Self Pay Patients

Self Pay is a type of payment where the patient’s own resources pay for the care. It is contract between the patient and the physician. Individuals pay for care with personal funds, health saving accounts, and other funds. 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.

Nails

Nail care is more than the proper maintenance of the fingernails and toenails. 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. Medical nail care includes preventing and treating diseases. Nail diseases are distinct from diseases of the skin. Although nails are a skin appendage, they have their own signs and symptoms, which can relate to other medical conditions. Nail conditions that show signs of infection or inflammation require medical assistance beyond a beauty parlor. Deformity or diseases of the nails are onychosis. Onychia is an inflammation of the nail folds of the nail with formation of pus and shedding of the nail. Onychia results from the introduction of microscopic pathogens through small wounds. The medical term for ingrown nails is onychocryptosis. Ingrown nails can affect the fingers and the toes. With this condition, the nail cuts into one or both sides of the nail bed, resulting in inflammation and possibly infection. The relative rarity of this condition in the fingers suggests that pressure from the ground or shoe against the toe is a prime cause. The movements involved in walking or other physical disturbances can contribute to the problem. Mild onychocryptosis in the absence of infection is treatable by trimming and rounding the nail. In more advanced cases including infection, doctors perform matrixectomy by surgically excising the in growing portion of the nail down to its bony origin and thermally or chemically cauterizing the matrix to prevent recurrence. The best results are by cauterizing the matrix with phenol.

Dry Skin

Many older people suffer from dry skin, particularly on their lower legs, elbows and forearms. The skin feels rough and scaly and often causes a distressing, intense itchiness. Low humidity--caused by overheating during the winter and air conditioning during the summer--contributes to dryness and itching. The loss of sweat and oil glands with age may worsen dry skin. Anything that further dries out the skin--such as overuse of soaps, antiperspirants, perfumes or hot baths--will make the problem worse. Dehydration, sun exposure, smoking and stress also may cause dry skin. Dry skin itches because it is irritated easily. If your skin is very dry and itchy, see a doctor. Dry skin and itching can affect your sleep, cause irritability or be a symptom of a disease. For example, diabetes and kidney disease can cause itching. Some medicines make the itchiness worse. The most common treatment for dry skin is moisturizing to reduce water loss and to soothe the skin. Moisturizers come in several forms: ointments, creams and lotions. Ointments are mixtures of water in oil, usually either lanolin or petrolatum. Creams are preparations of oil in water, which is the main ingredient. Creams are more often than ointments to be as effective. Lotions contain powder crystals dissolved in water, again the main ingredient. Because of their high water content, they feel cool on the skin and do not leave the skin feeling greasy. Although they are easy to apply and may be more pleasing than ointments and creams, lotions lack the same protective qualities. Lotions should applied more frequently to relieve the signs and symptoms of dryness. People should always use moisturizers to prevent recurrence of dry skin.