As bloggers go, I have not been too prolific. My excuse is that I have been setting up my practice for the past three weeks. Not physically yet, though I do have an address:
3176 Lancer St., Portage IN 46368
I plan to open the first Monday in February. I am certain that there will be things that I have forgotten, but nothing that will cause anything but some inconvenience.
One of the last, but most important pieces I have to put into place is to get a patient contract. I will acknowledge here the help of Josh Umbehr, MD and Matthew Priddy, MD, pioneers in the field of direct primary care. They have given me a lot of useful advice, in particular putting me in touch with lawyers who have written DPC contracts. The essence of these contracts are that patients will be told up front how much they will pay for their monthly subscription, what services they can expect for their basic subscription, and what services can be purchased with an extra fee.
Aside from my own services, Josh Umbehr has recommended that I offer wholesale medications and discounted laboratory studies. I have looked at the prices for these that I can offer and they are much less than I expected in most cases. For some patients, the reduced cost of medications and lab tests could pay for the subscription fee.
As for other services, I want to let patients tell me what they would find valuable. Many DPC practices negotiate discounted rates for their patients for x-rays and other imaging studies. Some practices have dietitians or physical therapists. I am not opposed to making any legitimate service available, as long as enough people are willing to pay for it through their subscription fee.
I will get the details sorted out, with a little help from my friends.
Urgent care clinics are springing up all over, and it is easy to see why. They offer patients the ability to get their need for medical care met without the hassle of making an appointment, often at times when traditional physician offices are closed. They exist and flourish because of the failure of primary care practices to meet the scheduling needs of their patients, and the continuity of patient care suffers as a result. It would be better if primary care practices took care of most of the problems that appear in urgent care clinics. This failure of primary care practices, though, is partly a result of the policies of insurance companies.
Urgent care clinics are paid more than primary care practices for the same services, to compensate them for the risk of having times when they are open but no patients are showing up. Urgent care clinics do this by using insurance billing codes that are not available to primary care practices. A primary care practice that adjusted its schedule to accommodate all the patients that wanted to be seen on a given day, just like an urgent care, would be offering a better service than one that packed its schedule full for days or weeks in advance, but it would be paid no more for its efforts.
Further, insurance companies generally don’t pay at all for medical care handled over the phone, even though that is a perfectly good way to handle many problems. There are a lot of complaints that I can evaluate without being in the same room with my patient, as long as I know him already. This is even more true if we add in Skype or FaceTime. But, since the insurers see no value in anything except face-to-face office visits, I am forced to inconvenience my patients in order to get paid, or send them off to the urgent care to be inconvenienced.
Direct primary care flattens the advantages that urgent care clinics have over primary care offices. Since DPC practices are not paid by the visit, rather by monthly subscription, there is no advantage to urgent care billing codes. In a DPC practice, the patient and I can choose to interact any way we want that solves the patient’s problem, I don’t have to insist that the patient interrupt his life for hours when proper care takes only minutes. Direct primary care allows physicians to care for their own patients, reducing the need for urgent care clinics.