Direct Primary Care (DPC) is a more progressive model of healthcare that removes the barriers between patients and physicians. First off, having health insurance is not the same as having health care. What I mean is that regardless of whether you have health insurance or not, we have all experienced the frustrations of a system with limited access to physicians, short appointment times, increasing costs, and frustration due to lack of follow up to medical questions and concerns. Even physicians are recording all time high issues with burnout. Medicine should be about helping people maintain meaningful and healthy lives with physicians working a sustainable system. Direct Primary Care helps create a more just and equitable system where physicians can actually have a more appropriate panel of patients that they can really focus on rather than try and meet a quota of patients to maintain their position as profitable in a company.
Yes, a significant majority of patients with insurance will actually save more money with DPC. A common question I get is "why should I pay twice, for insurance and a patient membership?" Well, the answer is you already do pay twice. You pay a copay for every office visit after which you may then get a separate office visit charge. If you have labs, imaging or procedural needs, you will be charged an inflated lab/radiology/procedure bill as well as prescription costs in order to meet your deductible. All this while paying a premium every month which may thousands of dollars for your family. Your deductible (usually in the range of $1000-5000+) isn't where the cost ends. On top of that you also have to pay coinsurance meaning even if you meet your deductible, you are still responsible for a percentage of medical care costs. Lastly, I would argue that just because you have health insurance does not mean you have healthcare. Whether it is cost, inconvenience, or unmet expectations, DPC can help where traditional care has failed. Having a third party payer like large insurance companies or Medicare to pay for primary care needs (both of which should be used for major catastrophic issues which will be discussed in the next question) actually decreases quality and transparency. DPC seeks to offer value for patients.
(A study by University of North Carolina Medical School and MBA program showed that those that chose a DPC practice spent 85% less financially while enjoying doctor visits lasting averaging 35 minutes per visit compared to 8 minutes for traditional models. ) Reference Link
Let’s start with an analogy using auto insurance. We all have to fill up the gas tank, buy new tires, and get oil changes, but we don’t use auto insurance for those maintenance issues. We use the free market to search for the most reputable and price-for-value businesses to take care of those things. Auto insurance does protect us from major crises like a total collision.
Healthcare coverage is similar. In the same way, it doesn’t necessarily make sense to purchase high premium insurance for primary care needs alone because insurance is for big unforeseen expenses (or for those with multiple significant medical issues), not routine care and 90% of sick visits. Coverage should protect patients from catastrophic situations like emergency room visits, surgeries, or hospitalizations (like from a heart attack or stroke). It’s a financial tool to protect patients from financial ruin if those issues do occur. For many patients, higher deductible coverage is oftentimes much more affordable in conjunction with DPC to handle your primary care needs as well as providing better care as you aren’t being billed hundreds of dollars for office visits until your deductible is met. Lastly, study after study has shown that when people have better access to primary care physicians, there is less utilization of emergency rooms and specialists. Urgent care centers are actually a symptom of a failed primary care system as your physician should be available when you need them most.
DPC can be helpful for patients that require more time with their physicians because of multiple medical issues or have frequent problems that come up throughout the year. If you are healthy and do not utilize the doctor's office very much, DPC can still be a better option as you may not need the "best" and most expensive insurance option. You could save hundreds of dollars a month electing to go with a higher deductible plan and using DPC for your primary care needs. It's a win-win for both groups.
For those patients who are on Medicare, I would ask how your doctor visits usually go. Do you feel your doctor has the time to address all your concerns and is appropriately monitoring the many issues that affect our Medicare population such as safety with multiple medications and management of multiple chronic disease? With so many patients, limited time, and increasing administrative/clerical work, it can feel like trying to hold on to sand, even for the best physician. There’s also the unfortunate fact that an increasing number of physicians are choosing not to take Medicare insurance (usually related to lower reimbursement). Insurance companies may have also requested you or your family/friends to change doctors because of arbitrary network issues. Medical issues can oftentimes be more complicated as patients get older and you would benefit from someone who has the time to sit down and answer your questions, including time to ensure proper medical management.
Yes. Based on circumstances and availability, you can make after hours appointments. I can also take care of most issues over the phone or text such as acute illnesses or last minute refills. I will do whatever I can so that you can avoid going to the emergency department. This brings me to my next point which is that urgent care centers are a symptom of a broken primary care system. Your doctor should be available when you need them most so you don't have to spend hours and then hundreds to thousands of dollars with an urgent care or emergency department visit.
Absolutely. I still recommend a high deductible insurance coverage or a healthcare sharing program for catastrophic issues, but I am happy to take care of you regardless of coverage or not. Traditional insurance medical practices disproportionately affects those who are uninsured as out of pocket costs typically are hundreds of dollars per visit.
If you choose not to pursue traditional insurance, healthcare sharing programs are financially viable organizations in which members pay monthly into a large pool. If large expenses occur, the organization is able to pay for your expenses after a certain amount. There are many organizations out there with their own set of rules for membership and some research online may lead you to one that fits your needs.
Unfortunately, cost of healthcare is going up and quality is going down. More and more Americans are having to choose between their wallets and their health or are fed up with feeling like their physician doesn't have time to listen. Your doctor appointments may only last 15 minutes or less meaning you don’t get fully educated on your issues, don't have your questions answered, and oftentimes deal with overprescribing of medications. Our video on our homepage can offer more information.
Being accessible means being available to you through text, phone, or email as well as the ability to make quick appointments the same or next day. This means you don't need to go to an urgent care center or use a teledoc service with someone who doesn't know you. When patients have more time with their doctors, they reveal more information about medical history, daily habits, desired outcomes and other psychosocial issues affecting health/wellbeing. Doctors then have more time to listen, ask insightful questions, have extra time to counsel on improving lifestyle habits, discuss the expected course of a disease process or inform patients about expected effects and side effects of medications. Doctors and patients should and can communicate more freely without restrictions.
Text me what you want to bring up at next in office visit, or photo of a rash, or name of medication you couldn’t remember at your last visit and I can respond back with answers, advice, recommendations, and behavior modification reminders.
Part of my promise to you as your physician is to provide you the best care possible. Philosophically, this means I do not like to prescribe medications or treatments unless I know it is necessary and safe rather than prescribing medications to fix symptoms without treating the underlying issue.
Primary care physicians such as myself can take care of about 90-95% of all problems you may encounter depending on our training and willingness to do procedures. Thankfully for you, I'm excited to do procedures if appropriate and am consistently taking continuing medical education courses to maintain and grow my medical knowledge as well as maintaining good procedural competency. I can take care of pediatrics (including newborn care), adult and geriatric medicine. I take care of a wide range of acute and chronic medical illnesses. I think most importantly though, I understand my limitations and if I don't know something, I will find an answer for you or get you to a specialist who does.
Yes. Part of the reason I am doing DPC is because I was getting tired of seeing hard working people pay exorbitant prices for their healthcare when I knew that prices were being inflated. It was unfair. Our lab costs are transparent and set at wholesale rates to save you money. With imaging, an MRI may be charged hundreds to thousands of dollars through insurance (of which you may have to pay either all or a percentage of) when I can order one for you that would cost $300.
For example, a standard set of labs for physician costs about $20 wholesale (see our pricing sheet) vs. up to $500 billed to insurance. If you have a 80/20 split then you would pay $100 but remember the actual wholesale cost is $20.
Yes and no. Although there is significant overlap, concierge medicine has a higher retainer fee ($200-500+ per month) and usually charges insurance on top of that. This can be quite lucrative for the physicians but is generally not affordable for most people. I wanted to make North Texas DPC affordable while maintaining excellence in care.
I use a service called RubiconMD which I can get specialty consultation for most issues which is a part of your membership costs. If a specialist is required to see you in person I am happy to refer you to anyone in your network (if insured). I have also developed relationships with physicians in the area who can see you at a reduced price if uninsured.
Telemedicine (also known as virtual visits) are becoming a more utilized tool due to convenience. I can also handle many of your concerns and questions without an office visit through telemedicine, but there is no substitute for an actual physical exam for certain symptoms and conditions to arrive at an accurate diagnosis. Same or next day appointments make it easy for me to schedule you to come in sooner for your problems if needed. Using telemedicine alone can lead to inappropriate prescriptions and missed diagnoses.
Our current healthcare system is unsustainable for several reasons. First, we have an aging population with longer life expectancy thanks to modern medicine BUT the ratio of patients to physicians is increasing which leads to issues such as massive patient loads in clinics, less time with your doctor, and lower quality. The number of physicians is also decreasing because of earlier retirement and physicians choosing other careers. This is due to burnout where physicians are becoming increasingly emotionally and physically exhausted by patient loads, insurance issues, and bureaucratic red tape. Cost is also becoming a significant problem as patient can pay for health insurance but not truly have health care due to cost. This is leading to a vicious cycle of patients becoming more frustrated at the nature of their health care (and perhaps getting sicker) while physicians are having to bear increasing patients loads. DPC helps with providing patients with better access and a closer relationship with their physicians. It also lessens the burden of insurance related coding and billing barriers and allows physicians to have a smaller patient panel.
I'm going to start with why a good doctor might need you to come back often. There are times when due diligence means seeing you more frequently such as after starting a new medication or addressing a worsening medical issue. However, with traditional insurance reimbursement, your physician does not get paid unless you see them for an office visit. This means there is no incentive to manage issues over text or email. With DPC there is no incentive to profit off of people's medical issues or questions through office visits as you have unlimited visits and open accessibility with me at any time.
If your physician is requiring to return because they do not want to address your concerns beyond a certain time frame without leniency or they will only address one or two topics at your appointment at a time, it may be time to look for a new physician (even if it is not with me). If you are not getting your medications refilled because your appointment is not exactly within certain time period (even though you have made a future appointment for refills) and you have to go days or weeks without your medications, it may be time to look for a new physician.
My patients will know well in advance of any vacations/time off I will take, however I will always be available by phone, email or text. In case of a need for an in office visit while I am on vacation, I will make alternate arrangements with a local physician to see you at no cost to yourself.
It is important to differentiate the difference between your primary care needs and medical insurance/coverage. DPC is not health insurance. We take care of patients with or without insurance however we do recommend coverage of some sort to protect yourself. By joining North Texas DPC's membership program and executing the membership agreement, you understand that the medical service agreement for DPC is not health insurance.