Wednesday, Feb. 01, 2012

Medical practice trying a different approach

To keep costs down, Timber Commons shuns insurers

A new medical practice in town offers a different kind of health care - and a new way for patients to pay for medical services.

Timber Commons Family Practice doesn't accept health-insurance plans or Medicare and Medicaid, the government-funded programs for the elderly and poor.

Instead, patients pay set fees, laid out clearly like a restaurant menu: $49 to see a doctor, $29 for a sports physical, $149 to get stitches or to get a worrisome mole removed.

Or patients can pay $49 a month to buy a sort of membership that allows them discounted trips to the doctor and a free physical exam and lab tests.

Timber Commons, which opened last month off Timber Drive, is part of Physician Care Direct, a Cary company that formed last year. The parent company aims to provide affordable health care to uninsured and under-insured patients by reducing its own costs. Since insurance companies aren't involved, its offices don't need to hire billing coordinators and other paper pushers. Fewer employees translate to lower costs for patients, the company says.

"That's really what this is about - access to health care," said Dr. Joseph Jenkins, chief operating officer for Physician Care Direct, which has 12 medical practices across the country.

Dr. Akash Patel, one of two doctors in the Garner practice, said he had seen firsthand the way traditional primary care works. And he didn't like it.

Patel, 31, said he worked at a family practice in Rocky Mount where he would typically see dozens of patients a day. He had to treat 20 people a day for the practice to break even, he said.

At Timber Commons, one patient is scheduled every hour, along with walk-ins. Patel said he wants to be able to spend time with his patients, to listen to what they have to say and get to the root of their health-care needs.

"We believe it's a win-win situation for everyone," Patel said. "I don't have to see 40 patients a day, and my patients don't have to wait two hours to see me for five minutes."

A guessing game

The set-price system allows patients and doctors to stop guessing about the costs of health care, Jenkins said.

Health-insurance companies often dictate how much they will pay health-care providers for patient services. That means one health-insurance firm could pay a different amount to treat a sore throat than another company.

Patients with no insurance, or those with high deductibles, often suffer most from that system, Jenkins said. That's because insurance companies can mandate that doctors charge those patients higher rates, he said.

"The issue is nobody knows what anything costs," Jenkins said.

As a result, some medical offices are filled with staff members tasked with coding services, billing insurance carriers and making sense of insurance reimbursement rates.

Timber Commons has four staff members - two doctors and two medical assistants. They all answer the phone, take out the trash and see patients.

With a bare-bones staff, Physician Care Direct is all about driving down the price of health care by focusing on primary care, said Chris Shoffner, vice president of practice development for the company.

The idea is that if patients regularly see family doctors and get preventive care, they might avoid serious health problems such as heart attacks and strokes.

Part of a bigger health-care problem, though, is that many medical school graduates aren't opting to become family physicians, Shoffner said. They can earn a lot more money by choosing a specialty such as cardiology.

Dr. Adrienne Fehr, who works at Timber Commons, said many of her classmates at Ohio University didn't want to get into primary care because of the paperwork hassles.

But it's the front lines of medicine, Fehr said, and she got on board with Timber Commons because she wanted to be part of a system that she believed focused more on patients' needs.

In medical school, she said, young doctors are encouraged to ask patients only about their top concern - there's not enough time to handle all of patients' worries.

"That's actually part of our training," she said.

A perk for employees

Since Timber Commons doesn't see many patients a day, the health-card membership plan helps cover costs.

Physician Care Direct partnered with the Garner Chamber of Commerce to let local businesses know about the program.

It's tough for small-business owners to be able to afford health insurance for themselves and their employees, said Josh Macon, who runs Aversboro Coffee with his brother.

He's already seen a doctor at Timber Commons, and Macon said he's considering buying memberships for his handful of part-time workers.

"This is a good little perk we can give them," Macon said. "This is a way to say thanks."

Patients have other options, of course. They can go to urgent-care facilities that typically accept insurance plans. But those without insurance will likely pay more than they would at Timber Commons.

And hospital emergency rooms treat patients regardless of whether they can pay up front.

But the hope is to reduce the number of patients who go to emergency rooms for ailments that aren't life threatening and could easily be handled by a primary-care doctor, Shoffner said.

Sometimes patients will need to see specialists for more-serious issues. Shoffner said Physician Care Direct is working to bring specialists on board to offer low-cost rates for patients.

And by spending more time with patients during an initial visit, Patel said he hopes to get in front of problems before a specialist is needed.

He said the first patient he saw at Timber Commons last month had high blood pressure. He gave her medication to bring it down and monitored her at the office for three hours.

"That cannot happen in a regular practice," Patel said.