Priced out of Primary Care

Rising health insurance deductibles have some turning to alternatives.

When a sore throat and runny nose make you miserable smack dab in the middle of a frantic week at work, you want relief as soon as possible. Years ago, that might have meant calling your friendly family doctor and being told to come right in. Today, getting help is a lot more complicated.

Primary care doctors are often booked up for days, and once you do get in, you can end up paying a triple-digit bill out of pocket thanks to a high deductible.

Deductibles have climbed in the past few years for several reasons, says Sara Collins, vice president for health care coverage and access at the Commonwealth Fund. “We’ve increasingly seen over the last decade or so the use of deductibles, and the amount of deductibles has also increased in order to help employers share the cost of health insurance with their employees,” she says. The Fund is a nonprofit, nonpartisan foundation that supports research on health care policies.

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A report issued by the Fund says that in Louisiana, people who have employer-sponsored health insurance policies have seen their deductibles rise between 2003 and 2013 from an average of $623 to $1,137. In 2003, about 69 percent of these workers had a deductible; in 2013, that number rose to 86 percent.

The trend began before the passage of the Affordable Care Act, often called Obamacare, and has continued as some of the newly insured under the more affordable ACA plans found their policies came with high deductibles.

Growth in deductibles has actually slowed in the past year or two, Collins says, but they can still take a big bite out of family budgets because incomes remained stagnant. Surveys show that people whose deductibles are more than 5 percent of their incomes are more likely to delay seeking health care, or avoid it altogether.

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In response to demand, some local business and health care professionals have opened a variety of same-day clinics. These clinics offer fast-track appointments with midlevel medical providers, such as physicians’ assistants and nurse practitioners, at a price that undercuts a typical primary care physician visit.

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MHM Urgent Care

Keith LeBlanc, CEO of MHM Urgent Care and Occupational Health Services, says he thinks the driver behind the trend of retail clinics is the inability to get an appointment quickly with a primary care doctor. In fact, the Louisiana Department of Health and Hospitals says that in 2015, St. Charles Parish is the only area in the state not experiencing a shortage in health care providers.

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LeBlanc partnered with Dr. Gerald Cvitanovich and opened MHM Urgent Care in New Orleans right after Hurricane Katrina. They now have 14 urgent care clinics and five occupational medicine clinics throughout Southeast Louisiana. MHM also operates a call center that directs those in need of services to their nearest clinic to make an appointment.

MHM clinics take most insurance plans, along with Medicare and Medicaid, but LeBlanc says some patients choose to pay cash instead and receive a discount. “Sometimes people are better off with a cash payment,” he says, because their plans have such high deductibles. MHM clinics are open 365 days a year and are physician staffed.

LeBlanc says the availability of same-day service also prevents unnecessary visits to hospital emergency rooms where care is pricier and patients can wait hours to get treatment.

For private employers, MHM occupational medicine clinics handle pre-employment physicals, drug screening and worker’s compensation injuries. The clinics are best known for “episodic care,” but LeBlanc envisions helping employers control costs by partnering with preferred providers who can offer the continuing care some patients require.

Kwik Clinic

In his former occupation managing medical plans for large groups, businessman Edwin Miltenberger saw how frustrated people would get when they couldn’t get primary care appointments in a hurry. He also realized that many of their ailments – poison ivy, infections and cuts, for example – didn’t require treatment by an M.D.

His solution was to open Kwik Clinic in 2011. The company now has one location in Covington and one in Franklinton, with plans to open in Hammond the beginning of July. At these clinics, nurse practitioners render care under the supervision of a physician.

Miltenbergers says the feedback so far has been very positive. “This last year we were able to make a profit, and anticipate that this year will be better,” he says. “This is what the people want.”

Patients who pay the same day receive a “prompt pay” discount, a savings passed down by the clinics who are spared the cost of filing the insurance.

People have become more accustomed to seeing a physician’s assistant or nurse practitioner, even in a physician’s office, Miltenberger says, and they can differentiate between ailments that can be handled at a walk-in clinic and those that need more extensive care.

At Kwik Clinic locations in Covington and Franklinton, nurse practitioners treat patients under the supervision of a physician — a move that cuts costs all around.
Photo courtesy of Kwik Clinic


All American Healthcare

Another result of rising health care premiums and deductibles is a rise in the use of alternative practitioners. Dr. Chip Curtis, a chiropractor with All American Healthcare clinics in New Orleans, Covington, Hammond and Shreveport, says many patients come to him with bigger co-pays and deductibles than ever. Although he does accept insurance, he notes that some patients are financially better off paying cash.

Curtis says many of his patients find regular visits for chiropractic care can control or eliminate neck and back pain with much less cost than traditional surgery and injections.

Chiropractic care emphasizes wellness, Curtis says. “Wellness is doing the things necessary to keep yourself from getting sick,” he says. Although chiropractors can recommend supplements, they do not prescribe medication. “A lot of people reach for those pain medications first,” he says.

Curtis says patients often tell him they’re at the end of their rope dealing with pain, and after treatment say they wished they would have come to him earlier. “I’m extremely proud of my profession,” he says.

Chiropractor Dr. Chip Curtis, with All American Healthcare, offers a pain control alternative to surgery and injections.
Photo courtesy of All American Healthcare


By The Numbers: Premiums and Deductibles

For people with employer-based health care insurance, premiums and deductibles rose significantly between 2003 and 2013 in Louisiana.

Average Premium
2003 | $3,317
2013 | $5,300

Employee Premium Contribution
2003 | $633
2013 | $1,214

Percent of employees with a deductible (single)
2003 | 69%
2013 | 86%

Deductible (single)
2003 | $623
2013 | $1,137



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