Direct Primary Care and Concierge Medicine

An American Family Physician Moving Towards DPC or Concierge Practice

September 22, 2020

Harsha Moole, M.D., MBBS

Initial Thoughts from a American Family Physician

Just think why is a patient-centered american family physician moving towards direct primary care (DPC) or concierge family medicine?

For a country that spends the most on health care, community family practice centers in the US are notorious for providing subpar health care services at steep costs – and both American family physicians and patients are no longer having it. It’s gotten to a point where the rest of the world has begun to take notice.

There are more than 9,000 billing codes for individual procedures and units of care. But there is not a single billing code for patient adherence or improvement, or for helping patients stay well.” ― Clayton M. Christensen

Introduction | The Path to Better Health Care Led by Patient-Centered American Family Physicians

An international comparison between 11 high-income countries reveals very telling results. According to CommonWealth Fund’s international health care analysis of Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States, America ranks first at 16.6% in health care spending as a percentage of GDP but comes in last at 11th place in terms of performance rankings.

The country’s shameful overall ranking is due to low scores in the domains of Access (Inability of patients to find a primary care doctor that suits their needs), Administrative Efficiency (Ineffective health care management), Equity (Failure to provide consistent medical support to American citizens), and Health Care Outcomes (High hospitalization rates and pre-mature deaths due to preventable diseases).

“The poor quality of primary care has contributed to inadequate prevention and management of chronic diseases, delayed diagnoses, incomplete adherence to treatments, wasteful overuse of drugs and technologies, and coordination and safety problems”, according to CommonWealth Fund.

If there’s anything to blame for such poor results, it’s the fact that third parties, such as insurance companies / corporate health care systems owned by Wall Street, have played king for so long while family care physicians, who know what’s best for their patients, are shunned, overworked, and made to do the pseudo-king’s bidding.

There’s no denying it: the current health care system has neither been in favor of doctor nor patient for quite some time now. This has taken a heavy toll on American family physicians as the physician burnout rate remains at an alarming level throughout the decade.

Based on Medscape’s National Physician Burnout & Suicide Report 2020, 42% of physicians reported that they are burnt out, with the following specialties topping the charts, as follows: Urology, Neurology, Nephrology, Diabetes & Endocrinology, and Community Family Practice.

Personal, albeit anonymous, testimonies included in the Medscape report also reveal that long hours, overwhelming workload, and lack of support are some of the major factors which push physicians to their breaking point.

A family physician who participated in the study shares, “Increasing Electronic Health Record (EHR) requirements have turned us more into technicians and less into caring, patient-centered family care physicians.”

Because of this, an American family physician is frustrated, fed up, and more fired up than ever to find ways to provide their patients with better health care; hence, the new and improved Direct Primary Care (DPC)/Concierge Family Medicine model.

Imagine this: in exchange/addition to an affordable monthly subscription fee (something like your Spotify or Netflix subscription), patients get unrestricted access to their family doctor; they no longer have to queue at their community family practice center; and they get genuine, first-class treatment from their family care physicians the way it should be.

Although patients will still have to retain their insurance plan, the plus side is that they are now able to reduce their premiums to cover hospitalization and in-patient services only.

This also minimizes a patient’s interaction with third parties such as insurance companies and corporate hospitals, rewarding them with premium health care in its most genuine form – direct access to their family care physicians, discounted lab procedures and out-patient services, and a slew of many other benefits.

From the Perspective of an American Family Physician

Key Differences Between the Traditional Fee-for-Service Model vs. Direct Care Model for an American Family Physician

There are stark contrasts between the traditional, fee-for-service health care model and the Direct Primary Care/Concierge Family Medicine model but one thing is for certain: in the latter, American family physicians are finally able to conduct their community family practice on their own terms.

As a patient, here are key differences between the two health care models you should be aware of:

In the traditional health care model, it is close to impossible to find a primary care doctor that sees less than 2,000-3,000 patients. Direct Primary Care/Concierge Family Medicine physicians have the privilege of seeing 200-800 patients only.

Patients in the traditional health care model are only able to see their family care physicians for 5-10 minutes. DPC/Concierge Family Medicine patients, on the other hand, are able to sit down and talk to their primary care doctors for 30 to 60 minutes.

Scrambling to find a primary care doctor is a major pain point in the traditional health care model, especially when the patient is sick. Direct Primary Care/Concierge Family Medicine physicians provide round-the-clock, specialized routine care, even more so when the patient is sick.

Booking an appointment at your community family practice center is a nightmare, with its tedious, time-consuming procedures. With the Direct Primary Care/Concierge Family Medicine model, patients no longer have to go through a middleman to see their family care physicians. They have 24/7 access to their primary doctor’s direct line.

An American family physician in the traditional, fee-for-service health care model tend to make decisions based on the best interests of insurance companies and corporate hospital owners. Instead of their patients’ well-being, the bigger priority is putting insurance companies or corporate hospital owners in a financially better position.

In contrast, Direct Primary Care/Concierge Family Medicine physicians have no vested interests because there are no third parties involved between them and their patients.

Instead of being able to find a primary care doctor they can rely on and trust, patients are usually passed on from one specialist to another in the traditional health care model. This is so that family care physicians are rid of the risk of liability.

On the contrary, Direct Primary Care and Concierge Family Medicine physicians have all the time they need to fully understand a patient’s medical condition and to instill patient adherence (the degree to which a patient correctly follows their family doctor’s medical advice).

The practice of an American family physician in the traditional health care model is limited to the clinic alone. Unlike Direct Primary Care and Concierge Family Medicine physicians who are on-call for sick visits and home appointments, traditional family care physicians are not expected to see patients outside of their office.

Traditional family medicine doctors are so overburdened that it seems they have misplaced their patient advocacy. They do not have the luxury to establish a genuine connection with their patients.

On the other hand, an American family physician in the Direct Primary Care/Concierge Family Medicine model regards patients like family. They treat their patients with meticulous care and genuine concern, especially when their patients are sick. This creates a layer of trust in the doctor-patient relationship – something that is vital to optimizing patient adherence.

What is The New and Improved Health Care Model According to a American Family Physician?

In 2020, a physician’s expectation of how their career plays out has rapidly changed, says Dr. Halee Fischer-Wright, MD, CEO of the Medical Group Management Association. “Physicians recognize that seeing a smaller number of patients may give them more time with patients and the ability to practice medicine at the height of their license, reducing non-clinical hours and enhancing both personal and patient satisfaction.”

This is why more and more American family physicians are drawn to this new and improved model.

The Direct Primary Care/Concierge Family Medicine practice fosters a direct relationship between an American family physician and their patients. Instead of patients worrying about copay fees and family care physicians dreading mountains of insurance billing paperwork, the Direct Primary Care/Concierge Family Medicine model makes use of monthly membership billing to be settled directly between doctor and patient.

This monthly membership fee, which usually costs a couple of dinners out only, provides patients with unlimited doctor visits, premium health care, and a more tight-knit relationship with their family medicine doctor.

Even if patients still have to retain their insurance premiums for ER visits, surgical expenses, and other in-patient services, the Direct Primary Care and Concierge Family Medicine model covers everything else under routine primary care and other out-patient services.

An American family physician in the Direct Primary Care/ Concierge Family Medicine practice are now able to provide their patients with round-the-clock care; convenient, virtual consultations via phone call or text message; same-day appointments; home visits; and discounted rates on out-patient labs and medical procedures.

Trust us: you can’t find a primary care doctor in the traditional health care model that offers all of these priceless benefits.

Why an American Family Physician Thinks the Direct Care Model is the Best Choice for Patients

1. An American family physician in the Direct Primary Care/Concierge Family Medicine practice is like an old friend.

You no longer need to queue just to see them; there is no need to endure robotic, insincere appointments; and you are able to sit down and spend enough time with them.

A crucial factor that draws American family physicians to this new health care model is time. The Izbicki brothers, who originally came from community family practice for another practicing physician and then a local hospital, were so frustrated for not being able to spend enough time with their patients.

“We were bitter, frustrated. We were in a failed profession. It was so bad that we really had to take a risk. We knew that what patients want more than anything else is uninterrupted time with their PCP and with that to build a level of confidence. They want relationship-centered care”, Dr. Jon Izbicki shares.

2. The Direct Primary Care/Concierge Family Medicine offers lucrative, long-term savings.

Apart from reducing insurance plans to cover in-patient charges and catastrophic health care coverage only, this new health care model provides patients with many financial benefits.

The Direct Primary Care/Concierge Family Medicine model features transparent, upfront pricing which covers everything you’ll ever need in terms of high-quality routine care – same-day office visits, family discounts, discounted lab procedures and in-patient services, medication at wholesale price, and so much more.

In an interview with KevinMD.com, the Izbicki brothers share all the financial benefits they are able to offer their patients. “[We] charge $780 per year for unlimited primary care, payable as $65 monthly or annually with a discount. Visits are as long as needed and are usually [booked] within the same or the next day.

[We] have developed contracts with clinical laboratories for highly discounted testing and radiology. [We] purchase generic drugs at wholesale prices and sell them to [our] patients at the same price.

For many patients, especially those with multiple chronic illnesses who are taking 5 to 7 prescription medications, this can save as much or more than the annual membership fee. It is this latter factor that especially encourages Medicare enrollees to join.”

3. An American family physician is able to return to the heart of their profession: understanding their patient’s medical conditions and determining ways to maintain their well-being.

For family care physicians like Dr. Ryan Neuhofel, he knew right off the bat that he did not belong to a typical, insurance-based practice. He says, “I saw that most American family physicians did not have fulfilling careers; they spent enormous time in administrative tasks rather than actually working with their patients. I knew I wanted to do primary care but it had to be in a model that let me earn a decent living yet let me give real quality care in a compassionate manner.”

Passing a patient from one specialist to another seems like regular behavior in the traditional health care model, but that is definitely not the case in the Direct Primary Care/Concierge Family Medicine model.

Instead of ridding themselves of the risk of liability, the privilege of time permitted by this new health care model lets family care physicians perform early disease diagnosis and in-depth medical assessment.

4. With the Direct Primary Care/Concierge Family Medicine model, family care physicians are able to build a long-lasting, equally satisfying relationship with each of their patients.

As a patient, nothing feels worse than being just another number to be called at your doctor’s office. Louise Aronson, a professor of geriatrics at the University of California San Francisco, enforces, “I think the appeal for both patients and doctors is that it addresses a failing of the regular health care system, which doesn't give anyone enough time for what one might safety call care.”

It makes sense: when American family physicians are happier, not overworked, and are able to fulfill their patient advocacy at the highest level, patient satisfaction rates, in turn, are much higher. A 2014 survey found that 90% of patients in the Direct Primary Care/Concierge Family Medicine model are satisfied with the care they are receiving, in comparison to 67% of patients who are in traditional community family practice.

In addition, 97% of DPC patients think “their doctors take a personal interest in their health care”, which is more than one-third higher than those in the traditional family practice.

The Perspective of a American Family Physician in a Nutshell

Summary

It’s amazing what the new Direct Primary Care/Concierge Family Medicine has accomplished in terms of providing better health care. No wonder more and more American family physicians are getting on board. From 2015 to 2017 alone, there has been an 8% increase in DPC-Concierge Family Medicine practices all over America – and numbers are expected to rise as the years go by.

As Charles Dinerstein, a vascular surgeon and senior medical fellow at the American Council on Science and Health, so perfectly puts it, “Concierge medicine, like many other things we purchase, is an experience as much as it's care. You have a much more personalized, intimate encounter with your doctor” – and at the end of the day, that’s all a patient ever really wants, is it not?

Authored by Harsha Moole, M.D., MBBS

Advocate of healthcare models that promote direct relationship between patients and doctors. Founder @ FindMyDirectDoctor, LLC.

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