Well has it not come full
circle? When I was a kid we had a Family Practice doc down the street. When you
got hurt, were sick you went to see the good doc. At the end of the visit the
Doctor’s wife (the lady siting at the desk) would hand you an envelope to give
to your mom. That was the bill. Everybody in the neighborhood went to see this
Physican, and we all did just fine. We all did fine until big CORPORATE took
over medicine, and broke the bond between the local Family Practice Doctor and
the neighborhood. This "concierge medicine” is just the second coming of a system
that should have never gone away! Thank goodness it has come back!
Forget insurance.
These Delaware docs only take fees
Jen Rini,
The News Journal11:32 p.m. EST
November 15, 2015
Cristy Beckman, who
suffers from chronic pain in her spine and osteoarthritis, spent six hours
in a doctor's crowded waiting room in severe pain.
That was enough, the Middletown resident decided. It was time to
make a drastic change in how she was treated.
At about the same time, Dr. Christina Bovelsky opened
Peachtree Family Medicine in downtown Middletown with a unique approach to
medicine.
Instead of dealing with traditional insurance, co-pays and
deductibles, her patients pay a one-year membership fee that includes an
annual physical exam and between two and four office visits. Small
procedures such as nebulizer treatments, strep tests
and electrocardiograms, are included.
Beckman, 46, became one of Bovelsky's first patients.
"There's an absolute peace of mind that someone is looking
after your healthcare," Beckman said. "I don't think there's any way
I could do something different."
Bovelsky's patients can
pay monthly fees between $65 and $75. Yearly rates for adults vary between
$780 and $900, depending on the number of visits a patient wants. Care for
children under 18 ranges from $240 to $360. Additional office visits cost $80
each.
Nationally, more health care providers are embracing the
direct-pay, or "concierge medicine," model.
A Physicians' Foundation 2014 survey found 7 percent of
doctors run a direct-pay practice and another 13 percent plan to
transition to some form of direct-pay model.
Most of Bovelsky's patients still
have insurance for additional procedures and tests not covered by the
doctor's fees, such as vaccines and lab work.
Health care providers say they are transitioning to direct-pay
medicine because they are able to spend more time with fewer patients, which
allows them to drill down to the cause of a medical issue instead of
ordering extra tests. The doctors are also more readily available to
patients after hours.
Specialists are also embracing the model.
David Wilderman, a
longtime physical therapist, decided to sell his physical therapy practice in
Pennsylvania and open a new one in Delaware to help patients, like Beckman, who
wanted a more personal approach.
"My belief is everyone should receive high-quality health
care," he said. "The optimal goal is for my patients is to avoid
medication and surgery."
Even with the extra attention, some fear direct pay and
concierge medicine will drive up medical costs for individuals. Insurance
representatives say consumers should make sure they completely understand a
direct fee plan and the cost of treatments from a physician who is not working
within a traditional insurance plan network.
Courtney Jay, a spokeswoman for America’s Health Insurance
Plans, a national trade association representing the health insurance industry,
said in an email that a doctor can charge more for a specific procedure than he
or she is typically reimbursed for by an insurance company, which means the
patient will pay more for that procedure.
"The out-of-pocket amount for the patient would vary
depending on the patient's specific policy within their plan," she said.
Dr. Nick Biasotto, a family doctor and past president of the
Medical Society of Delaware, said many doctors are exploring these new business
models because they are seeing more patients daily as practices merge and
facing higher medical costs with technological advancements.
And, as doctors age, they tend to want to scale back.
At 65, Biasotto, said he found he couldn't keep the pace. He is
beginning to transition to a direct-pay practice after becoming frustrated with
seeing 45 patients a day. In his 36 years as a doctor, he's seen 4,000
patients.
"It's time for me to slow down. I don’t want to join the
hospital system and crank out patient after patient," he said.
Under the direct-pay
system, he might see 500 patients in a year and he'll be able to make
house calls. He's heard of about eight other doctors pursuing these
models.
But he also had to let some employees go and help some patients
who couldn't afford monthly fees transition to new providers.
"That was the hardest part of the whole process ... saying
goodbye to patients I've cared for four years," Biasotto said.
A direct-fee model also helps doctors and patients eliminate
paperwork such as prior authorizations and filing for reimbursements. Bovelsky
said she uses that time saved to focus more on patients.
"The average time a doctor has with a patient is 7
minutes," Bovelsky said. "Here, it is at least 30 to 60 minutes.
Sometimes it's 90. When you take the time to sit down, you are going to find
the answer to what is going on with them.
"I love what I do and I wanted to spend my time with
patients. The way medicine is set up currently ... it really is a revolving door."
Insurance standards often
dictate what services specialists, like physical therapists, can provide and
how long they can care for patients, Wilderman said. Often patients in physical
therapy have between 12 to 24 sessions, but the amount of time spent with a
therapist is under a half hour.
"It's not in the patient's best interest," Wilderman
explained.
Under his model, patients only will need four to six visits, for
about an hour each, though there are no set number of visits a person must
have. An initial assessment appointment is $195 with any additional visit
costing $165. Patients can try to get their services reimbursed as well, he
said.
"This is helping people get better faster...People don't
have to lose valuable time away from work and family," Wilderman said.
"I don't have to go by the insurance company saying I'm not going to cover
that.
"When you tally everything up, it is cheaper in the long
run to do what I'm doing as an out-of-network provider."
