Dr. Natalie Gentile: Pennsylvanians deserve affordable, accessible access to primary care physicians

Dozens of national health care leaders recently called upon Congress to expand patients’ options for personalized, high-quality health care. One of the most important measures included in the recommendations was greater support for direct primary care (DPC), a growing health care model that replaces the fee-for-service insurance model of care with personalized attention from primary care physicians. However, greater clarity from both state and national legislators is needed and will help millions of Americans get better care.

A recent study from the Society of Actuaries found DPC patients demand for health care services fell by 12% overall, and used emergency rooms 40% less often, than traditionally insured people. As of now, there are at least 29 DPC practices in Pennsylvania, and this is forecast to grow as more doctors and patients realize the benefits of the DPC model. State lawmakers and Gov. Tom Wolf should follow the lead of 25 other states by making it clear that a DPC arrangement is not insurance and permanently exempting DPC practices from insurance regulations.

I’ve run a Pennsylvania-based DPC practice for the past year because this model of care empowers my patients. They pay me a monthly fee, we avoid the insurance middleman, and I’m often able to see patients the same day they request an appointment. This is a common outcome, with studies showing that most DPC patients see their doctors faster than a traditional practice, and patient-physician interactions are nearly three times as long during appointments as during insurance-based doctor visits.

I have not faced government pushback in my practice, but others’ practices — in states that haven’t clarified that DPC is not insurance — have. So while this uncertainty has been OK with me, it is undoubtedly holding other doctors back from making the jump and starting their own practices.

A paper by Dr. Phil Eskew makes clear how important statutory certainty is to empowering and expanding DPC access. Eskew highlights that many states have legal grey areas that confuse patients and limit access — or have laws that are outright hostile to an outside-the-box model of care. In Illinois, for example, the state’s insurance commissioner stated that he wouldn’t treat DPC as insurance. That was great until he was no longer in office — when confusion again reigned.

Contrast this with Iowa, which clearly delineates between DPC and insurance after the state’s Supreme Court declared in Huff v. St. Joseph’s Mercy Hospital that prepaid agreements for labor and delivery care were not insurance because the prepaid agreements covered a strict set of deliverables.

And while it was just a few years ago that DPC practices started becoming popular — they are now common across the country. Given the quality of care from physician-led DPC practices, DPC is becoming more popular as the status-quo in insurance-based primary care continues to break — and patients keep finding it harder and harder to schedule appointments or see a physician.

Thankfully there is already significant support in and out of the Pennsylvania medical community for DPC. In fact, the Pennsylvania Medical Society has actively supported DPC expansion, speaking in support of bills. And several bills have been debated in the Pennsylvania Legislature.

Really freeing the DPC movement will take action. Clarifying that DPC practices do not constitute insurance removes ambiguity, relieves physicians and patients from the regulatory uncertainty, and increases patient care while reducing its costs. Wolf and lawmakers should give patients the freedom to find care tailored to their need, instead of leaving doctors in a regulatory grey area.

Natalie Gentile, MD, owner of Gentile Family Direct Primary Care in Highland Park, is board-certified in family medicine and lifestyle medicine.