Unhappy working in a health care system that he felt was broken, Dr. Patrick Rohal opened one of Lancaster County’s first direct primary practices in January 2016.
“I was looking for a way to practice medicine the way I dreamed it would be while going to medical school,” Rohal says.
His practice, CovenantMD Lancaster at 930 Red Rose Court, Suite 104, fulfills passion to build relationships with patients, which he believes is at the heart of primary care.
Direct Primary Care is a health care option gaining in popularity nationwide. While there is no official registry of direct primary care practices, an unofficial source published by National Institute of Health, National Library of Medicine in August 2021 reports there were 125 practices in 2014; 620 in 2017 and over 1,500 in 2021.
All the practices disclose fees, services and medication costs on their websites.
Many doctors dissatisfied with health systems driven by insurance companies rather than the needs of patients are choosing direct primary care practices.
Lancaster County lists seven independent practices delivering direct primary care, including Rohal’s.
The Johns Hopkins University and University of Maryland School of Medicine graduate says direct primary care offers patients more affordable care through a monthly membership without insurance and eliminates co-pays and high deductibles. Hospitalization insurance is recommended and the staff will help explore options for it through government programs or Christian cost-sharing ministries.
Rohal’s staff includes Dr. Jason Bailey and Janelle Gregory, a certified physician’s assistant. A second location, CovenantMD York, opened in January 2019 and is staffed by Duane Furman, a certified physician’s assistant.
CovenantMD monthly fees range from $45 (for children up to age 18) to $85 (for patients 65 and older). For those over 100, the cost is $1 per month.
Medications are dispensed in the office or by mail to patients at low self-pay prices. The lower costs are possible through a bulk distributor and mail-order pharmacy. The cost savings for medications often pays for the monthly fee.
Visits can take place in the office, the patient’s home or their workplace.
“Health care should be about wellness, not just illness,” says Rohal, who emphasizes the importance of proactive health choices for patients.
Because of limited patient numbers, he says his practice can give the extended time necessary to discuss lifestyle and diet which can lead to less need for medications.
“Once a patient experiences direct primary care, they don’t want to go back to primary care insurance fee-for-service,” he says.
CovenantMD has many local employers who see the value of direct primary care.
Legacy Electric Services Inc., Manheim, has been offering direct primary care through CovenantMD Lancaster as an employee benefit for the past six years. The company pays the monthly fee for employees and family members up to five children.
“We’re a small company and our people matter. We want to take care of our employees and Dr. Rohal’s practice provides the absolute best care for them,” says Joshua Mellott, president.
Employees like the care so much they stay with the practice even when no longer employed by the company, Mellott says.
He likens CovenantMD direct primary care to the TV show “Little House on the Prairie,” where the country doctor knew and cared for all the family members.
“The cost savings is huge for the premium care provided. I hope more people discover direct primary care and more doctors do it,” Mellott says.
For Dr. Danielle J. Miller, direct primary care offers a new approach to old-fashioned medicine.
Graduating from Drexel University of Medicine, she worked in a local health system until opening her direct primary care practice, Luz Medicine, 29 Cloister Ave., Ephrata in October 2020. It was the third direct primary care to open its doors in the county.
The name of the practice comes from a Spanish/Portuguese word meaning “light.”
Miller says the practice seeks to bring light to medical issues with understanding and help for patients to be well.
“Taking care of patients is important to us and being available to deliver prompt available care means a lot to them,” Miller says.
She believes having access to their physician after hours is a big benefit.
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Kristy Arey, a certified medical assistant, works with Miller at the Ephrata practice.
The monthly membership fee range is $60 (ages 0-17) to $85 (18 and older) with a one-time enrollment fee of $150 per household.
She says unlimited office visits in person, virtually and by phone appeal to her wide mix of young and older patients.
Without insurance fees for service, costs are discounted and less expensive for many services such as lab work, radiology, bloodwork and office-dispensed medications.
Miller recommends insurance coverage for hospitalization, but doesn’t require it since some patients cannot afford it. Medicare recipients can use their plan.
The practice also offers fertility wellness and ongoing wellness for chronic illness.
Working in the health system, Miller saw thousands of patients. Now, she says, she sees hundreds and is able to give them more time.
The practice isn’t accepting new patients, but there is a waiting list.
For Miller, the decision to be a direct primary care practice physician was the right one.
“It’s wonderful to enjoy taking care of patients again,” she says.
Though uncertain about the future of health care, Miller thinks direct primary care is a current solution to a system which is broken and overwhelmed.
Dr. Chris Lupold agrees. In 2017 he opened his direct primary care practice, Alere Family Health LLC, 334 Hartman Bridge Road, Ronks.
As the son of Dr. Georgetta Lupold, a now-retired Schuylkill County family doctor, he fondly remembers growing up in “the good ol’ days of medicine.”
“Doctors knew the families. They took time with a patient and neither felt rushed,” Lupold says. “Medications were given during an office visit.”
After 16 years working for a health care system, the Bucknell University and Jefferson Medical College graduate was no longer happy going to work and needed a change.
Direct primary care was an attractive option to return to the way medicine was practiced in the past.
The smaller patient load gives him more time to foster relationships. He says a visit becomes “one-stop shopping for patients.”
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Along with primary care, Alere also provides hearing, vision and sleep testing.
The staff includes Lupold, Dr. Elizabeth Van Aulen, and certified medical assistants Amanda Keller-Aston and Brandi Parry.
Monthly fees are $20 (for children ages 0 to 18), with a $10 charge for three or more children, up to $95 (for ages 65-plus). The fee covers unlimited visits per month. There’s an initial enrollment fee of $25 for the first family member and $15 for each additional one.
With no insurance or Medicare billing, paperwork is significantly reduced. Patients are billed for the fee on a monthly basis.
Lupold encourages patients to have hospitalization insurance, but accepts those without it.
Getting patients hasn’t been a problem, and Alere isn’t currently accepting new ones. There are over 100 names on a waiting list.
“We’re in the process of hiring a new physician,” Lupold says. “Being always on call isn’t a right fit for every doctor.” But he’s optimistic about having another doctor on staff soon.
Lancaster resident Lyndsey Sherack cannot say enough positive things about Alere Family Health. She says direct primary care is “the best kept secret in the county.”
Sherack, 41, husband John, 38, daughters Natalie, 9, and Kylie, 6, have been with Alere since the practice opened its doors.
“Dr. Lupold really knows our family and has a personal friendship with us,” she says.
Sherack, a Realtor and Lampeter-Strasburg School District employee, says she likes the unhurried time Lupold spends during visits, whether in person, by phone or video chat. She’s also impressed with the “instant” response and the ability to have a same-day or next-day office visit.
The family has insurance for hospitalization through John’s employment at Constellation Energy, Delta.
“Dr. Lupold and I are birthday buddies and he never misses mine,” says young Natalie. The two share a July 16 birth date.
Sherack says she hopes others will check out direct primary care.
“For our family, Alere is a perfect combination of simplicity and efficiency with a friendly personal touch,” she says.