My hold time was over 20 minutes when I finally got through to my son's pediatrician office, only to have the human voice I had waited so long for bark at me "Name and date of birth". Many more questions and patient identifiers later, I was allowed to state why I was calling. I had a concern about my son and was asking to be seen that week. Next available appointment with my pediatrician? 4 months. My frustration was through the roof. As both a patient, mother and physician, I was done with health care. When I first learned about direct primary care or DPC in 2013, I thought it was too good to be true. Now, nearly 2 years into my own DPC practice, I realize that it is a little hidden gem that it is making healthcare great again. What do I mean by great? Affordable, transparent pricing, much fewer hassles in setting up appointments or obtaining care, the ease of getting care over the phone or while traveling away, talking to a real person when you call and so much more.
The hashtags #takebackmedicine and #bethechange are seen widely throughout the DPC community as primary care physicians like myself have pushed back against the traditional model of churn and burn that we know doesn’t work and we know isn’t providing the best care for our patients. Whether its pay for performance or a volume driven metric being shoved at us, physicians are tired of being squeezed by third parties from all sides: insurance companies, pharmacy benefit managers, big hospital conglomerates, CMS/Medicare. When you cut these middlemen out of our relationship- the one between doctor and patient- you are left with a simple solution to a problem that gives many worry: how to get good affordable healthcare. DPC is that answer. So what is DPC? Admittedly even though I have been involved with DPC for the past 5 years, my own husband still occasionally has questions, so I realize change takes time for acceptance. However, I would leave the practice of medicine rather than go back “in the system” that I know doesn’t work and can’t work for my patients because it is not physician driven, it is dollar driven and there are too many drivers in the driver’s seat. DPC simply put is a low cost monthly membership fee charged by your doctor that allows the member (you, the patient) to get care from me, the doctor, without the interference of third parties. This means same or next day visits for urgent care problems by a physician who knows you (no 2-hour urgent care wait for a doc in the box or expensive ER visit because it’s 10pm and you need care). This means seeing the same physician every time and me getting to know you and what you need and how you approach your care. This means the same real person picking up the phone when you call. Beyond just great access to care when you need it, it also means saving you lots of money, which often makes that small monthly fee pay for itself. While paying a monthly fee to your doctor is a new concept, it allows me to run the practice with very small overhead and pass on cost savings directly to you. That cost is about $2.46 a day for the average adult and ¢65 cents per day for children under 18.
How can you save with DPC? Well for one, price transparency. I can tell you exactly how much something will cost before you do it, so you can manage your healthcare costs. Need a cholesterol test? $4.44. Need a blood count panel? $1.04. Need a mammogram? $90.
Do you need something expensive like an MRI? You will be surprised to find out they aren’t as expensive as your insurance and hospital conglomerate would have you believe- $295. By the way, a typical hospital charge would be around $3,000 or more so if your deducible is $5000, then that $295 MRI will cost you $3000. Even if your deductible is $500, you’re still overpaying. What if you’ve already met your deductible and you just have to pay your co-insurance rate of 10-15%? Yes, you are still paying the full actual cost and more of the test. In other words, you’re paying 100% of the actual cost plus more. I could on and on (cholesterol medication: $1.93 for 1 month, depression medication: $0.90 for one month, EKG: free in my office, getting stiches: $15 in my office). Hopefully you can see how paying a little up front can save you tons down the road- kind of like how insurance is supposed to work. Best of all, you get the added benefit of being part of a small intimate practice where we know you well and we aren’t too busy to care for you. We do this same price transparency and cost savings for prescription and over the counter medications (a bottle of 100 Tylenol is $0.78). The money you save between labs, imaging and medications more than covers your monthly membership fee. What about people who only come to the doctor once a year or even less and never need any labs, imaging or medications? Those people pay the monthly membership fee as a hedge against not having to access costlier insurance based or emergency room care. If this is you and you still think DPC doesn’t make good economic sense, you are gambling. Even healthy “never get sick” types get sick, get cancer, need stiches or get appendicitis. Believe me, I do this all-day long. You’re worth the $2.46 a day and your kid is worth the ¢65. DPC isn’t the perfect solution in every situation and I acknowledge that, but it is far far better than the alternative: being stuck in a murky, rigid and costly system that is in a death spiral. #Bethechange