Self Pay Health Care

Self-pay is the basis upon which the healthcare financing system began. Patients paid physicians a fee-for-service. In its purest sense, the self-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. Some in the healthcare industry has referred to physician practices that do not accept health insurance as cash-only practices or self-pay patients. Self 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 self-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. Some physicians have found the self-pay model a way to regain meaning in and control over their practices, as well as to reestablish a physician-patient relationship in which there is time to care. Another option to consider in not accepting health insurance is to combine a self-pay model with a retainer practice. This hybrid practice would allow patients who could not afford a monthly retainer fee, to still receive care in their personal medical home and only pay for the medical care provided. For more information on retainer fees, see the discussion paper on retainer practices.

Nail Bed

The nail bed is the skin beneath the nail plate. Like all skin, it has two types of tissues: the deeper dermis, the living tissue fixed to the bone, which contains capillaries and glands; and the superficial epidermis, the layer just beneath the nail plate, which moves forward with the plate. The epidermis attaches to the dermis by tiny longitudinal grooves as the matrix crests or crests of nail matrix. As we age, the plate grows thinner and these ridges become evident in the plate itself. A nail is a horn-like envelope covering the dorsal aspect of the terminal phalanges of fingers and toes. The nail is made of a hard protein called keratin. Nails can dry out, just like skin. They can also peel, break, and become infected. The nail protects the ends of the fingers and toes from trauma and helps pick up small objects. Care of the fingernails and toenails is important. Poor nail care causes problems. Recommendations for maintaining nail health include: keeping nails clean and dry in order to keep bacteria and other infectious organisms from collecting under the nails; cutting nails straight across with only slight rounding at the tip; using a fine-textured file to keep nails shaped and free of snags; and avoiding nail-biting. Nail changes, swelling and pain can signal serious problems that may require a physician and medical nail care.

VIP Medicine is a type of medical practice now found in many metropolitan areas across the country. VIP Medicine has come to represent a higher level of healthcare for those who want a more personalized relationship with their physician. At the upper echelon are the practice associations, like IPA Health, which integrate the traditional concierge model and match it with an advanced care.

Epiderme

Epiderme is the one-stop for skin care. Moisturizers help keep skin youthful with elasticity. The epidermis is the outer layer of the skin. The epidermis helps the skin to regulate body temperature. The epidermis with the dermis forms the cutis. The epidermis is composed of four to five layers of skin, depending on the region of skin. The epidermis contains no blood vessels and nourishment of cells is by diffusion in the deepest layers from blood capillaries extending to the upper layers of the dermis. The amount and distribution of melanin pigment in the epidermis results in skin color variation in Homo sapiens. Melanin is in the small melanosomes, particles formed in melanocytes from surrounding keratinocytes. The size, number and arrangement of the melansomes varies between racial groups, but while the number of melanocytes can vary between different body regions, the number of melansomes remain the same in individual body regions in all human beings. In white and oriental skin, the melansomes aggregate but are small in size. Comparatively, in black skin, the melansomes are larger and distributed more evenly. The number of melansomes in the keratinocytes increases with UV radiation exposure, while their distribution remains largely unaffected.