Dr. Molly Rutherford: New patient-centered model, Direct Primary Care, is spreading across the state

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A new patient-centered model of primary care, Direct Primary Care, is spreading across Kentucky.

In his KyForward commentary on January 17, Patrick Padgett made several valid points in “Patients shouldn’t have to pay for Anthem’s poor business decisions.”

Another way to say this is, “patients and their physicians should have more control over their healthcare decisions.”

As our politicians and so-called “physician’s organizations” continue to discuss ways to achieve universal coverage for people in the U.S., a grassroots movement to provide better care at a reasonable price is growing throughout Kentucky and the United States.

Direct Primary Care physicians do not contract with insurance companies, but directly with patients. We provide comprehensive care at affordable prices with unprecedented access for patients.

Why would we expect a 3rd party, such as Anthem, to exhibit compassion or empathy toward patients, when they are not providing the care? DPC physicians believe a trusting relationship between patient and physician is the foundation of excellent health care for individuals. Our current healthcare system, with its over-involvement of 3rd party payers, interferes greatly with this relationship and is causing burnout among physicians and dissatisfaction among patients.

In the traditional system, physicians contract with insurance companies and government (Medicare) and bill them for services that are provided to a patient. The patient may or may not have a copay for services provided. The physician codes the services and sends a bill to the insurance company or government. Payment for a service provided today will arrive several months later and often after several denials from the “payer.” By the time a claim is paid, several other people, including coding specialists, billing specialists and claims review personnel, have been involved in the process. In fact, since 1970, the growth in the number of administrators involved in health care has far outpaced the growth in physicians.

For several years now, independent physicians have struggled to meet their overhead, due to the growing need for more staff to deal with this complicated process, and as a result have sold out to major hospital systems. Healthcare provided through hospital systems is more expensive, and I have met several people recently who told stories of higher bills from a physician they had seen for at least 10 years. When one patient’s physician was bought by a hospital, he received a bill for $150 that he had never received in the past, with no change in his insurance or his copay.

People are drawn to my practice because they feel like their physician no longer listens or doesn’t spend enough time with them. Most physicians who start DPC practices leave traditional medicine due to this lack of time. When I practiced for a “Patient Centered Medical Home,” I often saw 25 patients in one day, rarely had time to eat, and left the office feeling like I had probably missed something or failed most of my patients in some way.

As a physician charging my patients directly, I spend as much time as necessary to properly diagnose and treat them. I have time to spend counseling about lifestyle changes and behaviors that contribute to costly chronic conditions, such as diabetes, heart disease, and even opioid addiction. They have almost unlimited access to me by phone, email and text, and I have saved people time and money by evaluating for strep and other minor illnesses on weekends.

DPC also saves 80-90% on labs and imaging, and many of us also dispense generic meds in the office, often saving patients $50-$100 monthly, which pays for their monthly membership fee to the practice.

At this point, many people probably are thinking this is “concierge” care, but Direct Primary Care is very different from concierge care provided by MDVIP and other “boutique” practices. While we charge a monthly fee to patients, our fee covers all services provided within the office, including physician visits for illness, minor skin surgeries, injections, EKGs, strep tests, and urinalysis.

Fees charged by concierge practices are usually much higher and they cover enhanced access and/or specialized services such as a thorough physical exam featuring tests that are not usually covered by insurance. However, all services within a concierge practice are still billed to a 3rd party, which is why this model is more expensive to operate and therefore more expensive to patients. Where concierge and DPC are similar is in the increased value we place on time with patients; therefore, physicians in both types of practices limit their patient panel to 500-600 vs. at least 2000 in traditional practice.

My DPC colleagues and I wonder how this model that saves money and provides better care is not spreading faster throughout the country.

As Padgett demonstrates with his excellent article, many physician organizations continue to focus on “coverage” as the answer to the problems with healthcare in this country when the real problem is cost.

While insurance companies and physician organizations are funneling money to politicians to fight for coverage and funding seminars on how to reduce physician burnout, we physicians in the Direct Care movement are proving daily that healthcare can be delivered at a reasonable price, while also improving the health care experience for physicians and patients. The movement is not limited to primary care either. The Surgery Center of Oklahoma has removed government and insurance contracts from their services, and they are providing elective surgeries at a fraction of the cost of surgeries at a traditional hospital. Several self-insured employers throughout the country have agreed to pay for Direct Primary Care services for employees and have saved up to 30% on their healthcare costs.

In 2017, Governor Bevin signed SB79 into law to define Direct Primary Care and open the door for more physicians and patients to explore this innovative model of care. Our state can lead the way in improving health care by allowing more individual control over financing of health care services, by expanding HSAs, FSAs for people to use for Direct Care and by allowing our many Medicaid beneficiaries to also pay directly for their health care.

I invite all Kentucky physicians to visit my practice and consider ending their toxic relationship with insurance companies, who, as Padgett described, now possess the control and often make decisions that are not in the best interest of our patients.

Dr. Mary Rutherford

Dr. Molly Rutherford founded Bluegrass Family Wellness in Crestwood in 2015, where she provides comprehensive primary care and treatment for addiction. She is Board Certified in Family Medicine and Addiction Medicine, is past President of the KY Chapter of the American Society for Addiction Medicine and President elect of the Kentucky Academy of Family Physicians. She was born and raised in Virginia, moved to Kentucky in 2006, lives in La Grange with her family, and has been practicing in Kentucky for 11 years.

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One Comment

  1. Sara porter says:

    Does patient pay doctor or does employer work with DPC to pay costs?

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