A Look At Direct Primary Care

Coach is Right ^ | 11/7/14 | Michael D. Shaw

[Oldpuppymax]

Let’s start with the doctor/patient relationship—the disappearance of which has been lamented by many. The pertinent definition of “relationship” in the Oxford Dictionaries deems it: “The way in which two or more people or organizations regard and behave toward each other.” In one sense, every patient wants to be treated well by his physician, and in many cases, so-called “continuity of care” is most desirable. Likewise, the physician may wish to spend more time with a particular patient, but is forced by economic realities to rush the process.

Perhaps, some of this search for the ideal doctor/patient relationship is driven by nostalgia, and Norman Rockwell illustrations portraying a visit to the beloved family physician. Alas, times have changed. Medicine is high tech and expensive, and has of course been made vastly more impersonal by virtue of third party payers. In fact, the doctor/patient relationship has deteriorated precisely because the patient is no longer the client.

The client is now—and has been for at least 40 years—a third party, namely an insurance company or government. As such, he who is paying the piper is usually also calling the tune, with respect to treatment modalities. In certain cases, a provider may even be banned by an insurance carrier if he elects to offer therapies free of charge, in an effort to help a needy patient. Does anyone except a third party parasite think such policies help the doctor/patient relationship?

There have been efforts to re-establish at least the illusion of a doctor/patient relationship. Comfort features, such as...

[expat2]

yes, good, but how does it work in an obamacare world?

[hometoroost]

Direct primary care is the new name for concierge medicine. Concierge medicine conjures up visions of thousands of dollars in fees. Direct primary care providers and concierge providers eliminate third-party payments. That's what makes it more effective and in the DPC model it's what drives affordability.

There are some practices that mix the insurance model with the concierge model but this is tough to do. It's hard to treat one set of patients differently and you still have the overhead of dealing with insurance companies/the government.

This model and medical tourism (which can include domestic travel to centers of excellence and efficiency) could go a long way to cutting costs and improving service and outcomes.

[Grumpybutt]

Since we are not participating in the Obamacare scam due to cost and only one income, we are effectively uninsured. So... we enrolled in an rx savers plan at our local grocery store pharmacy which saves us big bucks, and pay cash at the same dr. we’ve been going to for 20 years... $58 for a regular office visit.... Beats the hell out of $700+/mo in insurance premiums with $6000+ deductibles. If the worst happens, the hospital will just have to work out a payment plan with us.

[YouGoTexasGirl]

Makes me want to buy a condo in Kansas. We just got our 01/15/15 increase for ‘affordable care’ and I lost sleep all last night being upset. Since Obama has been in office our premiums went from $461 to the new $1,036 per month. Now, that is with a $5K deduction and no (THANK GOD) pre-existing conditions. As I told my husband, it does not pay to be healthy now (with insurance premiums, not real life!) as all they consider is your salary and age. But, the insurance companies were with him on the deal thinking they’d make more money and what they got was the usual political pinch!

Oh, a Dr. friend of ours joined a group somewhat like the one talked about. You pay $1K/yr. for his office services which includes about 3 hours of annual physical and chatting time. If you have 250 patients, it’s a good deal.

Something has got to crack this crazy out of control platinum healthcare web. Even ‘therapy’, never ending which should be done by the patient from a piece of paper and/or family-friend assistance, not $65/hr. home health folks.

[kaila]

The only problem with primary care is that is all they offer- primary care. Medicine has been so sub specialized because of the vast increases of knowledge and technology, that a primary care physician cannot know it all.
Therefore, payment to a concierge type of service is only good for the patient if they do not need specialists.
Right now, specialty care has not gone the concierge route.

[kaila]

I totally agree with you on that.
The physical therapy representatives lobbied hard in Obamacare. Now, if you need a total joint replacement, even if you are bone on bone, you are required to have about a month of PT before they will authorize payment for surgery. A big waste of time and money.PT does not regenerate cartilage. PT is way over ordered due to insurance requirements.
Also, a big part of the rehab experience is for someone- with a family member or friend assistance- to get in the car and travel to the PT office. It gets patients physically moving. Now, it is all done at home. So, instead of one therapist to 2 patients at a time, you have a 1:1 session which does not include the therapist travel time. That increases the cost.We need to get rid of these frivolous waste of healthcare dollars..
When my husband had shoulder surgery, we went to PT once. I learned what needed to be done, and I rehabbed him at home. His shoulder turned out great.

[expat2]

sounds good but you will have to pay a 2.5% ‘tax’.
re the worst, you should probably consider a catastrophic policy, about $50/m, for major injury/sickness