Direct Primary Care

• by donr
• 2016-10-09 14:53:49
• General Posting
• 1002 views
• 3 comments

There's a new kid on the block in US primary care medicine. It's called Direct Primary Care (DPC).  So far laws allowing the concept to be created have been enacted in only 17 states out of the 50.  For a relatively exhaustive discussion of the programs, Google http://www.jabfm.org/content/28/6/793.full for an article by the national guru on DPC, Dr. Phil Eskew, who practices under the concept in Wyoming.

DPC can save patients significant money in prinary care through reduction in overhead by the practice.  The Afordable Care Act (ACA, or Obamacare) permits the several states to allow the concept through enactment of their own laws in accordance w/ the Tenth Amendment to the Constitution, so the practice may take on a different character on a state-by-state basis.  

Our #2 Daughter, an MD, has opened her own practice in Mississippi (Hereinafter called MS to save my fingers) in mid-Nov last year, with the dream of creating a DPC entity w/i the practice.  She sprung the ideas on us in about March of 2015 with the statement/question "Dad, I'm going to open my own practice.  I've already rented a vacant Bldg.  Will you build out the interior for me?"   You all know what the answer was.  Being "Retired," & having "nothing else to do," there was lots of time on my hands, so Wife & I started commuting the 500 miles between North Georgia, where we lived, & southern MS, where she lived, to take on the project.  Doors opened in Mid-Nov, 2015, w/ a typical general primary care practice, taking any insurance we could get, plus Medicare.  There were days when we saw ZERO patients.  We are now up to an average of 6 per day.  Our patient panel is up to 385 patients, as of this past Saturday.

Our area is severely short of primary care physicians, so we are building fairly rapidly.   The interior build-out is not complete yet, but we have one exam room, the bathroom, the reception area & waiting room ready for use, so we are able to see patients successfully.  About two months ago, she asked me to take on the job of Practice Administrator because all the admin/financial was driving her up a wall.  So I said yes & added to my duties as plumber, carpenter, electrician, general probblem solver - all the other crap that has to be done in a functioning medical practice.  She hired a "Billing Service" for 6% of the collected funds from our insurance patients - so I spend time on the phone w/ them every AM to review our latest problems w/ Medicare. 

Here's where we save a lot of expense - we hire no one to do billing - the billing company does that for us & they can do it far cheaper than we can by hiring our own employees.  Typical DPC practices have very small billling staffs - usually only 1-2 staff members.

So what are typical costs for DPC?  The rules of the game HAVE to be, by state law, that:

1)  you charge patients a flat monthly fee for the service.

2)  They have to sign a contract for a year.

3)  It is NOT insurance, it is a contract for yearly service.

4)  Others, but these are the salient points

It has taken me since February to put a comprehensive description of our DPC plan together, but it was rolled out on Sat, 1 Oct & we have signed up three patients out of the first three I tried to sell it to!  Our lowest cost plan checks in at $40 per month, after a first visit cost of $125 to cover all the comprehensive info required to be done during a first visit, which takes an hour - minimum.  That's a total of $480 per year.  That's a lot less than the $1500, PLUS, deductibles we hear about from patients.  We have also created a series of levels of care that we call  the "Chronic Specials."  They are for patients w/ any TWO of the following diseases/conditions - Diabetes, Hypertension, COPD, Asthma, Crohn's disease, Chronic pain.  We have a lot of patients in our panel w/ these issues - principally Diabetes/Hypertension.  These people require a significantly greater amount of time than others, flexibility in when they NEED to be seen & amount of counseling required when they are seen.  The flat monthly rate fits their need to pay & ability to pay for their care. 

The current commercial Insurance & Obamacare inmsurance does NOT help the primary care needs of the population.  Deductibles/co-pays are too high.  Something is needed to fill this gap - & DPC is the ideal concept.  There are several bills in the Federal Gummint right now that are aimed at merging the two concepts by allowing people to buy a "Wrap-Around" catastrophic plan to cover major conditions, " like trauma accidents, cancers, major surgeries, etc.  The programmed concept "Wrapped Around," is DPC.  The major insurance firms could do it right now, but lack the intestinal fortitude to do so.

Check & see if your state permits DPC.  It can save you big dollars in primary care costs.

Also, be glad to answer any questions  - just send them to me.

Donr