Direct Primary Care?

[CBnCO]

I heard one of the doctors at this clinic give an interview and after researching I think this is a great model for health/preventative care. Unfortunately, it seems that the insurance companies and single payer advocates aren't too keen on such a market based solution. As an aside, they advise having a high deductible policy in conjunction with the membership to cover emergencies and more complex problems.

http://atlas.md/wichita/our-fees/

Does anybody here have experience with or opinions on this type of health care?

[ETBen]

I am not a fan of concierge care. It can work and it has its place. But most people are not informed health care consumers. There a lot of factors to consider.  From a market standpoint, there are again a lot of considerations of how much space it should have in the industry.  The average PMPM is about $300-500 including all care and Rx.  Primary care is about 6 cents of the medical dollar. And while its increasingly difficult for PCPs to stay solvent, about 95% of them are run terribly from business standpoint. So a new model isn't necessarily the answer either.

Ultimately, I think its buyer beware.  Know what you're paying for and make sure you have other coverage  should you need it.  And given the state of our flawed payor system, I think its acceptable to say these groups can structure as they see fit and we need to respond as an industry (which isn't what I normally feel about existing regulated markets). 

[CBnCO]

I was researching a little further and found that if you are over 30 there seem to be Affordable Care Act restrictions on buying the over-riding catastrophic plan you would need to supplement a direct care membership.

Also, if I remember from the interview I heard, it seemed like these Primary Care clinics were trying to expand a little beyond what is traditionally considered "primary care". X-rays, prescriptions, phone and e-medicine, etc. I think they make the claim that 85% of medical needs can be handled in such a clinic. Of course, this is not 85% of the cost.

It's definitely a complex system to week through; but, the simplicity of the model itself and value statement certainly caught my attention.

[hops]

Here's more info about Atlas and some of the broader criticisms of concierge healthcare:

http://www.bloomberg.com/news/articles/2012-11-29/is-concierge-medicine-the-future-of-health-care

The people I personally know who are the most interested in it are older and affluent patients, or doctors looking to cash in. It's not anything I'm interested in myself, since I have a great PPO that makes it easy to find accessible physicians I trust, but my health needs are different than most.

[CBnCO]

Thanks for the post. I read this article and it was very informative. I found another trying to make a distinction between "concierge" and "direct" medicine. The implication is the "direct" model is the one cited in the article as the cheaper version of concierge.

I guess my perspective is that ultimately the market would fix the doctor shortage issue (the guy from Atlas claimed he was making $60K more than the average primary practitioner); but, the typical answer from others was to create new government regulations dis-allowing doctors from leaving the current system to go into private/direct business for themselves. I don't think we should shut down new, innovative, and entrepreneurial ideas with prohibitive regulation.

I have an employer sponsored plan for now; but, will keep my eye on direct primary care as I approach ER.

[AtlasMD]

Hello everyone,

My name is Dr Josh and i'm the founder of the AtlasMD Clinic mentioned in the articles. 

I appreciate your conversation and would love to add a few thoughts:

- Yes, its important to make the distinction b/c concierge and dpc
- Our DPC model charges $10-100/pt/month based on age for 24/7 access to your private doctor, unlimited home/work/office/technology visits, no copays, any office procedure is included free of charge, and wholesale pricing/discounts on medicines, labs, imaging, pathology etc for up to 95% savings.
- *free procedures: stitches, biopsies, joint injections, ultrasounds, bone scans (dexas), heart scans (ekgs, holters), lung scans (spirometry), rapid strep testing, urine testing, cryotherapy, lesion removal, minor surgical procedures like toenail removal (approx $500 cost at podiatrist)
- *sample lab prices: CBC $1.69, TSH $2.00, A1C $2.26, PSA $2.30, Lipid Panel $3, CMP $4, etc
- *physicians can dispense medications to their own patients in 44 states like a pharmacy - the DPC model is to charge cost +10%
- *radiology cash prices, $30-40 for xrayx, $100 for ultrasounds, $200 for CTs, $400 for MRI -- avg savings 80%
--We can then take this value and decrease employer premiums by 30-60% = raises for employees.

- Yes the majority of care that patients need is outpatient / primary care
- The majority of our patients are blue collar working folk who NEED the savings ($100/mo on migraine medicine) or who can't leave work to see the doctor but they can call/text/email for free

Thoughts? Happy to answer anything.
Josh

[Goldielocks]

I know quite a few people who are signing up for the Copeman Clinic, here, in Canada, where the doctor and hospital fees are normally paid for through taxes, but not for this.

Having the one to one time, consultation and health team coordination is so worth it for these working persons.
It saves a lot of time for routine check ups, and cuts waiting to get answers for questions.  Doctors that spend time with you instead of a 5 minute consult (which is becoming the norm, here, even with an appointment)

It is over $3000 per year, too.   This makes the $50 per month seem small, that the OP linked to...even though those services are less encompassing...

Check out the link...
http://www.copemanhealthcare.com/health-services/fees/

[JRA64]

I have gotten concierge care for my 88 year old mother. The doctor visits her at home twice a month if she's doing well, and as often as necessary when she is not. He emails or talks on the phone directly with me - I'm not talking with a receptionist telling me I need an appointment to get a basic question answered. Not having to take several hours off of work each time she has an appointment is a lifesaver. And he can spend some time with her. I consider it one of the best decisions I've made in coordinating my mom's care.

[BFGirl]

Do the fees paid for dpc or concierge care count towards the deductible on your insurance? 

[JRA64]

Do the fees paid for dpc or concierge care count towards the deductible on your insurance?

No, they don't. In this case, the time and hassle factor has been worth it. A doctor who will call me back or respond to emails - I've never had that with conventional Western medicine and I've tried with numerous doctors.

For comparison, when I can't get off of work and we pay a home health service to transport Mom to a doctor, the cost of that service (also not deductible as far as I know) is only slightly less than the average cost of a concierge doctor visit.

One of my mom's biggest struggles this year has been with depression. Since he's not limited to a 10 minute visit, and also visits regularly, he has time to listen to stories from her past. Stuff that she doesn't want to share with me, that I don't necessarily want to know. He can address her number one medical problem in a way that the typical primary care doctor who is limited to a 5 or 10 minutes visit cannot.

[BFGirl]

Thanks for the info.  I had considered doing this in the past, as it seems the continuity of and access to care could well be worth the fee.

[CBnCO]

Hello everyone,

My name is Dr Josh and i'm the founder of the AtlasMD Clinic mentioned in the articles. 

I appreciate your conversation and would love to add a few thoughts:

- Yes, its important to make the distinction b/c concierge and dpc
- Our DPC model charges $10-100/pt/month based on age for 24/7 access to your private doctor, unlimited home/work/office/technology visits, no copays, any office procedure is included free of charge, and wholesale pricing/discounts on medicines, labs, imaging, pathology etc for up to 95% savings.
- *free procedures: stitches, biopsies, joint injections, ultrasounds, bone scans (dexas), heart scans (ekgs, holters), lung scans (spirometry), rapid strep testing, urine testing, cryotherapy, lesion removal, minor surgical procedures like toenail removal (approx $500 cost at podiatrist)
- *sample lab prices: CBC $1.69, TSH $2.00, A1C $2.26, PSA $2.30, Lipid Panel $3, CMP $4, etc
- *physicians can dispense medications to their own patients in 44 states like a pharmacy - the DPC model is to charge cost +10%
- *radiology cash prices, $30-40 for xrayx, $100 for ultrasounds, $200 for CTs, $400 for MRI -- avg savings 80%
--We can then take this value and decrease employer premiums by 30-60% = raises for employees.

- Yes the majority of care that patients need is outpatient / primary care
- The majority of our patients are blue collar working folk who NEED the savings ($100/mo on migraine medicine) or who can't leave work to see the doctor but they can call/text/email for free

Thoughts? Happy to answer anything.
Josh

Thanks for posting Dr. Josh. Btw..I heard your interview listening to the Tom Woods podcast show.

I am curious about the catastrophic policy restriction for those over 30 that is part of the ACA. It would seem this would be a barrier to individuals like myself who are over 30 and would need such a policy to take advantage of a Direct program.

We just went through a pregnancy and newborn (3 weeks ago!), which has inherently meant many doctor visits and it was maddening for us that nobody could every tell us what anything would cost. Literally, we would ask and nobody (MD office admins or insurance co) could/would ever tell us an actual dollar amount of what anything would cost in advance. What a crazy system; and, as MMM is largely a community based on financial discipline, I would way not very mustachian!

[Schaefer Light]

Literally, we would ask and nobody (MD office admins or insurance co) could/would ever tell us an actual dollar amount of what anything would cost in advance. What a crazy system; and, as MMM is largely a community based on financial discipline, I would way not very mustachian!

This is what I hate the most about medical care.  They never tell you what anything is going to cost in advance.  You don't find out until you get the bill.  How are we supposed to shop around if we can't compare prices?

[BFGirl]

Literally, we would ask and nobody (MD office admins or insurance co) could/would ever tell us an actual dollar amount of what anything would cost in advance. What a crazy system; and, as MMM is largely a community based on financial discipline, I would way not very mustachian!

This is what I hate the most about medical care.  They never tell you what anything is going to cost in advance.  You don't find out until you get the bill.  How are we supposed to shop around if we can't compare prices?

Even when they tell you the bill and you pay up front, you invariably get bills after because either the insurance company wouldn't pay as much as they estimated or there is some additional charge.

[tipster350]

Most medical services are not commodities and that is why they can't accurately price your medical event. It's not the same as getting a haircut or getting your clothes dry cleaned. There are too many variables and unknowns going in. Services that are predictable, discrete, and controllable are easily priced, such as lab work , are a different story. You really can't shop around for the best price on brain surgery or emergency care.

[BFGirl]

Most medical services are not commodities and that is why they can't accurately price your medical event. It's not the same as getting a haircut or getting your clothes dry cleaned. There are too many variables and unknowns going in. Services that are predictable, discrete, and controllable are easily priced, such as lab work , are a different story. You really can't shop around for the best price on brain surgery or emergency care.

No, but for a routine diagnostic procedure that the medical professionals perform 20 of a day, you should be able to obtain a more accurate estimate and not have to pay an additional $300 afterwards.

[goatmom]

I work at a clinic that is a flat fee per visit.  Patients appreciate knowing how much each visit is going to cost.  They pay cash.  They get pleny of time - they are not rushed in and out.  Most of the people we see are working class people that just want decent health care.