Category: Direct Primary Care
Save the Foundation of Healthcare…..Please Shop Local and Help Pave a New Path
I am not writing about Covid-19 to make it a political issue (it’s not), to discuss what we should have and could have done better (hindsight is 20-20), nor am I writing about it to discuss all the fatalities and lives that have been adversely affected by it. It has been devastating for many people of all walks of life in so many ways- death, isolation, loss of income/jobs, loss of savings, etc etc. All these facts are known. The reason I am writing on Covid-19 is to try to see the hope in the devastation that it has caused. We as a society have a chance to better for ourselves and our children. We have seen the best and the worst of our society during the past few months. My hope is that we can be better to each other and for each other- learn how to meet in the middle on all issues, treat each other with respect, and have dialogue that may never end in an agreement, but that ends in mutually respectful disagreement with all parties learning something from one another. One of my favorite quotes is from Ayn Rand, who is admittedly a polarizing writer and thinker herself, but nails it with this one. “When I disagree with a rational man, I let reality be our final arbiter; if I am right, he will learn; if I am wrong, I will; one of us will win, but both will profit.”
With that being said, one thing I hope we can all agree on is that this pandemic has exposed the best of our healthcare system- the doctors, nurses, therapists, CNA’s, janitors, cafeteria workers, maintenance workers, etc that have kept hospitals/ERs operating like well-oiled machines so that people could be treated to the best of their ability, even while putting themselves and their families at risk by working every day with a lack of adequate PPE and support. Many have actually died themselves which I am pretty sure is not part of the Hippocratic Oath, yet they went to work because medicine is a calling not a job. Another aspect I hope we can all agree on is that the pandemic also exposed every aspect of our healthcare system that sucks. We are fragmented, the clinical staff of all ilks are underpaid and undervalued, we are overly expensive, and we are always reactive to everything rather than proactive. Ultimately, we don’t have a healthcare system, but rather sadly a “sick care” system. Being proactive, working to prevent chronic disease, and staying healthy are sadly not profitable nor “sexy”. Filling hospital beds, MRI machines, specialists offices, prescribing expensive drugs, and DOING more TO people rather than less are. Yet there is hope. We have an opportunity to rebuild a healthcare system that our children and grandchildren and generations following them deserve. We need this, but the question is do we want it badly enough? Do we really really want it? If you think we do then keep reading and ask yourself this- if given 5-10 million dollars to build a brand-spanking new ocean side mansion would you put it on top of a leaky, cracking, termite-ridden foundation?
My guess is that your response is a big fat NO. So now ask yourself why in gods name are we doing that in healthcare? Why have we devalued primary care to 7 cents of the dollar and a minute fraction of the spend from public payers like Medicaid and Medicare, from private insurers like BCBS etc, right down to the public itself that believes real primary care can be done well at a drive through clinic? In a ten minute visit? Costs nothing more than a 20-30 dollar copay? Can be done well by any Tom, Dick, Jane, or Harry with a white coat and initials after their name?! And these beliefs are mostly not the fault of you, the general public, as you have been brainwashed and trained over decades by the rulemakers- pharma, insurance lobby and bureaucrats- to believe them. If you do not believe this fact here is a reference: https://www.benefitspro.com/2019/07/26/u-s-spending-less-than-other-countries-on-primary-care/?slreturn=20200428161727 No wonder why our system is not affordable, easily accessible, and navigable?! Yet we- patients and doctors- can fix it. Let me restate that…it is UP TO US TO FIX IT!!!. From the bottom up, we can rebuild a system that works for us. We can be the rule makers. This is our chance for once and for all to stop relying on the wrong rule makers to fix it. As a dear friend and benefits advisor says “you can never win a game where the opposing coach and the referee are the same person. This is how we do it….
This article below was published in STAT news today and discussed how “Covid-19 has devastated independent primary care practices.” Well guess what? It isn’t Covid-19 that devastated it. It is the screwed up, inefficient, overly expensive way that we- or in most cases the way third parties like government, insurers, and self insured companies pay for it- and those dollars all come indirectly from working peoples pockets at hugely jacked up rates! It is what triggered me to write this post and urge people to help us rise like a phoenix from the ashes of this unfortunate nightmare that Covid -19 did nothing except shine a light on. https://www.statnews.com/2020/05/28/covid-19-battering-independent-physician-practices/?fbclid=IwAR17jbNkb02eHKZ0NKHh1Ue_3UiETM9PBsgfB87vSnE853nloCODjmKgk-k
So it is time we s&*t or get off the pot. For five years myself and many other primary care doctors across the country have felt like we are moving a whole beach by ourselves. We need help. We need the public to grab a pail and start moving some sand along with us, because it’s the wet, dirty heavy sand of the Northeast, and not the light, fluffy white sand of the Caribbean. NEWS FLASH! No one else is going to do it for you and if we continue to try to do it on our own we will burn out and fade away (which is already happening at alarming rates). Sorry but thats the reality. A contractor friend of mine says that a foundation of an average home is about 15-20% of the spend. Imagine if we did that for primary care in the US? Imagine insurance premiums that do not cost a mortgage? Imagine transparent, affordable care delivered to you the way you want with a doctor of your choice? All for less than 3-4 dollars a day? One can only dream. We all want change, but we often resist the path to change. Why? Because its freaking hard! So here is my call to action: grab your pail(s), walk with your feet, speak with your words and your wallets (and if you truly can not afford an average of 70 dollars a month for unlimited primary care, discount labs, imaging, meds telehealth visits- yeah hey policymakers/insurers us DPC docs have been doing them all included for 5-10 years so welcome to the 21st century- call your elected officials and demand a health savings account funded with money based on need to use toward primary care with Medicare and medicaid to cover all that happens outside of it). Stop using insurance like a credit card for stuff that doesn’t cost as much as a sandwich. It makes no sense. Join a DPC practice, or at a minimum, use an independent primary care practice that is not owned by an unchained Goliath- aka major hospital system. If you do not like the beast and hate what it has done to you and your income, be a David. Help us starve it until it dies. Find something positive out of the Covid-19 pandemic and act on it. Do it for those we have lost and for our children and grandchildren who did nothing to inherit the ashes of the Goliath that now rest upon the beach we all want. Or please….DO NOT complain. Take the PATH less traveled: https://dpcalliance.org/dpc-path. You may enjoy the hike. If not, I’m sure the cartel of “rule makers” will be there waiting to pull you right back in. “Where’s the tylenol?”
Seems That Amazon Likes DPC.
This article by Lydia Ramsey was published in todays Business Insider- Employers Could Use Direct Primary Care – and features our friends and colleagues Dr. Vance Lassey from Holton Direct Care in Holton KS as well as Dr. Kim Corba from Green Hills Direct Family Care in Allentown PA. The article discusses how the big three of Jeff Bezos from Amazon, Warren Buffett from Berkshire Hathaway, and Jamie Dimon from JPMorgan have announced that they are trying to fix our healthcare system Amazon, Berkshire Hathaway and JPMorgan Team Up to Try to Disrupt Health Care and they seem to be looking at using Direct Primary Care to build a solid foundation of affordable primary care for their employees. All of those questions from skeptics that I have been repeatedly asked over the past three years such as “why don’t you take insurance?”, “why should I pay twice for healthcare?” “why should I self-fund?” etc etc. are now being answered by people that have a lot more money and clout than I do. My hope is that maybe now people will not only start following, but also start teaming with a group of renegade primary care doctors across the country that have been doing this model for the last decade because they had enough of the “healthcare cartel.” If you use Amazon maybe you should also consider using a DPC doc.
An Uproar in the Land of the GIC
I know it has been a while since I have written anything, but it has been a bit since I have seen something that has really driven me to write about. Yesterday I happened to see an article that was in the Boston Business Journal regarding health insurance options for our state employees that are on GIC plans- police, fire, DPW, teachers, etc. The following is a link to a free version by Martha Bebinger at WBUR Major Mass. Insurers Dropped From State Employee Health System. The three major players that are now out are Tufts, Harvard Pilgrim, and Fallon. What I find interesting about this change is that the GIC is quoted in the article are saying that “moving members to a more limited, less expensive number of insurance plans will save the state $20.8 million in the next fiscal year with little disruption.” I am very curious to see what these premiums will look like to our valued state employees. As a self-employed business owner I had to do my renewal by January 1st and by choosing Tufts Direct I was not only able to have great hospitals like Lahey and Tufts Medical Center in the network, but also saved $400 a month in premium compared to a similarly structured plan (i.e. same deductibles etc) with Neighborhood Health Plan that is owned by Partners. So again, I am curious to see where the costs savings will be? I highly doubt it will be to the employees.
See the issue here is that no one is actually addressing the cost of health”care” and only focusing on the cost of insuring it. The public has been led to believe that everything in “healthcare” is so expensive that we need a prepaid “insurance card”- one with a very large finance charge while we are at it- so we don’t go broke. The irony is that it is the actual cost of insuring everything under the sun that is making people go broke. So employers- including the state government- have only two options to keep their spend under control: 1. transfer more cost to employees by raising out of pockets such as deductibles/copays/coinsurance and 2. limiting the network of hospitals/doctors employees can use with restrictive HMO-type plans. (As already mentioned, given that one of the options left here is NHP is quite strange given that Partners hospitals/practices are much more expensive but let us wait and see what the premiums are.) As a result of union leaders not wanting to see their employees carry huge out of pocket responsibilities such as deductibles and the like, what other options does the state have? When you expect a third party to cover 90-95% of your care this is what will happen. You lose money and the freedom to choose.
So my question to all GIC beneficiaries is do you really think your employer and the insurance carriers they are choosing are going to help address this cost equation for YOU? Are they providing the actual care you receive? No they are not , but they are determining where you can and can not get it from. So speak up! I lost a lot of you as valued patients when I stopped taking your “payment/insurance card” and instead wanted to be paid directly by you for all your primary care at a reasonable monthly fee that averages out to $75 a month. Sadly what you did not see is how on your side I was and continue to be. Your choices of payment cards are now fewer and fewer and my educated guess is that it will cost you more to carry the card(s) offered to you and fewer places where you can actually use them. So why not grab your local DPC doctor as an ally so that we can fight this fight together and get more options for you- like say a higher deductible plan that works like real insurance by covering major expensive medical care not the affordable part like primary care (lower premium) and combine it with a Direct Primary Care option. The only way we fix this system and the cost to you and the taxpayers of Massachusetts is to disrupt it from the ground up instead of letting policymakers do it for you from the top down. If you need more proof or evidence that it works look at what my colleague Dr. Rushika Fernandopulle has done at Iora Health in Boston for GIC members on Unicare: Iora Health and GIC Combine to Offer DPC to Unicare Enrollees. Why doesn’t NHP, Tufts, and HPHC offer the same? Hmmm. Also look at what Union County in North Carolina has saved offering DPC to their county employees! And this is with only 40% enrolled in the high decutible/DPC plan! Direct Care Helping North Carolina Public Sector Save Big On Health Care Claims. If you’re really bored but truly want to see how this worked in North Carolina watch this video. It includes my fellow DPC colleague and friend Dr Amy Walsh. It may be an hour but it is well worth it in my opinion.
I am willing to speak with any town administrator, union leader, state official you would like. Just ask them to schedule a meeting. You, that provide our communities with so much service, deserve much much more when it comes to your coverage and your care. Remember, they are usually not the same. Thanks for listening.
A Leap of Truth
This is dedicated to all of those on the precipice of choosing between your norm versus your actual truth. Not who you project but who you are when no one else is looking.
People often use the term “Leap of Faith” in their motivational language. Wikipedia defines a leap of faith as “an act of believing in or attempting something whose existence or outcome cannot be proved.”
Well I would like to coin a new term- a Leap of Truth. This is an act of believing in or attempting something whose existence or outcome can be or may already be proven, but one is too damn scared to admit it and step toward it. People often ask me what led me to take such a huge risk by leaving a very well paying job as a primary care physician working for one of the “best” hospital systems in the country. The answer is very simple- I took a leap of truth. I knew from the moment I filled out a coding/billing form in my residency clinic after seeing ten patients in one half-day session that this type of primary care medicine was not going to be my truth. For nine to ten years or so I struggled to put my truth into words- never mind being close to putting it into action. I could not even define it…yet. I just knew that 10 minute visit, impersonal assembly line medicine was not going to fit in the definition. I knew that spending a majority of my day trying to prove my worth to some 3rd party insurer or government agency was not going to be part of it either. I just wanted to do what I dedicated my education and life to- taking care of my patients to the best of my ability. Everything else was just useless.
So one winter night in December 2013 I was sitting on my iPad trying to figure out Twitter. After being on there for ten minutes or so, someone I followed retweeted a tweet from Dr. Josh Umbehr at AtlasMD in Wichita KS. It read something like this: “Imitrex injection for migraines 200 and something dollars in local ER. $9.10 in our clinic. #DPC” So I said to myself “what the hell is DPC and why I have I never heard of it?” Within 5 minutes I hit reply all and asked exactly that. Within minutes Josh messaged back and said he would be happy to set up a call so that I could learn more. So that next night I sat on a call with him and realized I was getting closer to defining my truth. My truth was and is Direct Primary Care. After researching the model and the labyrinth that we call American health policy for almost a year, I knew that I had to leave my norm and take a Leap of Truth.
Of course I had a lot of doubters, naysayers, skeptics and flat-out demoralizers tell me I was going to fail. Some of my favorites were “This isn’t Kansas…this is Massachusetts” and “This will never work in Massachusetts.” My all time favorite was when i told an elderly patient- one who had just switched to me after his prior doctor of 20 or so years had retired- that I too was leaving. As an employed doctor I was not allowed to do this, but I felt that it was the appropriate and right thing to tell him given his age and uncertainty in regards to his future care. So I explained the model of DPC and told him he was more than welcome to come with me if he so desired. His response upon learning I wanted to work for cash rather than government/insurers was “what are you some kind of greedy Jew or something?” You can not make this stuff up. My response was with a chuckle as I said “yeah I guess if you believe taking the biggest professional risk of my life and putting myself into a mountain of debt to do it defines a greedy Jew, then yeah I am a greedy Jew through and through and proud of it.” Needless to say, but this kind gentleman among many others did not come with me to my new practice. However, I persisted walking through the mire because I knew in my heart it was the right thing, regardless of what others had to say.
Those months from April of 2014 to December 2014 were some of the hardest months of my life. I was basically working two jobs. I was seeing a full load of patients act my old job and meanwhile trying to build a new practice. God only knows what my blood pressure was during those months, but I look back with not one regret. Sometimes doing the right thing is just really freakin hard, but once you find your truth you will find that there is nothing more comfortable….not even the norm you have grown so accustomed to.
My favorite television show of all time is Lost. Yes, some people hated it and some people loved it, but few were in between. The irony of this is that the whole series was really about the “in-between”- science vs faith, reality vs destiny, life vs death. It wasn’t about polar bears being on a tropical island. I have attached a video clip that shows the ongoing debate on the show between Jack Shephard as a man of science and John Locke as a man of faith. (Sorry for the length and ad that pops up in the middle.) So I guess the message here is that there is something between faith and science and between life and death, but it does not have to be a painful purgatory. It can be a truth in which you find peace. Do not settle for being a slave or pawn to the “system”. You put yourself through college, medical school, residency, debt, etc etc. When you think about the doctor you are vs the doctor you hoped to be you may realize that the truth is somewhere in the middle. So stop looking at DPC or some other career change as a Leap of Faith, but look at it rather as a Leap of Truth- your truth and only yours. No one can take that away from you no matter how hard they may try.
To Teach Is To Learn
Last week I was notified of an incredible honor. I received a citation of excellence in teaching along with 11 other clinical faculty in Family Medicine by the Tufts University School of Medicine 3rd year students. I am pretty sure this recognition does not come with a check, a free car, or a safari adventure but it means a heck of a lot more to me than any of those items. I would not be a physician today without the many incredible teachers I have had- from kindergarten through high school, college, medical school, residency, and clinical practice. There have been a few duds along the way, and not because they were not knowledgable, but moreso because they just seemed disengaged and unhappy teaching. Sadly a few of these duds were in medical school and unfortunately they had no idea the negative influence they had on me. One of them actually drove me away from the field of medicine that I was originally interested in pursuing. So I promised myself back then that I would never treat students that way if I ever had the opportunity to teach. I have only strived to have a positive influence on my students regardless of the field of medicine they choose. And now, by exposing them to Direct Primary Care, I hope they might realize that there is a future in primary care besides the current option of being an employed physician. However , what I did not realize when I first started teaching about ten years ago, was the incredible influence they would have on me.
Over the years, my students have reminded me of why I chose to pursue a career in medicine in the first place- particularly primary care. I see their thirst for knowledge, their drive to try to know everything, their passion to care for people, and their desire to impress me. I often chuckle on the inside when I give them a project or something to look up and they think its just a routine assignment I have given them, when in reality, it is solely so I can learn a new topic/disease or relearn an old topic/disease I have not seen in years. They keep me on my toes and challenge me to be a better educator, doctor, and person in general. They make me realize how under-appreciated primary care is as 6 week rotations do not even scratch the surface of the knowledge base that is needed to do this job well. One of the joys of medicine is that every day is a learning experience, and my students just enhance it and make it that much more enjoyable.
So, as my children finish 1st grade today (with perfect report cards I may add) I thought it would be apropos to write something that shows my appreciation for all the teachers out there, and for the students that remind us teachers that we too are still all students.
PS. Thank you to Tufts Medical School for allowing me to teach and for this incredible honor.
While Congress Fiddles, Patients Lose Patience
Published in the Boston Business Journal April 7, 2017:
The longer Republicans debate and dissect the Affordable Care Act, the more people are turning to Direct Primary Care (DPC) physicians. Unlike the recently proposed American Health Care Act — and the Affordable Care Act it is seeking to replace — direct primary care is both affordable and easy to understand.
The rising popularity of DPC practices in Massachusetts and in more than half the states where it is being practiced is in stark contrast to the utter confusion and fear that has ensued since Congress and White House set out to repeal Obamacare. A health care system once focused on prevention has given way to expensive intervention and specialty care. Experts disagree on how to fix our health care system, but it is well understood that what has been driving up the cost of health care are prescription drugs, overutilization of our hospital emergency rooms for non-emergency primary care, escalating prices for medical procedures, and unnecessary diagnostic tests. What patients — and doctors — need from our health care system is simplicity. Think of how we use car insurance to protect us from personal injury and car damage — not for the replacement of tires or windshield-wiper blades. We shouldn’t use health insurance for routine primary care.
Rebuilding the primary care foundation of our health care system won’t fix all of what is ailing health care, but it would reset a system that now largely benefits the insurance industry and pharmaceutical companies. A study by the health policy journal Health Affairs found that a direct primary care practice they studied was nearly half the cost to the patient when they purchased a lower-premium, higher-deductible insurance plan. A 53-year-old man who would have paid $11,068 for a one-year $1,000 deductible plan instead bought a higher-deductible plan and cut his health care costs by more than $4,000 annually — and he actually spent more time with his physician.
During the course of an appointment that is typically an hour or longer, DPC physicians can figure out why a patient hasn’t been sleeping rather than just writing them a prescription and dashing off to the next 12- minute appointment. We get to know our patients, their diet, whether they are exercising. That consultative relationship is critical to prevention of future and expensive illnesses such as heart disease, cancer and diabetes. Direct primary care physicians aren’t necessarily better doctors — we just spend the time that it takes to be a good doctor and actually listen to our patients. But you can’t fix what you don’t have the time to see or hear.
DPC, The Netflix of Healthcare
When is the last time you went to a Blockbuster Video store on a Friday night to peruse the shelves for a rental? Yup, almost ten years ago. The key question is why is it extinct? There are many obvious reasons- inconvenience of having to go search the shelves, finding out the movie you want is out, and the most obvious is innovative disruption by companies like Netflix and Amazon (see article from Forbes below).
The key component of the decline of Blockbuster Video/On Demand and the rise of Netflix is what network scientists refer to as the “threshold model of collective behavior.” In other words, this is how innovation takes hold and finds success in society whereas other products/concepts fail and drift away because they do not keep up and change to meet the needs of the consumers of the service. Blockbuster tried to adapt but it was too late. It dropped its late fees- which was their key to profitability- and spent approximately 400 million dollars instead. All the while Netflix was charging an affordable monthly fee, could deliver DVD’s to your door, and figured out how to stream content. And even though their library was not as extensive, their affordability and no hassle service made them what they are today.
So what in gods name does this have to do with me? Well, I think it is pretty obvious. The Direct Primary Care model is the Netflix of Medicine. You pay less than a coffee a day, or less than an average cable/cell phone bill a month, so that you can receive primary medical care the way it was and should be delivered. It is easy, accessible, transparent, dependable, and personalized. We bring care to you not vice versa. There may be a month when you stream ten different TV shows or movies (not speaking for myself of course) or there may be a month when you watch none, but Netflix is always there. DPC is the same, and more importantly, there is a personal relationship and level of trust that is built to help you stay healthy, be accessible when you’re sick and need care, and more importantly help guide you through the tangled web of the US Healthcare/Insurance system.
The current system of insurance-based primary care requires in person visits for all care in order to bill your insurance – even for matters that could be handled remotely with a quick phone call, text message, or Skype session. This same in person care requires copays/deductibles for each visit, provides a maximum of 10-15 minutes with your doctor on a good day, and is inflexible to scheduling around your personal life. Also, with more and more people on high deductible health plans cost is being shifted onto patients. How do you shop for elective, outpatient care like labs and imaging studies in a system of zero transparency? How, in a country as developed and wealthy as ours, did it take this long to apply simple, affordable innovation to the most important, yet most costly, consumer-based product we have- our health and well-being. The current model of insurance-based primary care is Blockbuster video. Where do you want to be when it goes bankrupt?
Endnote: it is well worth an hour of your time to watch this incredible lecture by David Goldhill- CEO of the Game Show Network and author of “Catastrophic Care- How the American Healthcare System Killed My Father”- that I was fortunate enough to be present at this October in Dallas. His book is also worth the read. Besides a mortgage, healthcare is the largest expenditure we have so be informed and learn.
If you want to learn more in depth details about the decline of Blockbuster, please read this great article from Forbes A Look at Why Blockbuster Failed
Why DPC IS The Answer!
Yesterday Dr. Edmond Weisbart wrote this article for Family Practice Management (http://www.aafp.org/fpm/2016/0900/p10.html#commenting) which we posted on our Facebook page last night. He basically gives reasons why he feels DPC is not a solution to our healthcare crisis. I took the liberty of writing the below rebuttal which I have since emailed to their editorial staff for publication as well as a medical blog called www.KevinMD.com. I truly hope you will read this, and if you agree with my arguments, help us DPC doctors across the country that are trying to fight for you, our patients, and speak up to everyone. Send letters to your congressmen and congresswomen. Send it to our governor. Share it on social media. WE- patients and doctors- need to fix this as people are paying more for healthcare than their mortgages and getting less and less in return.
September 14, 2016
I am writing this letter on behalf of my fellow DPC colleagues in response to the Opinion piece by Edmond S. Weisbart, MD, CPE, FAAFP from your September-October issue titled “Is Direct Primary Care the Solution to Our Health Care Crisis?” I will be so bold as to answer Dr. Weisbarts questions with an affirmative “yes” and will try to respond to each of his bullet points. For further reading that is excellently done and supported by fact please refer to Dr. Phil Eskews piece “In Defense of Primary Care.” (http://www.aafp.org/fpm/2016/0900/p12.html)
- DPCs exacerbate the growing physician shortage: No Dr. Weisbart, plain and simply our current system is exacerbating the shortage of physicians. People who choose to go into a primary care field want to care for patients and not be burdened with an excess amount of bureaucracy that prevents them from following their oath to provide said care. One could argue that many physicians taking administrative jobs, such as a CMO of a pharmacy company, could also be contributing to the “care” shortage and access problem. Maybe we should stop doing that? And having a panel size of 2,300 patient is a good thing? If our system continues down its current path our primary care will be nothing more than an Urgent Care clinic.
- DPC’s are essentially unregulated insurance, capitating physicians and removing vital protections: Where do i begin with this one? Insurance by definition is to protect people against major financial loss for major unexpected events i.e. life insurance, car insurance, home insurance etc. Primary care is not an insurable event, as everyone needs it and should have it. Primary care is actually highly affordable, but has been made expensive BECAUSE we insure it. And the difference between captivated plans from an HMO and DPC is that there is NO THIRD PARTY determining the capitated value for the primary care services. The sole value determinant is the actual patient. What a novel concept that we have completely failed to see since third party payers have stepped into primary care. You know? To help weed out those greedy PCP’s- compared to the affordable premiums people (many with chronic disease) are paying to to carry, only to have 3,000-6000 deductibles and zero transparency on pricing for outpatient services in the third party system. Plus, if providing your technical skills and knowledge for a set monthly fee is unethical or illegal, then why can lawyers, accountants, etc do this everyday? And as far as your HIPAA concern, in true DPC guess who has access to the patients file? me and the patient!. Thats it. No one else unless its the patients choice. Can’t get more private than that can you? If I do sell patients info to vendors I am pretty sure my state BORIM and the exodus of my patients will regulate me sufficiently thank you very much. No other third party or acronym needed for that.
- DPC relies on an erosion of medical benefits: Lets look at your first sentence. The under-utilization due to HDHPs is actually due to the fact that people have no access to transparent care due to this third party payment cartel we have abided by for decades. Secondly, the current system is THE “hardship to patients” because it is an over regulated Gordian knot. DPC is accessible, affordable, and transparent with discounted pricing on imaging, labs, and meds in most states- i.e. those that allow dispensing. We actually help patients navigate this nebulous system, save them money, and yes, get them to specialists when needed with less fragmentation of care through better communication with said specialists. The only thing that makes specialty referrals difficult is the insane red tape that already exists (ie HMO patients needing an “in-network PCP” as their gatekeeper. So much for being “locked in” to something right?) We also use services (at no extra cost to patient I may add) like RubiconMD that reduce a lot of unnecessary speciality referrals that the 8 minute visits in our current system exacerbate. Also, many specialists will also see patients for a cash price if uninsured or underinsured. Thirdly, as far as employer plans go, the employers allow their employees to choose their own physician. DPC is offered as an option, not a mandate. They still have insurance, albeit with copays and deductibles, if they choose to have a PCP in the 3rd party system. So that statement is completely erroneous.
- DPCs exacerbate disparities in care: I will simply ask this in rebuttal- instead of citing studies. Have you actually visited a DPC practice and spoken to the patients that are members? Yes, the wealthy can afford anything. But what about all of those people you mentioned in paragraph 2 of section 3? A 90 dollar lipid panel at a hospital based lab is better for a blue-collar patient/family than a 75-95 dollar a month primary care medical home with no copays/deductibles and a 6 dollar lipid panel? Do the math. And as far as your inference to “cherry picking” patients with chronic diseases such as diabetes- that is just completely false and presumptuous. If anything, myself and my colleagues have many patients whom the current system has completely failed. But again, maybe you should actually speak with some DPC patients? Many of us actually have Medicaid patients. Being “insured” does not equate to actually receiving “care.” I will even provide charity care for those truly in need. Maybe policymakers and Medicaid administrators would actually work with us to make the model more accessible to Medicaid patients? Maybe the government could give those patients a voucher card for DPC no different than they do for food stamps etc?
The bottom line Dr. Weisbart is that nothing we have done or continue to do with this top down approach to fix our broken healthcare system is working. We have many administrators, policymakers, and CEOs telling us how to fix this and plugging fingers in the dyke that is ready to collapse as people pay more for insurance than they do their mortgage! So why don’t we try listening to the doctors and patients that have become the blips in the matrix on how to fix this mess for a change? The best solution to a complex problem is often the simplest. Remember Occams razor?
Jeffrey S Gold MD
Owner/CEO Gold Direct Care PC
123 Pleasant St Suite 105
Marblehead MA 01945
DPC Coalition Steering Committee Member
To Rent or To Buy: That is the Question
Depending on your age and income, and whether or not you are shopping for a car or a place to live, the answer to this question may vary. If you enjoy getting a new car every few years then leasing is clearly the way to go, but if you really like your car then buying would be the better choice. You will likely take better care of the car because you actually own it and have zero interest in having to make new car payments once it is fully paid. Same goes for renting an apartment versus buying a home. When you rent you are just simply handing over money to a landlord to live there. There are benefits to it such as maintenance and landscaping being covered, and if you only plan on being there a short time then renting is a great idea. However, if you are looking to have a long term or permanent place to live then buying is the way to go. You are investing in the roof over your head, your yard, and the upkeep of your property. In the long run it is a much better investment.
See chart from Trulia.com here for a visualization of how buying saves in the long run:
So I ask this question: why would anyone not want to do this for their healthcare, especially primary care which is the heart of medical care? This is nothing against the many great physicians that are employed and contracted with 3rd party payors, but when your primary care physician is being paid by a third party you are technically renting/leasing them. Maybe they will drop or be dropped by that third party? Maybe they will burn out and fade away which is happening all across the country? Maybe you will get lucky and just like the old days they will stay in one place and be contracted with your third party payor for years to come? Yes they took an oath to care for you which they do to the utmost of their abilities, but technically, given that they are being paid by their employer through your insurer they aren’t technically working for you
So what if you could own the relationship with your primary care physician and have them work only for you rather than leasing it? What if you- the patient/consumer- were the only party determining the worth and value of your doctor and the care that he/she provides instead of a third party that knows zilch about you as a person? What if you could have a mutually beneficial relationship with your personal physician based on respect and trust that exists in sickness and health? And what if you could have all of this investment for less than a coffee a day? After all isn’t your health, peace of mind, and wallet worth the investment? If the answers are yes then Direct Primary Care is here and here to stay. Lets take primary care and medicine back one doctor and patient at a time. You can rent DPC for a year and if you really like it- just like Chevy Chases’ rubber gloves in Fletch- it comes with an option to buy 🙂
Employers and Direct Primary Care: A No-Brainer!
Not surprisingly, recent studies have shown a broad value proposition that links workplace health and well-being to favorable business performance. So why don’t more employers invest in programs that promote healthy employees? Expense is one glaring reason! Employers, both large and small, are being crushed by the rising cost of providing insurance benefits to their employees. Most employers address this growing cost by shifting it to their employees in the way of increased premiums, higher deductibles or higher co-pays. There is a cost effective solution and this solution is Direct Primary Care.
With Direct Primary Care, employers pay a fixed amount for all primary care services. This removes the guessing game on how much money will be spent on claims filed by employees. Direct Primary Care can be inserted into the overall health insurance plan offered to employees and ultimately control downstream costs. DPC, combined with an appropriate supplemental catastrophic plan, can save employers up to 40% on healthcare costs! This is all in accordance with the Affordable Care Act, so employers won’t get fined for non-compliance.
If saving money wasn’t enough to convince you, other perks for the employer include: decreased absenteeism, decreased workman’s comp claims, utilization of telemedicine to evaluate employees so they don’t leave early for doctors’ appointments or miss work altogether. Employees benefit too, as they receive same day appointments, a personal relationship with their physician, telemedicine/virtual visits, decreased out-of-pocket expenses, no more visits to urgent care centers.
Direct Primary Care physicians can be an employer’s most valuable ally as they search for ways to control healthcare costs, while simultaneously offering their employees the highest quality of care. Check out this article http://www.directdoctors.org/blog/direct-primary-care-a-solution-for-small-businesses to learn more.
If you are a business owner or know a business owner call us at 781-842-3961 to start saving money!