Op-Ed

Get insurers out of doctor-patient relationship

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Patrick T. Padgett, executive vice president of the Kentucky Medical Association, made several valid points in his commentary, “Patients shouldn’t have to pay for Anthem’s poor business decisions.”

Another way to say this is, “Patients and their physicians should have more control over their health-care decisions.”

As our politicians and physician’s organizations continue to discuss ways to achieve universal coverage for people, a grassroots movement to provide better care at a reasonable price is growing throughout Kentucky and the nation.

Direct primary care physicians do not contract with insurance companies, but directly with patients. We provide comprehensive care at affordable prices with unprecedented access. Why would we expect a third party, such as Anthem, to exhibit compassion or empathy toward patients, when they are not providing the care?

The over-involvement of third-party payers interferes greatly with the relationship between patient and physician and is causing burnout among physicians and dissatisfaction among patients.

Since 1970, the growth in the number of administrators involved in health care has far outpaced the growth in physicians, due to an overly complicated coding and billing process. Independent physician practices have struggled to meet overhead and sold out to hospital systems out of necessity. Health care provided through hospital systems is more expensive, and many patients now receive unexpected bills simply because the physician is now hospital employed.

When I practiced for a “patient-centered medical home,” I often saw 25 patients in one day, rarely had time to eat, and left the office feeling like I had probably missed something or failed most of my patients in some way.

By eliminating third parties, I can spend as much time as necessary to properly diagnose and treat patients. I provide counseling about lifestyle changes and behaviors that contribute to costly chronic conditions, such as diabetes, heart disease and even opioid addiction.

Patients have access to me by phone, email and text, even on weekends. DPC also saves 80 to 90 percent on labs and imaging, and many of us also dispense generic meds in the office, often saving patients $50-$100 monthly, which pays for their monthly membership fee to the practice.

Unlike more expensive “concierge” or “boutique” practices who continue to bill third parties for services, DPC membership fees cover all services provided within the office, including minor skin surgeries, injections, EKGs and urinalyses.

While insurance companies and physician organizations are funneling money to politicians to fight for coverage and funding seminars on how to reduce physician burnout, DPC physicians are proving daily that health care can be delivered at a reasonable price, while also improving the health care experience for physicians and patients.

In addition, several self-insured employers throughout the country have agreed to pay for direct primary care services for employees, saving up to 30 percent on their health-care costs.

In 2017, Gov. Matt Bevin signed Senate Bill 79 into law to define DPC and open the door for more physicians and patients to explore this innovative model of care. Our state can lead the way in improving health care by allowing more individual control over financing of health care services, by expanding health savings accounts or flexible savings accounts to use for DPC and by allowing our many Medicaid beneficiaries to also pay directly for their health care.

I invite all Kentucky physicians to consider ending their toxic relationship with insurance companies, who, as Padgett described, now possess the control and often make decisions that are not in the best interest of our patients.

Molly Rutherford, M.D., of LaGrange, founded Bluegrass Family Wellness in Crestwood, where she provides primary care and treatment for addiction.

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