Is Direct Primary Care right for you?
How does direct primary care work?
You pay a monthly membership fee — typically $40 to $100. In exchange, you get a more generous allocation of appointments, the same day or the day after you called. Appointments last longer than the average seven minutes per insurance-based visit. The doctors are accessible via phone or secure patient portal email and may even make house calls. There are no additional copays. Basic tests and procedures are included, if not covered by insurance. Privately insured patients may seek reimbursement for such costs on their own by asking for an insurance submission form, for a small fee.
Physicians and researchers cite three reasons — but all relate to one thing: insurance is not now paying for many undeductable costs and the time consuming hassles of dealing with insurance for both patients and primary care doctors.
Money: Under the traditional system, most medical practices need a large staff to ensure that they are reimbursed by health insurers. This results in higher overhead — which eats up to 60 percent of a typical practice’s revenue — and forces doctors to see more patients in order to cover costs. At the same time, insurance reimbursements to physicians have decreased in recent years. “Most estimates show that a medical practice spends 30 percent or more of its time and money just trying to collect payments from insurance companies,” says Ryan Neuhofel, D.O. who operates a pay-as-you-go family medicine practice in Lawrence, Kan., consisting of himself and a nurse.” And when we’re taking notes about patient visits or care, it’s mostly about checking off boxes to satisfy insurance requirements.”
Freedom: To get reimbursed, insurers may dictate how doctors must treat each patient based on their concern. “Sometimes, in order to get paid — and meet the insurance metrics model — a doctor must make you come in to order a test, refer the patient to a specialist or prescribe medication,” says researcher Dave Chase. “Communication with patients is their most valuable tool, but they know that if they get into detailed discussions, it blows their productivity numbers.”
Better care for patients: Without insurance mandates, doctors treat patients as they deem fit. The membership model provides a steady income, allowing doctors to see fewer patients each day — and therefore freeing the doctors to spend more time with each.