Doctors Urge Vermont to Embrace Markets

Published May 10, 2015

At a public event in Vermont, physicians from Kansas, Maine, New Jersey, and Vermont discussed how they deliver top-quality, inexpensive, and hassle-free health care directly to patients without the expenses and red tape associated with third parties.

The event is indicative of the quiet physician-patient revolution underway to bypass health care middlemen and pass the savings on to consumers, known as patient-driven health care.

Dr. Alieta Eck, a private practice physician from Piscataway, New Jersey and the conference’s keynote speaker, says care based thoroughly on the doctor-patient relationship delivers the ultimate in health care service.

“The goal is to offer patients the most choice possible so that they can choose their doctor, health plan, deductible, and what’s covered,” Eck said in a conversation before the event. “Just give them the highest degree of choices. Then doctors become the coaches, and the patient feels in control. [That] changes the whole dynamic.”

Eliminating Third-Party Payers

Eck, a past president of the Association of American Physicians and Surgeons and an internist who runs the Zarephath Health Center, which serves many poor and uninsured patients, says direct primary care is a model for how health care should work.

Under direct primary care, patients pay a monthly fee of about $50 to receive personalized health care services from doctors. For that fee, they get same-day office visits for acute conditions, managed care for chronic medical problems, minor surgical procedures, blood and urine tests, generic medications, EKGs, and more. Patients and doctors also stay connected through social media.

“There are doctors across the country now who are saying, ‘Look, buy a membership into my practice,” said Eck. “For between $50 and $100 a month, you will be accessible to me by visits, e-mail, phone, and we’ll figure out the best way to care for you.’ That’s leaving the insurance company out of everything. Now it’s between you and your doctor.”

Dr. Michael Ciampi, a family medicine doctor from South Portland, Maine, quit working with insurers and Medicare in 2013 and now works directly with patients. Ciampi’s service charges $50 per month for individuals and $140 for families.

“The direct primary care model has been very successful around the country, so we decided to transition to that,” Ciampi said.

Ciampi says eliminating the middleman in health care could transform medicine all across New England.

“It will stabilize the income of practices so they are financially viable, it will allow physicians to spend more time with patients and do less tests, and it will increase patient satisfaction,” Ciampi said. “It also saves doctors from getting burned out.”

Ciampi says he was burned out when he was part of the third-party payer system. His overhead costs were soaring due to Affordable Care Act regulations, and he increasingly found the system did not give private doctors a level playing field.

“We were finding that there’s a lot of unfair competition with hospital practices,” Ciampi said. “When I was taking insurance, I was allowed to bill a patient for professional services. But a doctor who works at a hospital would bill for that as well as a facility fee of about the same amount. So hospital practices were making twice what we could, and hospital practices are nonprofit, so they weren’t paying taxes. That puts private practices at a really unfair disadvantage in the revenues we could bring in.”

Still Need Insurance

Direct primary care advocates are quick to point out their patients still need insurance for big-ticket medical concerns such as major surgeries and hospitalization, but it’s possible the direct-pay model could transform big-ticket medicine as well.

Surgery Center of Oklahoma (SCO), a physician-owned, state-of-the-art medical center in Oklahoma City, takes its payments directly from patients and employers. SCO’s surgery menu ranges from ankles and spines to cardiovascular, urology, and gynecology. According to SCO’s online pricing, most surgeries range between $1,000 and $6,000. SCO’s most expensive surgeries, including spines and full knee and hip replacements, can cost as much as $25,000.

It can be difficult to find what hospitals charge, and they often charge inflated amounts for the same procedures. The uninsured typically end up getting stuck with the highest prices.

Eck says direct-pay health care works because the insurance-based health care system is broken.

“They’ve gotten the insurance companies and the government involved in the decision making, even for the very smallest of health care needs,” Eck said. “You have to ask permission for this antibiotic and that medication. We doctors need prior authorization for medicine that costs $10. Why in the world is the insurance company bothering us with that? It’s very odd the way insurance is overreaching and trying to make all the decisions.

“We don’t do any insurance, because I don’t want that third party getting between my patient and me,” Eck said. “Patients are willing to pay a very reasonable fee to come to us. We just bypass the insurance. We’re primary care. I’m an internist, and my husband is a family doctor. We don’t charge more than Jiffy Lube.”

Precise numbers are hard to come by, but an estimated 4–6 percent of doctors have left conventional third-party payer medicine and instead offer their services in practices similar to Ciampi’s and Eck’s.

Bruce Parker ([email protected]) writes for, where an earlier version of this story appeared. Reprinted with permission.