Thoughts on Direct Primary Care?

[swamprooter]

My doctor just sent us a letter stating jan 1 he will no longer take any insurance. Nothing but cash. To remain his patient , he will charge a monthly fee of 50 bucks per family member and 20 bucks per visit. So a family of 4, I have to pay $2400 a year regardless if we go for a visit or not. He is fed up with insurance dictating his income as well as Uncle Sam . However I have insurance through my company. Any thoughts or experiences ? Is this the new trend?

[Deltaquack]

It's going to be a trend for a portion of the population. It's going to be a sort of boutique practice. Insurance is what has driven offices to this. It's getting to the point where it requires more time to enter electronic charting and costs more money than what you can charge insurance to do things. By not taking insurance, you can basically practice how you want to within the guidelines of the Medical Practice Act. Insurance was never meant to be what pays for services. Insurance started out as a "catastrophic" prevention.....basically for real big things to keep a family from having to go bankrupt over an accident and such. People started abusing the system and using insurance plans like a debit card. Now, insurance is the driving force and people don't expect to pay anything out of their pocket. Doctors don't have a relationship with the insurance company.....only with you.

You can still likely file a claim with your insurance company to reimburse visits. That'll get tricky though as it's getting impossible to learn medical coding....and they'll likely have to have access to a EHR to pay the claim.

[Blackduck]

I wouldn't be surprised. Medical cost and oversight have skyrocketed. I'm not talking about what I charge but what I have to pay to keep in compliance with Medicare, hospitals, ect. Things like maintaing an electronic medical record, document storage, transcription ect. Currently I pay about $1500-$2000 a month for a electronic medical record that I do not want nor fully utilize but I pay that so Medicare won't cut off and/ or reduce my payments. Extortion is what it is.

[swamprooter]

I d rather pay him the cash he deserves for his services. But I need insurance for castestropic events like hospital stuff. May have dual coverage. This will be interesting

[Long Cut]

As stated it will be a trend in the near future. It sounds good in theory especially to self employed guys like me at first glance. The problem that I see is that I can not self insure through all of the medical specialties that my family requires, example my wife's OB/GYN, Kids Pediatrician,allergist, ER Visits if that is needed etc. So if my primary care DR. goes to a membership cash type of model that cost my family a few grand per year plus I have to have at least a catastrophic plan with an HSA if not a better plan then I'm not coming out ahead, it just added to my healthcare cost bottom line. If I go without insurance then I pay the gov at tax time and I roll the dice that I don't get into a car wreck or we don't have a major medical situation that could bankrupt us.

The model that your provider is switching to will have the monthly access fee and then the $20 fee for a visit which is like a copay but the programs that I have researched like this also have an additional menu board for service for example flu test is another $10, blood work an additional $20, injections are an additional fee and so on. I'm pretty sure that the $20 visit is not all inclusive. The physician may come out ahead in this situation but I'm not sure the patient does. I get that you will probably have more 1 on 1 time with the Dr and better care which is important but what if every office went to this model, it would cost a small fortune just in membership fees for access.
For the financially secure patient it is probably the way to go and you will get what you pay for but more personalized medicine but for my family I just don't see it being a viable option. This program is going to be good for the Dr. because some patients will leave that cant afford the model and his work load will be cut down (fewer patients to see in a day)but his reimbursement will actually stay the same or go up based (he's knows he's making at least that $50 per patient for maybe not seeing them plus no medicaid patients to lose money on). Smart business move on the DRs side.

[mfalkner]

Interesting. I'm like you, don't mind paying for access to a doctor that I trust but I would be concerned over the a la carte costs adding up. I just had a full lab panel run for my annual Healthy You physical and it was almost $600 (to my insurance).

[deltadukman]

BCBS renewal rates are through the roof. You can thank the ACA.

[Long Cut]

[mfalkner]

My company is a small group insured through BCBS and our rates actually went down this year.

[swamprooter]

I think I am going to keep my company insurance for Emergency care and sign my wife and myself up for his additional monthly Direct Primary care and but keep the kids with Pediatrician and regular insurance. So in short $50 x 2 x 12 months plus office visits is what I am out of additional. If my wait is shorter in waiting room and I still get that same level of service plus some free labs...It's a bargain....It's pretty sad to me our smartest and hardest working citizens particularly in the General Health Care profession such as my internist basically at a fixed income due to insurance. This is going to be interesting for sure in next decade or so