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Plugging the Holes with Direct Primary Care

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!

I hate waiting in the waiting room forever!

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 $1500 for the year for a family of 4. Can you use an extra $4500/year? I know I certainly can!

Here's another way to break this down. The above price is for a family of 4. If each of you have a yearly physical and that is all, then you will pay to your provider $300 X 4 or $1200 for the year. All of that will go to your deductible. So, what happens if you each get sick, just once more in the year. You will have to see your provider again. Chances are, they will want to see the entire family because that is just usually how it works. This visit will cost you $150 each, unless you go to the urgent care down the street where it is $120 each. So your provider will be 4 X 150 = $600. At the urgent care, 4 X 120 = $480. Yep, it went to your deductible or co-pay, but you still paid it. Now you've paid 1200 + 600 = $1800 to your provider and/or your deductible, the other would be $1680. So just with one physical and one sick visit for all of you, you have more than covered your membership in the clinic for an entire year, everything else for the year is icing on the cake for you. OR you can keep paying your deductible!

One last thing to keep in mind, when you have a provider that takes your insurance, they have signed a contract with your insurance company. This means that your provider must practice within the constraints placed upon them by your insurance company, otherwise they won't get paid. Let's be frank here, the bottom line with the insurance company is money. They LOVE your money, and they DON'T want to spend it. I chose to leave "big box medicine" because the constraints of the insurance companies severely limit my ability to practice medicine. In my opinion, this is not in the best interest of my patients. I've chosen not to be a subcontractor for the insurance company or the government. As a DPC provider, I strive to work with and serve my patients with a goal of forming long lasting relationships. The doctor-patient relationship is built on trust, which is gained over time. It is called direct primary care, because it is a direct relationship between you and your provider or nurse practitioner with no red tape from the insurance company or government. I went into medicine, after all, because I want to care for people…not be told how to care for people.

If you want to find a direct primary care clinic near you or want to learn more, then here are some resources:

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