Health Care Revolution? Traditional Medicine versus Direct Primary Care

“When you think of Andy Griffith-style medicine, the doctor had a clinic in the local town. It’d be strange for him to say, ‘What kind of insurance does Opie have?’” (Michael Tetreault, quoted in DirectPrimaryCare.com)

When I compare medical care from when I was growing up to the medical care of today, today’s version falls far short. I remember having appointments with our family doctor as a child. He knew me and wasn’t distracted by the hubbub of computers, insurance requirements and the like. It felt like an authentic relationship and that made me want to become a doctor.

I’ve now been practicing medicine for 20 years, and I genuinely struggle with today’s insurance-based model where so little time is spent on listening, on building relationships, on disease prevention. With only a few minutes allotted per doctor-patient visit, time is typically spent trying to alleviate current symptoms rather than delving into root causes of problems. So, not surprisingly, money is spent after the problem occurs – after the heart attack, after diabetes has already developed, after the patient receives a discouraging diagnosis.

Because of this model of medicine, insurance policies where I practice (in South Carolina) are going up an average of 25 percent for 2017, for a total increase of about 70 percent over the past five years. And, as costs skyrocket, deductibles are also increasing along with restrictions that can prevent patients from getting the medicines they need. It’s fair to say that doctors and patients alike are extremely frustrated, and that’s why I’ve made a big change in how I practice medicine.

I’ve switched to a direct primary care model which quite literally is a direct relationship between patients and physicians. In effort to provide high quality healthcare, I will take on fewer patients, be available to them when they need me and spend more time with my patients.

Direct Primary Care is sometimes confused with Concierge Medicine. Though Direct Primary Care physicians do provide concierge level care, we are an insurance-free, lower cost primary care membership model. Don’t let insurance free scare you; we are not anti-insurance by any means. We just don’t believe that your primary care should be determined by the type or level of insurance that you have; and by not accepting insurance as payment we are able to offer lower costs, longer visits, more access, low costs medicines, lower costs ancillary services (x-ray, ultrasound, etc), wholesale labs; none of which would be possible if insurance was accepted. Direct Primary Care isn’t available everywhere in the country although participation is growing. The first physicians to offer this were practicing in Seattle, Oregon and Bellevue, Washington – and that was in 1996. Today, there are approximately 400 group practices existing with this model, with about 1,300 total doctors. Approximately two percent of the American Academy of Family Physicians’ 68,000 members currently offer direct care.

Direct Primary Care Analogies
With this form of medicine, patients pay a monthly fee to their primary care physician which covers the costs of all visits, annual physicals, in-office procedures and offers other benefits such as wholesale costs on medications and labs. You can compare this to having a gym membership. You pay a monthly fee and then do what’s right for your health without worrying what else the gym will charge you for that day’s work out. With direct primary care, you typically only pay extra for lab work or prescriptions, and prescriptions are often at wholesale prices. You can also compare direct care to auto insurance. If we used auto insurance for vehicle maintenance the way we are using health insurance, your auto insurance premiums would be unaffordable. Your flat tire, wiper blades and gasoline may be covered (after a significant deductible), but they would dictate where to go, how much is covered, what brand is allowable and to what extent. Some Direct Care patients find extra financial value through purchasing a less expensive, high deductible insurance plan for hospitalizations and catastrophic events while other just simply find value in the personal service and high quality care.

Advantages and Disadvantages of Direct Primary Care
With rising insurance and medical costs, finances are front of mind for many patients. And, an MDVIP study (network of private physicians) revealed a 72 percent reduction in hospital visits for patients using direct primary care and a savings of $2,000 per patient annually. Without the need for insurance paperwork and unnecessary overhead, doctor office costs are reduced, and these savings can be passed along to patients. Wholesale prescription prices are another benefit. Collectively, this is estimated to save the economy billions of dollars.

Next, patients and doctors can sit down and actually communicate with one another, with the result being individualized care, not what the insurance company dictates a person should have. Instead of looking at a computer screen, entering in data and codes for the insurance company, your doctor can actually look at and listen to you.
Your physician can focus more on preventive medicine because there is enough time. As just one example, I have studied nutrition in some depth and often recommend the Mediterranean diet. Science shows it lowers your risk for heart attacks, cancer and stroke. It lowers inflammation naturally, which has a significantly positive effect on overall health, and I will now be able to talk to my patients about its benefits and personalize how to integrate it into their life.

With direct primary care, you don’t have to worry about switching doctors if you need to switch health care insurance policies, because they’re no longer connected. The doctor-patient relationship doesn’t have to be disrupted. You don’t have to start all over explaining health care concerns and medical history to a brand new person.

Although this model is beneficial for most people, no one model is ideal for everyone. You might think that people who are seriously ill are one of the exceptions, but they in fact can greatly benefit from the personalized attention and wholesale prescription prices associated with direct care. People who won’t necessarily financially benefit from direct primary care include people with excellent insurance coverage from their workplaces with low copays and no deductibles. If these people have doctors that can provide them with enough access, time, and attention, then switching to direct primary care probably isn’t financially beneficial. However, receiving high quality, personal primary care and really taking control of your health has long lasting value.

Some people on Medicaid wouldn’t benefit from direct primary care, either, although that may change as the current insurance model is being reviewed for overhaul by the new administration. Note: in the state of Washington, contracting out for direct care for Medicaid patients is estimated to save the state between 15 and 20 percent.
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Additional Resources

• NPR has published a good direct care overview: Would Paying Your Doctor Cash Up Front Get You Better Care?
• How the 15-Minute Doctor’s Appointment Hurts Health Care by the Wall Street Journal shares how 54% of physicians who are under these tight time constraints met the criteria for burnout in 2014, up almost ten percent from 2011.
• Forbes raises two excellent points in With Direct Primary Care, Health Care Doesn’t Have to Be Expensive: “Medical providers will tell you that over 75 percent of health care can be provided in a primary care setting” and that doctors are currently spending up to 40 percent of their revenue on submitting insurance claims. ​
  

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​Bio: Dr. Brandon Sick has been practicing medicine since 1996. He opened his own practice, Rock Hill Primary Care, in Rock Hill, South Carolina (January 2017) so he can deliver old-fashioned medicine in our modern society. Email Brandon at [email protected]