Direct Primary Care, (also known as Retainer Based Medicine, or Private Medicine) is simply a return to the original medical model that existed for thousands of years. In this model, the patient maintains control of their care and is treated as a client and friend rather than “just another patient” of a large HMO or other similar organization. The physician does not work for the insurance company, a large hospital system, or an HMO. Your doctor works for only one person…YOU!
Consequently our success and satisfaction is directly tied to yours rather than the volume of patients we see in a day. We are genuinely dedicated to helping you achieve optimal health. Since we do not accept insurance, our overhead is kept low, we don’t have to get permission to do what we feel is appropriate and there are no delays waiting for insurance approval. Additionally, our total patient enrollment is very small by today’s standards. This allows our total investment in YOU, our patient. Simply put, Direct Primary Care is all about YOU…YOUR time, YOUR health, and YOUR convenience.
Starting in the 1960s with Managed Care and other efforts to control healthcare costs imposed by the government the healthcare system has developed into a massive machine dominated by insurance companies, bureaucrats and large healthcare systems. In this model, the Patient ultimately gets lost and the Doctor becomes increasingly frustrated by their inability to provide effective care for his or her patients in a 7-10 minute office visit (the national average). In effect, the only relationship that matters, the Patient’s relationship with their Doctor, becomes more of an afterthought as efficiency and profit lead to patients being “herded” into “cookie cutter” care plans.
The reality is that all patients are different and have unique medical challenges and health goals with equally unique solutions. Additionally, the elusive goal of “Preventative Care” is almost impossible in our current system where the average primary care physician has 2,000 – 5,000 patients assigned to them and often see more than 35 patients daily. With such a schedule, most physicians can barely keep up with fixing problems once they arise rather than preventing their occurrence in the first place.
Not many years ago, patients saw any doctor they chose. They could call their doctor’s office and be recognized simply by their voice. One could expect to call and speak to their doctor at almost any hour of the day or night or might just catch them in passing at the grocery store and be instantly recognized. If they needed a specialist referral they could be certain that a direct conversation between their doctor and the specialist would occur. Not only did one’s doctor know them, but he or she most likely knew the entire family, and with it the patient’s entire medical history. If someone was away from home and had an urgent medical need or question, their doctor was only a phone call away and was ALWAYS available when needed. For their services, doctors would charge a reasonable fee (or in some cases a chicken) paid directly from the patient.
The problem started with what seemed like a good idea: medical insurance. Initially, the physician would still bill the patient and the patient would then be “reimbursed” by their insurance company. Over time insurance companies and large health-care systems realized they could increase profits by directly hiring the doctors and then managing the doctor-patient relationship. This alters the patient-physician relationship by placing a business between them.
Through their employers, insurance companies enrolled huge numbers of patients then used these patients as a “carrot” to contract with doctors. Since filing for reimbursement was complicated for patients, they required physicians to bill the insurance company directly and completely removed the patient from the financial picture. At first, this seemed like a win-win for patients and doctors. Unfortunately, the “stick” was that to make profit, the insurance companies consistently increased the number of patients assigned to contracted doctors, thereby decreasing the personal care (time with your doctor).
Naturally, this resulted in physicians being burdened with massive patient volumes for which they were paid increasingly less. Eventually, not only the care provided, but also the cost for that care, was being driven by the medical industry instead of by patients and their doctors. While efficient and profitable for the health care industry, this model was detrimental to patient satisfaction, physician satisfaction, and patient care. Additionally, through a complicated pricing “arms race” the cost of health care has skyrocketed out of control. The ultimate outcome is that patients are paying much more and receiving much less. It is estimated that $.40 of ever dollar collected by the physician goes straight to the overhead related to billing insurance and government payors.
The Solution… Back to the Basics!
This “new model” of caring for patients, called “Direct Primary Care” is not new at all, and it is not, as the name implies, frivolous luxury for the wealthy. It is simply a return to the important relationship between patient and physician – in the modern world of technology and medical knowledge.
With Direct Primary Care you CAN once again KNOW your doctor and they can know YOU! By eliminating the insurance companies, the patient/physician team is in control. You can always seek reimbursement by your insurance for services provided in our office [We provide a superbill which you can use for reimbursement. (This does not apply for Medicare/Medicaid)], Either way, everything done within our office is covered by an annual retainer fee.
Recent studies show that this model is not only improving patient satisfaction, but that it is having a dramatic effect on patients’ health outcomes in the form of fewer ER visits, fewer medications, fewer redundant testing, fewer hospitalizations, and fewer readmissions to the hospital following discharge. A recent study comparing patients of retainer based practices v. those in a traditional fee-for-service practice found that the former saved about $2,000 per year on total health care spending even though they were paying a monthly retainer fee regardless of whether or not care was actually needed!
The American Journal of Managed Care published a study in 2012 of a group of Direct Primary Care patients and found a 79% reduction in hospital admissions for medicare aged patients, and a 72% decrease in hospitalizations for privately insured patients between ages 35-64 enrolled in Direct Primary Care practices. Additionally, readmission rates for diagnoses such as heart failure, myocardial infarction, and pneumonia were only 2% in Direct Primary Care patients compared to the national average of 16-24% for the same diagnoses.
Financially, these patients in the Direct Primary Care practice study group alone saved themselves and the healthcare system $300 million in a single year. Not to mention they were healthier and enjoyed a better quality of life. It’s amazing what can be accomplished when the patient and their doctor are able to work together to optimize their health and wellness.
Our goal is to add life to your years and years to your life!