Some local doctors drop insurance, directly charge patients

A handful of area primary care physicians no longer take insurance and instead use a model where patients pay flat fees to their practice.

The movement is fueled by doctors who say they are burnt out, want more time with patients and are pushing back against the requirements of the insurance industry.

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There aren’t many direct primary care practices. American Academy of Family Physicians states that as of 2018, about 3 percent of its members operate with some type of direct primary care model. There are about 30 listed in Ohio by a direct primary care blog DPC Frontier.

But Dr. Patrick Jonas of Neighborly Family Medicine said he thinks the model is gaining appeal from physicians who feel like their job isn’t the career caring for patients that they thought it was going to be.

Physician burnout is a major problem in health care. In 2017, 50.5 percent of family physicians experienced at least one burnout symptom, according to a survey by the Mayo Clinic.

He said physicians might have only 10 minutes with a patient. In some surveys, family physicians spend more time filling out electronic medical records than they spend face-to-face with patients.

“There’s more pressures to be corporate and a data enterer than connected to a patient and listening to the complexity of their story,” he said.

With direct primary care, physicians have more time with patients and also have less administrative burden since they don’t have to deal with insurance companies or keep types of documentation required by insurers, Jonas said.

Direct primary care isn’t for all physicians and it isn’t for all patients.

“People with the top dollar coverage and a doctor they love shouldn’t change,” Jonas said.

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America’s Health Insurance Plans, a trade group that represents health insurers, has said patients could be essentially paying double with direct primary care if they already have coverage and then pay memberships.

Tom Campanella, director of the Baldwin Wallace health care MBA program, said when thinking about choosing direct primary care, it is still important that patients make sure they find a physician that is patient focused.

Being independent, Campanella said these doctors could help some patients save enough money to make up for the membership fees if they help a patient find cost effective quality services without feeling like they need to refer patients to services within their employer’s network, Campanella said. He said there can be huge differences in costs for services like lab work, MRIs and surgeons, so it matters who a primary care doctor refers a patient to.

“One of the big values of these individuals is they have no allegiance, one could say,” Campanella said.

Campanella said the interest in direct primary care speaks to common frustrations, including providers frustrated with health insurance and bureaucracy.

“On the other end, individuals get frustrated because it is hard to find a doctor. It’s hard to get an appointment. You don’t feel like the doctor is really an advocate for you personally,’ he said.

While the model is similar to concierge practices, direct primary care and concierge care are not the same thing. Concierge practices also charge a regular fee but typically charge higher fees, cater to a higher income clientele and often continue to bill insurance for some services.

At Beavercreek Family Health Center, a single adult would pay $60 a month to include all visits or $45 per month plus an extra $30 for visits. Neighborly Family Medicine charges $75 for an adult membership.

These fees don’t, however, take the place of health insurance and direct primary care providers still recommend having a health insurance plan in case of a major expense.

What these fees cover depends on the practice, but typically cover basics such as visits, care management, physicals, and health education. Some include minor procedures in their fees.

For an infrequent and insured patient, direct primary care membership fees would cost more than a co-pay or two a year.

Jonas said it is also a good value for patients with high deductibles who are already paying for much of their own care.

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Dr. Phil Whitecar, with Beavercreek Family Health Center, which is direct primary care, said even patients who now don’t frequently go to the doctor could get value from memberships to direct primary care by getting help being healthier in ways that a traditional doctor might not have time, such help with health education.

Whitecar and two other doctors, Dr. Sarah Khavari and Dr. Mary Beth Rhodes, started their own practice Beavercreek Family Health Center in 2013 which was originally a traditional practice that contracted with insurance and then switched in 2016-2017 to a direct primary care model.

Several of the providers also said that they also offer other types of value to patients. With lighter patient loads, they keep flexible schedules so patients can call their doctor or quickly be seen when they are sick, potentially avoiding an urgent care or unnecessary ER trip.

Rhodes said the doctors spend more personal time on tasks, such as personally calling patients about lab work instead of having staff call and taking the time during appointments to understand each patient.

“Most of our appointments are 30 minutes and sometimes up to 60 minutes long,” Rhodes said.

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