Paying for health care services is, for some, becoming as difficult as it is to read the medical bills.
It’s complicated, and the lack of cost and billing transparency doesn’t make it any easier for patients and physicians alike, according to Dr. Edward Zurad, president of the Pennsylvania Academy of Family Physicians in Harrisburg, a professional member-driven association for more than 5,000 Pennsylvania family physicians and family medicine residents and students.
Some primary care physicians started offering fee-for-service systems, and more are gravitating to a direct primary care system.
According to Zurad, direct primary care, or DPC, is a model in which patients pay a flat monthly fee to have access to their doctor. The fee varies based on the doctor, but the fixed fee allow patients unlimited access to the physician for a full range of primary care services, including acute and urgent care, regular checkups, preventative care, chronic disease management and care coordination.
“Direct primary care has been around for five to eight years now,” Zurad said, explaining that patients can speak to physicians in person, by email, by phone and by texting.
The model also allows primary care physicians to bill patients directly, without having to depend on insurance company policies.
“While currently only a small percentage of our membership is engaged in DPC practices, we expect the model to grow in response to high out-of-pocket deductibles now faced by many individuals and families in Pennsylvania,” said Zurad, who also has an independent, solo practice in northeastern Pennsylvania. “Studies have shown high deductibles are causing many to forego their primary care needs, which ultimately leads to preventable chronic conditions and associated high care costs.”
Zurad, however, said it’s still important for patients to have insurance, including high-deductible insurance that can cover catastrophic events, hospitalizations and specialty care.
Even with only a high-deductible plan to fall back on, Zurad said this type of service model can help improve patient care. Physicians won’t be glued to computers, worrying how to code treatment in order to get reimbursement from insurance companies.
“The main appeal is that the relationship between physician and patient is restored,” he said. “(Billing) has become overwhelming for a lot of us.”
Zurad said that with direct primary care, services — including lab tests such as MRIs — can be offered without prior authorization from an insurance company or concerns over denied services.
Direct primary care has been gaining more ground as a model in Pennsylvania and across the country. The state House of Representatives in late September unanimously passed House Bill 1739 that would give patients and doctors the right to directly contract for care. The state would recognize these arrangements and define them as being outside the scope of state insurance regulations, according to the Pennsylvania Academy of Family Physicians, whose members include nearly 80 percent of the state’s family physicians.
According to state Rep. Matt Baker, R-Tioga, who sponsored the bill, HB 1739 would add Pennsylvania to the list of 23 states that allow the use of a direct primary care model. In a news release announcing the bill’s passage in the House, Baker said the legislation is not intended to encourage the model, but rather remove the barriers for those providers who seek to offer the services to patients.
“This legislation can be of benefit to those individuals with a high deductible on their health insurance plan,” Baker said in a news release. “Patients could also use their Health Savings Accounts to cover the costs of their care.”
The bill will go to the state Senate for consideration. Zurad and the academy supports the legislation.