Delaware Buyers Club: more doctors offer direct-pay care

More and more physicians are adopting the direct-pay healthcare system, also known as ‘concierge medicine model,’ USA Today reports. For instance, Dr. Christina Bovelsky – founder of the Peachtree Family Medicine in Middletown, Delaware – offers patients a one-year membership including a yearly physical exam and at least two and up to four office visits. Small procedures involving hospital equipment supplies like nebulizer treatments, strep tests and electrocardiograms are included in the fee. Prices range between $65 and $75 monthly fees; $780 and $900 annual rates for adults; and $240 to $360 for care for children younger than 18. Extra visits go for $80 apiece.

Also in Delaware, physical therapist David Wilderman opened a new practice after selling his old one in Pennsylvania, intent on providing a more personal approach. “My belief is everyone should receive high-quality health care,” he says. “The optimal goal is for my patients to avoid medication and surgery.” A 2014 Physicians' Foundation survey found that 7% of healthcare providers run a direct-pay operation, while a further 13% are planning to make the transition to a direct-pay system, as an alternative to conventional insurance’s co-pays and deductibles, and to be able to devote more time to fewer patients. At the same time, patients may retain insurance –as do many of Bovelsky’s patients – for procedures and tests not included within their doctor’s honorariums.

Family doctor and former president of the Medical Society of Delaware Dr. Nick Biasotto is making the transition to direct-pay care, under which he might be able to see 500 patients a year and still make house calls. The downside is that has had to say “goodbye to patients I've cared for for years,” as well as employees. Biasotto has heard of 8 other doctors switching to direct-pay healthcare, which he attributes to seeing more patients daily as practices merge and facing increasing costs with technological breakthroughs. He says that after seeing 4,000 patients in 36 years “it’s time for me to slow down. I don’t want to join the hospital system and crank out patient after patient.”

But in addition to having to let long-time patients and staff, concierge medicine also allows doctors to get rid of prior authorizations, filing for reimbursements, and other paperwork, freeing up time that can be spent with patients. “The average time a doctor has with a patient is 7 minutes. 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,” Bovelsky said. “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.”

In spite of all the apparent benefits, though, some insurance representatives warn that the concierge medicine might increase medical costs. One such voice is that of America’s Health Insurance Plans spokesperson Courtney Jay, who says that a physician can charge more for a particular procedure than what they would be reimbursed by an insurer – with the consumer ponying up the difference. “The out-of-pocket amount for the patient would vary depending on the patient's specific policy within their plan,” Jay said in an e-mail. On the other hand, insurance standards establish what services specialists can provide and how much time they can set apart for each patients, something that is “not in the patient's best interest,” according to Wilderman.

Related: Look at all the uninsured people, where do they all belong?