With the uncertainty in the health care market, concerns over the fate of the Affordable Care Act (ACA), physician burnout, frustration with insurance reimbursement, and the rising cost of doing the business of medicine, Americans are driven to consider other alternatives to access health care. Innovative free market solutions such as Direct Primary Care (DPC) is quickly becoming a mutually agreeable alternative for both those who access health care and the Direct Primary Care doctors providing their care.
In the 1940s, post-war America saw the implementation of third-party insurance companies and Americans began to see a sharp rise in employer-based insurance coverage. Prior to this, Americans paid cash for virtually all of their health care. Gradually, the third-party payment systems in both private health insurance and government programs have become increasingly complex and costly, less transparent, and more economically inefficient. In the environment of these increasing complexities and inefficiencies, exponentially dissatisfied doctors and patients are looking for innovative ways to deliver and receive primary care. Direct primary care has become an attractive and cost-saving solution for many of today's Americans.
In a Direct Primary Care setting, doctors are paid a membership fee by their patients, rather than filing claims through the patients' insurance companies. Generally, in exchange for the membership fee, doctors provide their scope of services and 24/7 access to care through technology and in-office visits. The agreements can vary, with some DPC doctors providing monthly memberships at a discounted rate, then charging additional fees when care is accessed, such as a copay for office visits or procedures, or fees for after-hours access, while others opt to charge a higher monthly fee, but waive any copays or additional access fees. When comparing DPC practices, it is important to understand what is included in the membership and if there are any additional fees that would increase overall costs.
Direct Primary Care is most economical in the setting where broad-based primary care is provided and the physician is proficient in treating many health conditions and performing a wide variety of primary care procedures. Additionally, because this is a free market solution, there are steep discounts on other services, such as imaging studies and additional laboratory testing. In the DPC setting, consumers quickly become enlightened regarding the true cost of heath care, which stands in stark contrast to the inflated costs they have experienced through third-party payers. For example, what is often a $1300-2500 CT scan through a patient's insurance plan, can be purchased on the free market for around $300. A cholesterol panel can be as little as $4 instead of the sharply inflated cost of $128 on average. It quickly becomes obvious that these savings alone can pay for a DPC membership.
What most people do not consider until they are forced to access the health care system is the distinction between health insurance and health care. Unfortunately, health insurance does not guarantee access to health care. Skeptical about this statement? Consider the Medicare and Medicaid benefits programs, HMO commercial products and the ACA Marketplace (aka Obamacare). Those covered under these programs are often frustrated by their lack of choice of in-network doctors and hospitals and ancillary services, which greatly reduces their access to care. This is happening all over the country and is only worsening as bureaucratic burdens become more complex, time-wasting paperwork takes longer than actual patient care, and the cost of claims processing increases while reimbursement decreases. Uncertainty in the new Administration's heath care policy is causing increasing volatility that will only lead to more burden on the individual consumer to ensure adequate access to care.
Studies have demonstrated with predictable reproducibility that Direct Primary Care provides better health care for the patient, reduces unnecessary hospital and urgent care visits, creates a positive work environment for physicians and staff, and reduces the economic and bureaucratic burdens placed on doctors and patients. More importantly, this setting cultivates the doctor-patient relationship and removes third party intrusion in patient care, thus greatly improving the quality of care for patients. DPC has also demonstrated its value through lower costs not only for the individuals who participate, but also for employers. This type of cost containment strategy can be implemented in small and large group settings to reduce benefits costs when coupled with a catastrophic health insurance plan. It is also beneficial in regards to employee retention and reduced absenteeism.
Individuals often question why they should consider Direct Primary Care when they have employer-provided health insurance. To reiterate, there are many benefits of DPC that extend beyond having health insurance, most importantly, access to care when needed. There are other invaluable benefits, including same day service, short wait times, direct contact with your personal doctor 24 hours a day, 7 days a week, and personalized, comprehensive, quality care that re-vitalizes the doctor-patient relationship. Beyond this, many people find themselves with high deductible insurance plans that require them to pay out-of-pocket until the deductible is met for office visits, procedures, imaging and labs. When your consider the fact that less than 13% of people with health insurance meet their deductible each year, yet must pay out-of-pocket for one or more of their services, the cost of Direct Primary Care could have deferred that cost and afforded additional access to their doctor throughout the year. There are many instances where people have sought care at an acute care facility or stand-alone emergency room for simple complaints, such as strep throat or wound closure only to receive a bill for more than $4000. This is a common price-gauging practice and does not represent the true cost of health care. Fortunately, this can be avoided by having access to a Direct Primary Care doctor. Just like insurance, no one can predict when it will be needed, but when it is, there is nothing but gratitude that a DPC doctor is available 24/7.
Go to http://www.dpcfrontier.com to find the DPC practice nearest to you.
In my practice, the monthly membership fees range from $75 to $200 based on a person's age, which is a common price structure in DPC. There are no penalties for pre-existing conditions. I practice preventative medicine, rather than reactive medicine, and find that Direct Primary Care is the most effective way to achieve this in today's health care environment. There are no copays for office visits, same day care is offered, virtual visits are available through the use of technology, wait times are very rare, typical visits are 30 minutes to 60 minutes, and comprehensive annual physical examinations with full health review, screening labs and all in-house procedures are included in the membership. Broad-based primary care is provided, making the membership particularly beneficial since referral to a specialists is often unnecessary for many of our members' health care needs. Our goal is to provide comprehensive, affordable Direct Primary Care and a medical home for our members.
ABC Coverage of Direct Primary Care or Membership Medicine
Dr. Cynthia Stuart practices Direct Primary Care in Carrollton, Texas, and is a member of Diamond Physicians, an innovative DPC practice on the cutting edge of the health care revolution.
Comments
Post a Comment