‘Dr. Ken Rictor says in article … “What really prompted the changes were changes in the way insurances have worked and new restrictions that are coming in under Obamacare.”

By Marcus Rauhut

CHAMBERSBURG, PA — After being in practice for 25 years, Dr. Ken Rictor worries he spends more time taking care of his business than his patients.

He said the current business model continues to put a strain on his family practice, which is why next month the practice will stop participating in insurance plans.

A small but growing number of physicians are moving to a direct care model, where patients pay a monthly membership fee for unlimited access to a doctor without insurance co-pays or deductibles.

startup-entering1“We’ve really been looking at this model for the past two to three years. It’s not a new model but it’s been gaining popularity,” Rictor said. “What really prompted the changes were changes in the way insurances have worked and new restrictions that are coming in under Obamacare.”

His practice is believed to be the first in the region to adopt the model, which has been called “concierge for the masses” because it is similar to the concept of “concierge medicine.”

Under direct primary care, patients pay a monthly fee to cover their primary care needs. They are encouraged to have a high-deductible, low premium or “catastrophic” health insurance plan for major expenses like a hospital stay or surgery.

Scotland Family Medicine Direct Primary Care will charge a monthly membership fee of $65 for adults and $10 for children. Patients would have unlimited physician access, including expanded telemedicine services.

The advantage for doctors is they can spend less time billing insurance and can take on smaller patient loads, which allows for longer visits and an emphasis on preventative care.

direct primary care journal2However, one of the biggest concerns is whether the model will save or cost patients money, particularly if they already have a good insurance plan.

Rictor said that by not participating in insurance networks, he can pass on savings on medications and lab work that would justify the cost of the membership fee. He also said that the trend in insurance plans has been toward higher deductibles with less coverage.

With the switch next month, Rictor hopes that many of his patients will stay but said he recognizes that each family situation is unique.

It may also seem odd for a practice to move to a direct pay system at a time when health insurance is being required as part of the Affordable Care Act.

But Rictor said that under the current business model it is simply harder to stay in business.

In primary care, reimbursement costs eat up more than 40 cents out of every dollar, according to the Direct Primary Care (DPC) Coalition, a group that advocates direct care. New regulations also place an added strain on business, Rictor said.

“In order to stay in business you have to see 8 to 10 people an hour,” he said. “With new provisions in October, that’s going to put a real vice on practices. We just keep seeing more and more time and revenue going to the business end of it.”

A study released last year by the Physicians Foundation found that about 7 percent of physicians plan to switch to concierge or cash only practices in which third party payers are eliminated.

“This is really an evolving process,” Rictor said. “It really opens up a new way to think about health care. We spend so much time taking care of business and not patients. We were trained for this (caring for patients) and we feel like we’re being pulled away from this.”

Marcus Rauhut can be reached at 262-4752.


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