDHPs) in your practice?
Terence McAllister, MD: Yes we are certainly feeling that in our own practice,
as far as the drop off that we've seen in [patient] appointments for chronic care [is concerned]. From the other perspective, from the fact that we own the business here and provide health benefits to ourselves and our employees, we are providing a HDHP to our employees and ourselves. And so we certainly feel the effects of it from both sides.
Leann DiDomenico McAllister: I think the biggest increase in expenses over the past five years have been two things: technology and health benefits. And really nothing else compares to the rising costs of those two t
hings. It's very frustrating when I know I'm paying 30 percent more for our commercial HDHPs than I was even two years ago. And yet fee reimbursements from those same plans have not increased in the same numbers.
PP: Are you altering your prescribing practices to accommodate inflated drug prices, for example, Mylan's EpiPen?
TM: [In that instance] I'm not altering my prescribing practices, because [Mylan is] a monopoly. There really is no option, these kids need it. … In the past some families have asked to have a backup pen available, or one they keep in their car, one they keep with them, as well as in school. So they are not doing that as much anymore. They just have the one at home that they have to remember to bring with them all the time. That certainly is a little of a safety concern, not being redundant [like] in the past, by having that many. It affects us here in the office. I have an emergency response kit and I don't keep an EpiPen in it anymore. I keep epinephrine and a syringe. So that would slow things here in the event of an emergency, but I've had to use it once in the 10 years we've been open.
PP: Are your patients less reliant on medications because they are children?
TM: Most of our patients aren't on many medications. Kids with asthma or attention deficit hyperactivity disorder (ADHD) are on chronic medications, but you are right most pediatric patients are not on many medications. So prescriptions are not as much a burden on my patients as they would be in an adult practice.