Direct Primary Care: A New Way to be an Advocate for your Health

by | Oct 20, 2017 | 1 comment

Remember the last time you had to face down a ridiculously large medical bill, thousands of dollars more than you expected? Well, these days, patients aren’t the only ones feeling the bite of rising medical costs. Doctors, too, are getting hit by the effects of an increasingly bureaucratic health insurance industry. Insurance policies are changing more and more rapidly, and in order to keep up, doctors are forced to spend more time and money on administrative work. This turns into a double hit against patients: doctors who spend more time on administrative work have less time to actually care for patients, and hospital billing departments have to spend more time and money on personnel, which takes away funds from improving patient care.

Most doctors didn’t go to medical school to deal with the health insurance industry. They want to spend their days focusing on their patients, rather than laboring at their desks on administrative tasks. But not all doctors have resigned themselves to the grind. Recently, some doctors have bucked trends to develop and implement a new model, aimed at getting around insurance in order to prioritize what really matters: health care. This new model is called Direct Primary Care (DPC).

What is Direct Primary Care (DPC)?

Direct Primary Care is a small but fast-growing movement of primary care physicians, pediatricians, and family practices that bypasses the insurance process. Instead of submitting claims to insurance, these doctors charge a small monthly membership fee that covers what the average patient needs, like visits, exams, and even prescription drugs. The patient directly pays their doctor for any services rendered and care provided. Because these doctors don’t need to spend their resources on a complex billing process, and because they don’t have to send anything through a third-party, they save money on overhead expenses. These savings get passed on to the patient in the form of lower bills. These doctors can also avoid any insurance requirements for the care they provide, and can treat their patients according to their specific needs.

How does DPC make it easier to advocate for your health?

1. More manageable medical expenses

While the exact amount varies, according to the Direct Primary Care Journal, DPC memberships average from $20-85 per month (and less for children). That flat rate typically covers all care the doctor provides (sometimes with the exception of more expensive supplies). It can also provide steep discounts on your prescriptions, which are often sold directly from the doctor at near-wholesale prices (traditional pharmacies can mark-up prices considerably). If you pair a DPC with a high deductible plan, you will also be paying lower insurance premiums than if you had a low deductible plan.

The ease of billing is an additional benefit of a DPC. Depending on your plan under the traditional model, pricing is not always transparent. You often don’t know how much you will end up owing until it has been processed by your insurance. At that point, it’s too late to find a less expensive alternative and you’re stuck with a large medical bill. With a DPC, on the other hand, there are rarely any surprises. Your membership fee stays the same month to month, and you will be aware of any additional expenses at the time of service. Under the DPC model, you have a much clearer picture of your health costs.

The model is similar to car or house insurance. With those models, you don’t expect your insurance provider to pay for oil changes and cleaning out your HVAC system. Instead, you only submit claims for catastrophic events, like a car accident or a house fire. Under a DPC model, you pay for your health maintenance care, like annual checkups and prescriptions, and use your insurance for catastrophic events and specialists. A high-deductible plan with a lower premium is a great match to a DPC primary care provider.

Dr. David Cunningham, who left a large medical group to open a two-doctor direct-care practice in Massachusetts, says that many of his patients think it should cost more. He states, however, that “that’s only because we have this bloated way of paying for it.” (In his old practice, more than 60 cents of every dollar went to administrative costs.)

Comparison of Direct Primary Care and Family Practice

Source: Business Insider

2. Better access to your doctor

It’s no surprise that the doctor-patient relationship can often be strained under the traditional model. Between the added administrative burden, requirements for treatment from insurance providers, and other hoops for doctors to jump through, the traditional model leaves doctors rushed and patients frustrated. Under the DPC practice model, however, “you’re not on the hamster wheel of getting paid based on the volume you do,” says John Meigs, president of The American Academy of Family Physicians. “Patient satisfaction goes up. Physician satisfaction goes up. Quality goes up and costs go down because you don’t have to prove it to Uncle Sam or an insurance company.”

Another contributing factor to a better doctor-patient relationship is that doctors are easier to access. While doctors under both models are starting to turn to tools like Facetime to improve patient access, it’s become standard among DPC providers.  “For a patient, life doesn’t happen in the confines of a brick-and-mortar doctor’s office,” says Dr. Cunningham. “Communicating with patients throughout their lives can be very helpful for them. Telemedicine lets patients have that continuous conversation with their DPC physician…they have access to DPC from their pocket.”

While DPCs are relatively new, the medical community is starting to recognize their benefits and voice their support. The American Academy of Family Physicians has voiced its support, and recognizes the benefits of DPCs: “Direct primary care rewards family physicians for caring for the whole person, while reducing the overhead and negative incentives associated with fee-for-service, third-party-payer billing.”

Overall, DPCs improve the doctor-patient relationship by letting doctors focus on their patients, instead of administrative details. The no-insurance model allows doctors to decrease overhead expenses and improve collection rates, which improves their profits. Additionally, it allows doctors to spend more time with their patients, which leads to fewer medical errors, better relationship, and better care. For anyone who wants to take control of their healthcare and become their own advocate, direct primary care providers are a powerful tool.

Our Patient Advocate Office is ever just an email or phone call away: 703-222-1300 – we’re happy to help! A phone call is free and it could save a life or reduce a large hospital bill.

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