How It Works
Direct Primary Care?
Direct Primary care is both old-fashioned and new. It is old-fashioned in that it goes back to days when there were not so many layers between patients and their care-givers. It is new in that it uses technology to circumvent many of the things that have made care inaccessible to many, if not most, Americans.
There are two main features of Direct Care:
Doctors/Providers are paid directly by the patient (or employer) for the care they give, not accepting payment from third-party (insurance) payors.
Payment is mainly through a low monthly charge (less than $100 per month), with no charge for office visits.
The Insurance Model of Care: Complexity
The Direct Model of Care: Simplicity
Why is it important to pay directly?
There are a number of reasons why it is better to avoid payment of primary care using health insurance:
Primary care is not expensive, and so insurance is not necessary to cover the cost (much like automobile insurance doesn’t cover gas, tune-ups, and flat tires).
Insurance payment hides the cost of care from those paying for it. If you go to most doctors and ask them what an office visit costs, they won’t be able to tell you. In direct care, all costs are explained up-front, which makes the care accountable and the cost predictable.
Avoiding insurance greatly lowers the overhead for the provider, allowing a smaller office staff, smaller patient panels, and longer visits.
It increases the importance of providing something rare in healthcare: value.
It removes any third-party from the exam room, interfering with the care the doctor/provider wants to give to the patient. The medical record is liberated from being a record to justify billing (as is the case in insurance-based care) to being an actual record of patient care.
Why is the monthly fee important?
When you see a fee-for-service doctor, they are financially rewarded for:
Bringing you in for any problem, no matter how small.
Having you be sick, the sicker you are, the more the financial reward.
Doing as many procedures on you as possible.
Spending as little time with you as possible (to see more patients per day).
None of these are in your best interest, and doctors are forced to choose between good business and doing what is best for the patient.
The monthly fee changes this completely, rewarding exactly what the patient wants:
There is no reward for pointless office visits. Care can be given (where appropriate) via text message, over the phone, or via video conference. The majority of care (up to 75%) does not require an office visit.
The practice is motivated to keep people healthy and happy so there are many openings in the schedule. This means that same-day appointments are almost always available.
The practice isn’t rewarded for doing any unnecessary procedures.
A lighter schedule means that more time can be given to each visit. Our practices offer 30 minutes for simple visits and 60 minutes (or more) for new patients. This allows for a better relationship between the provider and the patient.
The lighter schedule also means wait times are almost nonexistent.
What about insurance?
While primary care is inexpensive and can be done without insurance, the same cannot be said for the rest of the system. There are still expensive conditions, medications, and procedures that can often cause huge financial stress for both individuals and companies paying for employees’ health. Many who can’t afford insurance have found DPC to be a good way to get care they otherwise had no access to, but they face huge stress still when the need for surgery, hospitalization, or expensive medications comes up.
We do recommend that our patients have insurance to give them the care they need when these expenses arise. While some can get it via the Healthcare Marketplace (healthcare.gov), this option is not available to may/most people, and it doesn’t serve as a solution for employers who want to take care of their employees by offering insurance.