Direct Primary Care as an alternative Payment Plan

Our health system has grown into a size that is no longer self supporting. Most of our care is in an outpatient setting which should be very inexpensive The chart below displays the huge diifferences in cost.  Just by eliminating the administrative positions in an office decreases overhead by 50% or more

Paul Thomas MD, physician-owner of Plum Health, a DPC practice in inner-city Detroit understands the needs of economically disadvantaged patients. “I intentionally selected a health professional shortage area as a place to start and grow my medical practice,” he says. “I believe that the DPC model gets us closer to the goal of truly affordable health care for our patients and communities.”

But DPC practices don’t just serve patients in inner-cities and suburbia. Donna Givens, MD, is the physician-owner of Grant’s Pass Family Medicine in rural Oregon. “Most of my patients are in the gap between qualifying for Medicaid and being able to afford insurance,” she says.

DPC practices can also provide a safety net for minority patients. Belen Amat, MD, the owner of Direct Primary Care of West Michigan, estimates that 70 percent of her patients are primarily Spanish-speaking.

Across this country, DPC practices are filling an important niche by providing care for underserved patients. But rather than indenturing themselves to a government or corporate entity, physician-owners of DPC practices are providing care on their own terms, without bureaucratic headaches and red-tape frustrations.

Direct care cuts out third-party payers like Medicare, Medicaid, and insurance companies. Instead, patients pay the doctor directly, usually through a monthly fee, which averages $77 for DPC practices.

Because direct care doctors are not beholden to the insurance company, they spend less time on unnecessary documentation and more time on patients. And because doctors don’t have to spend a fortune trying to get paid by an insurer, they can often keep their overhead remarkably low, passing savings along to patients.

It is easy to criticize a new model if you don’t really understand what DPC doctors do. The Journal of the American Medical Association (JAMA) argued that DPC is structurally flawed, in that it incentivizes physicians to accept healthier patients.

But this argument does not match with the reality that many DPC practices experience. In my practice, most patients have multiple chronic illnesses — the very reason they see the benefit in paying a monthly membership for care. New patients have sometimes been without health care and off medicines for months to years, and require frequent visits to get stabilized.

And many times, rather than being “cherry-picked,” patients come to DPC practices because they have been dismissed from conventional practices. For example, Tiffany Blythe, DO, the owner of Blue Lotus Family Medicine in Kansas City, will accept unvaccinated children who are often unwelcomed into other doctors’ offices. “I’ve found that many anti-vax parents really are trying to do the best they can for their child. They just need education, patience, and support to find their way.” And with the additional time that DPC offers, Blythe has been able to convince some parents to vaccinate their children ultimately. “It takes time to overcome fear with facts,” she notes.

In my practice, I have several patients who were dismissed from their regular doctors. One 80-year-old Medicare patient came to me tearfully with a dismissal letter from her previous doctor in hand. She was “fired” from the practice, she said because she refused to talk to a chronic care coordinator. “I was just tired of them bugging me all the time,” she told me. “They kept calling me, and a nurse would come to my house and tell me the same things my doctor did.”

If you talk to DPC doctors, you will hear many stories like these. Inspirational stories not only of patients accessing affordable, quality health care but also of physicians who are happy to practice medicine again.

DPC offers an alternative practice model for doctors to regain the joy in practicing medicine. When medical students and residents hear DPC doctors talk, they get inspired to practice primary care. And studies are clear: more primary care docs equal better health care across populations.

Affordable care, better patient experiences, better patient outcomes, and physician well-being: the quadruple aim. And this is exactly what direct primary care provides.

PLUM HEALTH BENEFITS

• A direct relationship with your doctor
• Fewer patients = more time with your doctor
• Your health and wellness are the priority
• Call us at any time, email us, or text us
• Save hundreds on labs, imaging, and prescription meds
• Clear and consistent pricing
• Peace of mind

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  Direct Payment

Insurance Plan

     The difference in cost is huge. These differences only apply to outpatient vs Hospital Cost.  Hospital charges are difficult to analyze and are maximized because of the manner in which insurance companies reimburse them.                                                                                                                                                                                                                                                                                                

CONVENTIONAL HEALTHCARE

• Rushed appointments
• Doctor's have thousands of patients = less time
• Sometimes you'll have to see a mid-level provider
• Only available during business hours, typically 9 - 5
• 2-10x markup on labs and services
• Services billed at the highest rate possible in order to maximize reimbursement from your insurance company

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Pamela Wibble, MD started the Ideal Medical Clinic in Oregon some years ago before anyone knew what Direct Primary Model even existed. Dr Wibble created this practice model because of her own personal experiences with physician suicide. Many physicians 'burn out' because of the moral conflict between the Hippocratic Oath and the necessity of economic realism.