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Direct Primary Care: A Solution to Saving Healthcare


By Jessica Kelner, D.O. - September 27, 2018

What exactly is Direct Primary Care and can it help save healthcare? 

Direct Primary Care (DPC)
is a model of medical care where the patient pays the physician directly for their care.  The payment is usually a small monthly fee ranging from $50 - $100. There are other models similar to this one like concierge (retainer based) medicine where there is one upfront cost per year.  The goal with this type of model is a small patient volume, increased time spent with patients where the focus is on the patient/physician relationship and keeping the patient healthy.  This monthly fee gives the patient full access to their doctor.  This will often include phone visits, telemedicine visits, and email exchanges.  These practices will usually have contracts with lab and imaging centers in the community that drastically reduce out of pocket expenses for the patient.  Costs in medicine are often overinflated due to insurance billing where the company may not get paid for a certain amount of services they bill for.  Subsequently, that cost gets put onto the next patient. All of this is avoided with Direct Primary Care.   

Direct Primary Care doctors have a much smaller patient volume.
 They have about one quarter of the patient load of a typical primary care doctor.  They may have around 600 patients, instead of 2,500 patients in an insurance run practice. This means your doctor can spend more time with you.  Without having to see a patient every 15 min to make enough money to support the practice, they can choose to spend more time with you, their patient. This is HUGE for patient care and building a relationship with your doctor.  How can you receive adequate care in 15 min? Most people don't feel like that is possible.
 
With Direct Primary Care, you receive more personalized care that isn't just focused on making the insurance companies happy, but focused on your needs.  For example, an insurance company may require that a patient receive an X-Ray in order for them to pay for an MRI.   The physician may know this X-Ray is pointless for the patient's particular injury, but with insurance billing, that patient may be forced to be exposed to the radiation from the X-Ray and delay their MRI, which then delays their treatment for their injury. 

Insurance companies are hindering patient care
What most people don't realize is that insurance billing takes away about 70% of the overhead of a practice.  The doctor has to spend time documenting/coding their chart (for billing purposes), often someone has to be paid to check this, there has to be a full time employee (or equivalent of that) to try to collect the money from the insurance company, then get clarification on the billing, and then turn around and try again to collect this money. Often the money the practice is owed is never paid, which is a loss for the practice. This in turn requires the doctor to see more and more patients to support the practice.  Additionally, over the years, the reimbursements from insurance companies have gone down dramatically, which subsequently creates a situation that requires doctors to see more patients in a shorter time period of 10-15 minutes. The insurance companies continue to increase documentation requirements from physicians that do not affect patient outcomes or the quality of care.  This too takes up physician's time, which means there is less time to spend with their patients. 

Patients can no longer afford health insurance
According to Bloomberg's article by John Tozzi (August 2018), "Priced Out of Their Health Insurance, Americans Rig Their Own Safety Net", "Though the ACA expanded coverage to 19 million Americans, some of those gains are reversing. About 28 million remain uninsured. A study by the Kaiser Family Foundation, a health-research nonprofit, determined that most uninsured families simply found health insurance too expensive." In this article you can read more about real people and their situations where the cost of health insurance drove them to find another solution to their healthcare, Direct Primary Care.   

https://www.bloomberg.com/news/features/2018-08-22/priced-out-of-health-insurance-americans-rig-their-own-safety-nets

"Though the ACA expanded coverage to 19 million Americans, some of those gains are reversing. About 28 million remain uninsured. A study by the Kaiser Family Foundation, a health-research nonprofit, determined that most uninsured families simply found health insurance too expensive."   

Patients and Doctors are Dissatisfied with the Insurance Model 
Patients often may not consider how their doctor is feeling seeing 40-60 patients a day.  Yes, this is what some doctors are forced to see due to insurance billing. Yes, this is also exhausting.  Yes, they too aren't satisfied with the care they are able to give.  Most doctors go into medicine wanting to help people and improve the quality of their life.  Doctors are not able to give patients the care they want to in a 10-15 minute appointment.  While they become more and more frustrated with their institution for requiring them to do this, they are forced to accept this because they feel helpless in finding a solution to this problem.  

Patients are also distressed with their care. I can't tell you how many of my patients have told me "I don't go to the doctor because they don't do anything for me, they just order labs, and give me drugs that I don't want" or " I don't go to the doctor because they only spend 10 minutes with me and they don't seem to care about helping me or my issue."

Newer graduates from medical school are avoiding going into primary care for this reason, which is leading to a primary care physician shortage in our country.  This is actually creating more disease and sickness because patients struggle to find a primary care doctor that can see them in a reasonable amount of time.  If it is more than a week or two, they often give up or their health issue may get worse.  Many doctors are leaving health care all-together.  This is the wrong direction to be going entirely. 

Is Direct Primary Care a solution to our health care crisis?  Many experts believe that this is a component of the solution.  The book The Evolution of Medicine by James Maskell (2016) discusses the various aspects of how to change the course medicine is on, the challenges we face, how to end chronic disease and improve patient care with this model of medicine.
 
Direct Primary Care isn't meant to replace insurance entirely.
 It will decrease costs while improving the quality of care and health of the patients in the practice.   Many experts encourage patients to carry a high deductible catastrophic insurance plan for situations and expenses like hospitalizations that would be well beyond what they could afford to pay out of pocket.  These plans are often much cheaper than comprehensive health insurance and will not drain the bank account of a four-person family. 

If you want to learn more about Direct Primary Care, you can check out the Direct Primary Care Coalition's website https://www.dpcare.org/.