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Upfront Surgery Pricing

As Americans grapple with a health care system that costs $10,000 per person annually, a form of health care that avoids the insurance system — known as direct primary care — is starting to become an alternative option.

The American Academy of Family Physicians defines direct primary care as giving “family physicians a meaningful alternative to fee-for-service insurance billing, typically by charging patients a monthly, quarterly, or annual fee. This fee covers all or most primary care services including clinical and laboratory services, consultative services, care coordination, and comprehensive care management.”

The model aims to simplify the system for both health care professionals and patients.

“We have significant bottlenecks and barriers in health care both on the provider side as well as the patient side,” Dr. Akash Goel, a gastroenterologist at Weill Cornell/New York-Presbyterian Hospital, told Yahoo Finance.

“So from a provider perspective,” Goel explained, “people are rightly frustrated because they're overburdened with [a high number of patients], short patient visits, unsatisfactory timelines to interact with patients, pressure from billing and external pressures that I think are on physicians that make the experience somewhat unsatisfactory.”

Health care spending in the U.S. continues to grow. (Source: California Health Care Foundation)

From a patient perspective, “people have insurance, but they're paying a lot for it,” Goel said. “The average person is spending somewhere in the range of $10,000 a year on health care, and they have high-deductible plans, so you have health insurance, but you don't necessarily get to use it because of the high deductibles or you have to pay out-of-pocket for it.”

The direct primary care model is “a little bit more streamlined in terms of receiving your health care,” according to Goel, partly because it limits the number of patients doctors are seeing and gives patients the option to avoid costly insurance plans.

‘We believe the system is broken’

Surgeries handled through the direct primary care method involve patients being able to see the total price for an operation and find a specialist for that price.

At the Surgery Center of Oklahoma, patients do exactly that. They choose surgeries at specific prices and pay a flat rate up front, with no insurance involved. The center was started by anesthesiologists Keith Smith and Steven Lantier. After years practicing medicine, they felt growing “frustration” with the health care system.

“We both started despising what was going on financially with the patients,” Lantier told Yahoo Finance (video above). “Because when you look at the bankruptcy statistics — medical bankruptcies for patients now — it’s egregious. The average American cannot afford health care today, so we believe the system is broken.”

A look at the Surgery Center of Oklahoma's website. (Photo: Screenshot)

The reason we could put it online is because we don’t take federal money

The Surgery Center of Oklahoma’s website allows potential patients to look up price quotes for all kinds of surgeries. Individuals simply have to click on the area of the body where they would need a surgery or a procedure done, find the exact name of the procedure, and a price is generated. From there, an option appears to request a specialist for further details.

“We took all of the numbers, added them up, then added about a 10 or 15% margin to all of that, and that’s the price we put it online,” Lantier explained. “The reason we could put it online is because we don’t take federal money. If we took any federal money — Medicare or Medicaid — we couldn’t do that.”

-Article by written by Adriana Belmonte, Yahoo Finance, 5/18/2019

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