A kinder, gentler health care model?
Direct Primary Care is NOT insurance, but with physician burnout on the rise and patients yearning for more time and attention, it could be a viable option.
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From the pages of In Business magazine.
January marked a career milestone for Nicole Hemkes, M.D. The board-certified family practice doctor opened her new direct primary care clinic, Advocate MD LLC in the Middleton Hills area, as an independent physician. She is one of hundreds of direct primary care doctors around the country who’ve bucked the large health system model in favor of small independent practices not beholden to corporate rules and regulations.
Some consider direct primary care “health care the way it used to be,” and it’s gaining traction, according to Consumer Reports, which included the DPC model in a November article titled “5 Smart Money Moves for 2019.” Around the U.S., CR reports there are about 900 practices serving an estimated 500,000 patients.
It’s critical to understand that direct primary care is health care, NOT health insurance. Patients are strongly advised to carry a separate health insurance plan.
DPC is not a panacea either. Patients electing this model must be prepared to pay out of pocket for any services or tests their DPC physician cannot routinely perform in their office. On the flip side, physicians are in full control of their daily schedule, and patients experience vastly improved access to their doctors.
There are no on-site cost barriers, such as insurance co-pays or co-insurance at check in because office visits are covered by a flat-rate monthly membership agreement. Appointments are scheduled directly with the physician via phone, text, or an email to the doctor.
Routine physicals and office visits are included at no extra charge, and members are not limited to how many times they can see their doctor, whether it’s 300 times a year, or two. Sound too good to be true? We’ll let you decide.
In most cases, direct primary care is a transparent model of health care whereby patients agree to pay a flat monthly fee for 24/7 access to their primary care physicians. Fees increase with age and cover the most common treatments at no extra cost.
Hemkes, for example, has been soliciting new patients online since October. Her monthly fees range between $44 and $111 per month based on age, including physicals or basic services commonly covered by a family doctor. Additional fees may apply for after-hours or house calls, so it’s always best to check first.
Her 2,000–square-foot practice includes a waiting room, two exam rooms, a lab/medication area, kitchen/storage area, and personal office. Hemkes administers care to patients of all ages, including preventive care, treatment of chronic illnesses (e.g. hypertension and diabetes), and also at no extra charge mole-removal, orthopedics/joint injections, and common aches and pains and miseries such as colds and sore throats. “Because of my background in emergency/urgent care, I’m comfortable handling issues of a more urgent nature, too,” she says.
As an independent physician not tied to any clinic or health insurance group, it behooves her to negotiate prices with clinics and laboratories in advance. She also can dispense a variety of common medications from her office at a pre-negotiated rate that she says can be “pennies on the dollar.”
The DPC community argues that by removing barriers like co-pays or co-insurance, they’re offering better health care because patients will be more likely to visit the doctor more regularly if it’s already included in their membership fee. “The DPC model tries to triage things over the phone, too,” she adds. “So if we can comfortably handle a patient concern, great! If I need to see you, we can agree to meet that same night or schedule something the next morning.”
The idea is to lessen referrals to specialists by treating issues before they develop into larger problems. Direct primary care offices may have just one or two employees, including the doctor. Patients needing to schedule an appointment or get a quick callback usually speak directly with the doctor, and if they can’t at that moment, they’ll hear back from the doctor very promptly. “That’s unheard of in today’s world!” Hemkes states.
She believes strongly that patients should have a choice in their health care based both on quality and cost, and there are no pre-existing condition clauses.
“Let’s say we have a nonaffiliated radiology office in town that charges $850 for an MRI, but I know that in Milwaukee that exact test would cost $500. Why shouldn’t I give that information to my patient — in a non-urgent scenario, of course?”
DPC physicians also keep their own patient records and share them as needed. If a patient requires more extensive tests — such as x-rays, cat scans/MRIs, hospitalization, or chemotherapy — Hemkes would refer them to a clinic or hospital as directed by the patient’s own insurance plan.
In light of the nation’s opioid crisis, Hemkes likely won’t be administering chronic pain medication. “Patients should probably see pain clinics for that,” she advises.
After 10 years as a physician, emergency/urgent care doctor, and hospitalist in Chicago, her home state of Florida, and now Madison, she decided it was time for a change. “I think what’s happening around the country is that both physicians and patients are frustrated,” Hemkes states. “Physicians are disillusioned because we’re spending the majority of our time in front of a computer and we’re being told how many patients we need to see and how much time we can devote to each.”
Job satisfaction usually comes down to two things, she explains, including “a feeling of purpose in what you do and autonomy. Autonomy is mostly gone, yet that’s where this profession came from.”