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Plugging the Holes with Direct Primary Care

March 13, 2017

There's a hole in your healthcare,

Dear Liza! Dear Liza!

There's a hole in your healthcare,

Dear Liza, A HOLE!

PLEASE fix it, Dear Doctor, Dear Doctor!

PLEASE fix it, Dear Doctor! FIX IT!


I'm trying dear Liza, I'm trying, I am.


Whenever I think of the ever-increasing costs of healthcare, this song pops into my head.  The bucket is healthcare, your money is the water, and the inefficiencies of the system are the many holes.  How can you possibly fix a bucket with SO MANY HOLES?  


I really can't say that I have found the "golden ticket" answer to this question, but what I can tell you that what I have found is pretty stinkin' close.  What am I talking about?  Well, I am glad you asked.  Direct Primary Care (DPC); and this blog is devoted to answering these questions about DPC: 1) What is it?  2) Why should you choose it?  3) How can you find out more information about it? and, 4) How can you find a direct primary care doctor in your area?  So sit back and ruminate, whilst I illuminate...


Direct Primary Care is a membership-based primary care agreement between a patient and their chosen doctor or nurse practitioner.  The patient pays a low monthly membership, usually ranging from $10-100, and in return gets excellent primary care. These primary care services include whatever you would normally go to your regular primary care doctor for, i.e. yearly visits, sick visits, chronic health maintenance, simple procedures, basic vision and hearing screening.  There are some valuable perks with the membership, such as, incredibly discounted lab costs, wholesale medication costs (that often times can't even be beat by Good Rx), and discounted radiology that is arranged with local independent providers.  But the benefits don't stop there!  


Do you hate taking half a day to see your doctor because you know you will wait 45 minutes to an hour in their waiting you?  In a direct primary care practice, patients are scheduled so they don't routinely wait more than 5 or 10 minutes.  Of course, sometimes emergencies happen that create some wait times.  In those cases, I often call the next few patients to let them know and give them an option of rescheduling.  I believe your time is just as valuable as mine, and I like to stay on schedule.  Office visits are scheduled for 30 and 60 minutes in length; no 7 minutes with your doctor in this practice!  You are paying to pick my brain about what is going on with your health.  We can never get that done in a measly 7 minutes.  Life and health are complicated and it takes time to figure some things out.  


Do you hate calling and never speaking to your provider?  Or, worse yet, maybe no one calls you back? Yeah, I hate that too!  Wouldn't it be nice if your doctor actually answered the phone when you called?  That is what routinely happens in a DPC practice. It is kind of funny when I answer the phone with "Accomplished Health and Wellness, this is Dr. Smith.  How can I help you?" There is often a pause and then some "Uh... Uh..."  It is unexpected to actually get the doctor on the phone when you call.  I completely understand.  It still makes me chuckle to myself.  I figure I might as well answer the phone since the call is most likely for me anyway.  If I am with a patient though, someone else will answer and take a message or the voicemail will catch it.  But then guess who calls you back?  Yep, it's me.  If I am super busy, my nurse may call back depending on the urgency of the response needed.  


Hey, have you ever thought about emailing your doctor or even text messaging?  I converse with my patients routinely through email, and I even have a few who text me. That way we aren't playing phone tag all day.  The electronic medical record that I use allows for those emails and text messages to securely flow into the patient's chart seamlessly for later reference, if needed.  It makes getting a hold of each other easy, and who doesn't love easy.  It is a rarity in medicine to find something easy.  


Speaking of "easy".  Have you ever looked at your bill to see what your care costs before and after insurance?  Some bills are so confusing you feel as if you need a bill reading degree to decipher it, and then you would still be hard pressed to understand it.  Check out your Explanation of Benefits (EOB) that comes from your insurance company.  It gives you an idea of what you paid or are going to pay.   Compare this to your doctor's bill to help you decipher it.   Next time you go to the doctor's office, I urge you to ask at the front desk how much your visit will cost.  They will respond to you with a deer in headlights look because they have no clue. And quite frankly the doctor won't either until, he/she gets into the visit with you because there are so many layers that go into coding and charging a visit.  And the provider can get dinged if they under-code or over-code.  This is why transparency is a joke in healthcare.  But in DPC, it is simple.  You pay your monthly membership fee plus any extras as you go.  You will always know the cost of the extras ahead of time so that you can make an informed decision. On average, a sick visit costs about $150 in a traditional primary care practice, which, for a 30-year- old, would cover 3 months’ membership in my practice at $50/month (with unlimited visits and direct contact with me).


Do you hate paying those stinking co-pays?  Ugh! I heard recently that co-pays were going away and some people are just paying everything until they reach their deductible!  What is that about?  You pay your insurance company and you pay 100% of your care until you reach that deductible!  That is crazy!  Why not forget about that deductible, save it for specialists, and just pay a low monthly membership fee which covers all of your visits!  There are usually no co-pays in DPC, and we definitely don't deal with deductibles.  That keeps more money in your pocket, which makes for a pretty happy, and healthy, piggy bank.


People ask me "Why would I pay you when I have insurance?"  I explain that you are paying your doctor every time you get seen.  You pay it in the form of a co-pay.  Instead of co-pays, we make it easy with a monthly membership fee.  Then I hear is, "But I am paying you every month instead of just when I need to be seen."  Yes, that is true. Whether you pay co-pays or you have an all deductible plan, you are going to be paying a large sum before your insurance kicks in. A conservative deductible/co-pay plan easily runs about $6000 out of pocket for a family before it begins to pay for any of your care. With a DPC membership you can forget your deductible and pay $125 a month in the clinic, which adds up to a grand total of