About Direct Primary Care
Direct Primary Care (DPC) is a new name for an old idea. It wasn’t so long ago that people simply paid their doctors directly for their services and left the insurance companies out of it. In fact, that’s pretty much the way things always worked until about a century ago, when health insurance came into being to cover hospitalizations.
Unfortunately, what started out as a fine idea has since suffered from a bad case of mission creep. Instead of just needing insurance for hospitalizations, now the common expectation is that health insurance should cover hospital bills AND physician visits AND prescription drug costs. The moral hazard of having 3rd-party payors has led to skyrocketing costs as more and more dubious claims get justified for reasons of “medical necessity.” Medical vendors aren’t dumb. Ever wonder why you see commercials on late-night TV for powered wheelchairs featuring unnaturally happy people blissfully tooling around in circles? Powered hospital beds and Miracle Ears and all manner of other cures and wonderful devices and expensive new medications that you should ask your doctor about? Those ads might not be so prevalent (nor the prices on the products so expensive) if consumers had to pay for those things directly.
As it is, insurance premiums have skyrocketed to keep pace with increased utilization of medical services, and medical insurers increasingly use the excuse of keeping costs down to get pretty intrusive in their management of the physician-patient relationship. They’ve become micro-managers of doctors, and the decisions they make will always be in the insurance company’s best interests, not necessarily in yours. It’s a classic case of the Golden Rule of Economics: Those with the gold get to make the rules.
Direct Primary Care is an invitation to patients to skip the middleman insurance companies and be in a much better position to call the shots. You might think this would be expensive, but it doesn’t have to be. In fact, once you start comparing the monthly costs of low-deductible health plans vs. the costs of high-deductible health plans (aka “catastrophic coverage” plans), you might start realizing that DPC makes a bit of financial sense. Having the right high-deductible health plan (HDHP) entitles you to contribute to a Health Savings Account, and once you roll in the investment and tax advantages that the HSA bring for a lot of people, switching to DPC with a HDHP could become a total no-brainer.
That’s just the financial end of things. What about the quality of medical care?
Well, one of the problems that a lot of physicians have with medical insurers is that they’ve really cut payments to the bone. This means that if a doctor wants to be able to earn a good income AND pay for all of the extra people they need to mitigate the headaches of working with insurers, that doctor really has to hustle throughout their day. They don’t have time to stop and think things through. They don’t have time for pleasantries. They often don’t have time for lunch. They need you to be as concise as possible when stating your problem, and when they’re behind they’ll do everything they can to save time so they can catch up.
The sins patients may witness are endless: overly-brief (or even skipped) physical exams, failure to ask detailed background questions, overlooking important and relevant bits of medical history, failing to review medication lists or be on the lookout for bad drug interactions, failure to make sure that patients know what they’re taking and why they’re taking it, making otherwise unnecessary referrals only because docs can’t afford the time to deal with problems themselves, refusing to address more than one or two problems in a visit, and interrupting to get you to please shut up so they can nail down your plan and hurry on to their next patient. Ever wonder why a nurse or medical assistant asks you a bunch of questions beforehand that aren’t relevant to your visit, and that your doctor might not even bother looking at the answers to? Insurance billing. Ever wonder why some (not all) doctors sometimes order a bunch of apparently superfluous lab tests or imaging studies that don’t seem to make much sense? Sadly, it might be because they feel they need to do that in order to justify the medical complexity / decision-making rules that apply to the insurance billing codes they want to use. Phew. Many a patient has confided in me that they generally don’t like doctors. With experiences like those, it’s no wonder.
Fortunately, when doctors don’t have to worry about jumping through hoops to get paid by insurance companies, they can start focusing on things that matter to their patients, like great customer service and great quality of medical care. Rather than only addressing one or two problems (which is the most economical way to bill and get compensated by an insurance company), docs can start addressing laundry lists of issues and see everything in the context of everything else. It’s a lot easier to do an outstanding job for your patients when you only see maybe 6 people in a day (in addition to the follow-ups, calls, texts, and e-mails for the simple stuff) than when you have to see 4 or 5 times that many.
As a DPC provider I am free from a lot of headaches. I don’t have to worry about not getting paid by an insurance company for visits over the phone, via text, or via video chat… so you won’t have to come into the office unless there’s a particularly good reason to bring you in, like a physical exam. (Those are still difficult to do over the phone.) Want a same-day or next-day appointment? Can do – I can enjoy a fair amount of “empty” time in my schedule on most days by efficient handling of so much of the nitty-gritty work of medicine via e-mails and texts and quick phone calls instead of pointless office visits. Want the doctor to return your call quickly? Will do. No problem. Wish you could see your doctor after work, late at night, or on a weekend? Certainly (perhaps with a bit of notice).
Having significantly more time to spend with my patients allows:
- Better communication of your problems to me.
- Time for me to understand you and the life that you’ve been living.
- Time for me to give enough feedback to you so that you can be confident I really understand what’s been going on with you.
- More time to review your chart and put “what’s happening now” into context of what’s been happening in the past.
- Time for me to really look over the labs, the studies, and the notes from other doctors in depth and minimize the chance that I’ll miss something important.
- Time for me to explain the significance of those lab results to you, both the totally normal and grossly abnormal ones as well as the “off just a little bit” ones that may point to some more subtle issues to follow up on.
- Time for me to review your medications and supplements, ensuring that you understand what each is supposed to be doing for you, that you’re taking them appropriately, that they’re working for you, that you can afford them, and that I have the best chance of identifying any interactions or unintended side effects that would make us want to do things differently.
- Time for me to read up on things I might not deal with every day, improving the chances that I not only reach the right diagnosis but that your treatment plan is as good as it can be. This means less chance of complications, hospitalizations, and missed diagnoses.
- Time for you to ask questions and for me to answer them (or promise to get back to you with the answers when I don’t already know them).