DPC patients pay a monthly/quarterly/semiannual/annual fee that allows direct, full access to their primary care physician. We still encourage patients to carry insurance for catastrophic events such as hospitalizations, surgeries, unforeseen ER visits and specialty care. However for most people the majority of their health care needs are done through their PCP (office visits, labs, imaging, etc) along with occasional expenditures on specialists, ER visits, urgent care visits, etc.
For the typical high deductible health insurance plan, a patient has to pay 100% of their health care expenditures up to a set deductible of $1000-$5000 or more. For a family, this can be significantly more. Every office visit, lab, imaging test or procedure the patient will pay for the entire cost until that deductible is met. The advantages of a high deductible plan is that the biweekly/monthly premiums are lower than a typical PPO and participants can use a health savings account (HSA).
However, when charges for services such as labs or imaging are run through insurance, a patient will pay a significantly higher amount than if the patient were to pay for that service on a cash basis. And the bill will typically come 1-3 months after the service is performed. This can lead to significant confusion with the patient who may not even remember having that service performed, and yet they have a bill that can be significant. Many people will rationalize cost by saying “well, at least that goes towards my deductible.”
As an example, if a brain MRI with and without contrast is ordered at a hospital imaging center and run through insurance, the insurance company first questions the doctor about whether this is an appropriate tests (in other words they don’t want to pay for an expensive test). Many times they will deny this outright, causing the provider to spend a significant amount time trying to convince the insurance company to approve the test. If the test is ultimately approved, and MRI is done…great! Right? Well on the back end, the patient who has a high deductible plan will get a bill several months later for somewhere around $2000. If the deductible has not been met, then the patient pays that through their HSA fully 100%. “Well at least that goes towards my deductible…” Ummmm, sure…
The advantages of DPC are that prices are open and transparent. The monthly fees are set, and the cash lab and imaging prices are significantly lower than running those through insurance and those can all be paid through an HSA (those just won’t go towards a deductible and that deductible likely won’t be met anyway). Around Omaha, the cash pay price for that same MRI is about $425.
Lastly the monthly fees for my new clinic are $30 for children to 18 years old, $100 for those 19-64 and $125 for those 65 and over. A couple will pay $175, and a family will pay no more than $250 per month. These monthly, recurring fees allow us to focus on improving access to quality care when and where it needed the most. Since I will be in control of scheduling patients, I will be able to give each person the most appropriate amount of time (I usually have a good idea how much time is needed for a particular problem or set of problems whereas a scheduler in most other clinics do not have that knowledge). I can also see patients much more quickly if they call in needing to be seen more urgently. If someone calls in saying they have an acute issue, more than likely we will be able to get them in the same day or next day. I would also have the option to do home visits if that is deemed necessary. Insurance companies do not reimburse phone calls, text messages or other types of communication that could be used in evaluating someone. Not all problems require an office visit—some can be handled by a short call, text message or email. But in the current insurance driven world, these are not reimbursable, so this drives the provider to automatically say that someone needs to be seen in the office, which increases costs and cuts out time that could have been saved for someone who really needed to be physically evaluated.
I currently have approximately 2500 patients at Maple Hills. This is about the average for most primary care physicians. I believe this is too many because the more people we take care of, the less time we have with each person, and each person has a more difficult time getting seen in a timely manner. The less time we have with each person, the quality of care suffers, and ultimately this can negatively affect patients’ health.
At Good Life Medicine DPC, I will likely limit my patient panel to about 600 patients. This will allow greater amount of time with each patient and allow us to see patients as much as we need. If you are interested in seeing me at Good Life Medicine DPC, you can sign up online or call if you are interested. I’d love to see you!
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