Pa. doc offers discounted fee for service plan

A northern York County-based family physician has become the first in state and one of only a handful of doctors in the northeastern U.S. to offer a discounted fee for service membership program to patients.
Dr. Shawn S. Moyer of Pinchot Family Medicine, 7489 Carlisle Road, Rossville, said that he developed “The Pinchot Plan” to make primary health and wellness care simple and affordable. The fee-based membership plan is not a form of insurance, Dr. Moyer emphasized.
“In a nutshell, it’s basically $30 per month and $15 per visit,” Dr. Moyer said. “Doctor's charges are based on insurance reimbursement rates, (such as Medicare, for example). People, who self pay, would have to pay that full amount, (as much as $150 for an office visit).”
There is a one time “initiation fee” of $80 per individual or $160 for a family household of up to five members, he said. That fee pays for setting up the patient’s account under the plan.
“The reason I wanted to start the plan is that I knew there is a need for basic medical care for people who are uninsured,” said Dr. Moyer, whose practice is celebrating its second anniversary, this month. “If we can make it affordable, it is a win-win situation.”
Dr. Moyer, 41, is a 1988 graduate of Dallastown High School and 1998 graduate of Thomas Jefferson Medical School, Philadelphia. The main reason he can offer care at such a low rate is due to the fact that he does not have to process insurance claims, which account for a major portion of a practice’s expenses, he explained.
The Pinchot Plan is based on “Health Access,” a discounted fee for service membership program pioneered by Dr. Michael Fine, a primary care physician from Rhode Island. The major hurtle in launching the program in Pennsylvania was getting a ruling from the state insurance department, determining whether the membership plan did or did not fit the criteria of insurance.
In a July 2008 letter, Trevor I. Poremba, an attorney with the Pennsylvania Insurance Department Office of Chief Counsel, responded to the proposal by first outlining what criteria were used to define an insurance plan: “indemnification of the insured by the insurer; profit motive on the part of the insurer; an element of risk;” and other actuarial and fiscal elements common to insurance companies.
A discounted fee-for-service membership health care program “does not appear to present an insurance risk … the overall arrangement of the program does not appear to constitute the business of insurance in Pennsylvania,” the letter stated. With that, “The Pinchot Plan” was given a shot in the arm to proceed.
“If it had been ‘insurance’ we couldn’t do it,” Dr. Moyer said. “It took forever to get through the channels.”

The plan covers:
Maintenance of physical and mental wellness through annual physicals, gynecological and well child exams, vaccinations and cancer screening.
Immediate problems, such as treatment of sore throats, coughs and colds, suturing lacerations, removing earwax, etc., “anything done in the office.”
Manage long-term medical conditions, such as asthma, diabetes and high blood pressure – various tests such as glucose, urine, pregnancy and others done in the office.
Coordinate care, which involves organizing and forwarding pertinent information from primary exams, lab tests and x-rays, to specialists.
Dr. Moyer said his practice does not manage chronic pain with narcotics. The plan does not cover the cost of serums and other vaccines – but does offer them based on the price paid by the office.
“I’d really like to grow this for small businesses which do not offer insurance for their employees,” Dr. Moyer said. “The sad part (is) … by taking insurance companies out of the mix, we don’t have to spend as much time trying to get reimbursed.”
In Pennsylvania, one in 10 people do not have medical insurance, Dr. Moyer said. Often, those who are insured have high deductibles of $1,000, $3000 or more, he said.
“We believe that 85 to 90 percent of care is provided in outpatient primary care offices,” Dr. Moyer said. “We have a shortage of primary care physicians.”
The reason – incomes for specialists are much higher than those of primary care physicians. Dr. Moyer said that of 2,000 slots allocated for primary care/family practice residencies, only about 1,000 were filled.
“We just began offering the plan last month,” Dr. Moyer said. “Primary care doesn’t have to be expensive. I’m really excited to see this take off.”
Dr. Moyer is still accepting patients. In most cases, he offers same day and next day office visits. The Pinchot Plan also includes consultation by phone with a physician 24 hours a day.
“This is not concierge medicine,” Dr. Moyer said. “It’s not insurance. We are the first office in the state to procure this service.”
For more information call 502-4149; email Smoyer@PinchotFamilyMed.com; or visit www.PinchotFamilyMed.com.