Direct-pay Medicine

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, Delaware 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.

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 for 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."

Jen Rini can be reached at (302) 324-2386 or jrini@delawreonline.com. Follow @JenRini on Twitter.