Some Say Paying The Doctor Directly Makes Sense | Eastern North Carolina Now

    Publisher's note: The author of this post is Katherine Restrepo, who is Health and Human Services Policy Analyst for the John Locke Foundation and a contributor to the Carolina Journal, John Hood Publisher.

    RALEIGH     A massive government overhaul of our health care delivery system continues to unfold, and the nation is embarking upon uncharted territory. Providers are fed up with reduced payments, spending more time wading through convoluted third-party paperwork, and not being reimbursed in a timely fashion. (Can someone say NC Tracks?)

    However, an increasing number of medical providers are taking on a business model that avoids Obamacare's additional unhealthy layers of regulation. By cutting out the middleman insurer, more doctors are delivering primary-care services to patients in exchange for direct payment. Also known as "concierge care," direct primary care has been a niche market for years.

    While it once catered to affluent patients, the trend is now shifting toward offering affordable services to middle-class and low-income patients.

    Here in Raleigh, Dr. Brian Forrest's practice, Access Healthcare, has piqued interest in the local news and on the national front. Featured in the Weekly Standard, Wall Street Journal, Forbes, and the American Academy of Family Physicians, Forrest describes how he offers patients varying primary-care service packages for a monthly fee.

    Unlike traditional medical practices, Access Healthcare does not have to divert substantial amounts of revenue toward overhead and staff members responsible for medical coding, billing, and tracking down proper reimbursement from insurers. According to Forrest, such practices typically require an average of four full-time employees per one physician to take on these responsibilities successfully.

    Freed from these obligations and cost, more time can be spent with patients. And patients, therefore, can access preventive medical care at a much lower cost.

    You may now be wondering whether direct primary-care practices can survive under Obamacare, since it mandates that all individuals purchase health insurance or be faced with a tax. First, it should be noted that the tax amount isn't much of a heavy hitter. Second, it turns out that language within the federal health law (section 10104) doesn't prevent direct primary care, so long as those patients purchase a "wraparound" plan that includes services beyond basic preventive care, such as hospitalization. But, in order for insurers to offer these plans on the exchanges, the secretary of Health and Human Services must give ultimate approval.

    The Heritage Foundation further explains:



    Patients with catastrophic coverage who also access direct primary care can still see savings. The Wall Street Journal weighs the pros of accessing direct primary care coupled with a high-deductible policy:



    It's an idea worth exploring during these times of major health care change.