November 3, 2014
A Look At Direct Primary Care
By Michael D. Shaw
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 better lighting, seating, and even fancy coffee and tea services are appearing in many waiting rooms. In a number of large hospitals, a big box retail notion of customer service has been instituted, whereby all personnel wear large badges emblazoned “May I Help You?”
And, then there’s concierge medicine. At its most basic, concierge medicine requires the payment of a retainer fee, which can range from a few hundred to tens of thousands of dollars annually. For this fee, the patient obtains enhanced access to his physician, and other services may also be included. Generally, concierge fees are in addition to any co-pay amounts, and are not a substitute for insurance. By its nature, concierge medicine is usually limited to primary care practices, and often co-exists with non-concierge operations within the same medical office.
The concierge model is revenue enhancement for the doctor, and cuts the wait time for the patient, but still allows the 500 pound gorilla (the third party payer) to dominate the room. Is there a better way? Former ultra high end concierge doc Samir Qamar thinks so.
Qamar is the founder and CEO of MedLion, one of the first purveyors of Direct Primary Care (DPC). DPC offers a subscription-based medical service, with no involvement of third party payers. In a refreshing twist, DPC puts health insurance back to its original intent: coverage of catastrophic, rather than routine health care matters. Proponents claim that they can cut 40% of a medical practice’s overhead, by eliminating insurance billing. As a result, fees are kept low.
Another up-and-comer in DPC is Kansas-based Atlas MD. Why “Atlas”? Maybe it’s a nod to Ayn Rand. On its website, one frequently-asked question is “What sets Atlas MD apart from other practices?” The answer begins “We have shrugged the bureaucracy.” And the rest of the reply is pretty cool, as well…
“We have shredded red tape. In refusing to recognize any interference with the sanctity of the patient/physician relationship, we have returned family practice medicine to its root values of clinical excellence for and compassionate knowledge of every patient. In every aspect of family health care, and custom health care, we promise accessibility, convenience, and affordability.”
I’ll leave you with my favorite Atlas MD FAQ. “Does Atlas MD accept health insurance?” The answer reveals wit and compassion: “No. Happily, no. While the tender mercies of an insurance company might apply to the fixing of a damaged fender on your automobile, we see no reason for any insurer to have a voice about either the quality or the cost of your family’s health care. We forgo insurance payments in order to save our patients from the arbitrary, intrusive decisions that inevitably follow with third-party payers.”
At the moment, Atlas MD’s clinical operations are limited to its home state, but the company also provides software, which enables physicians anywhere to emulate their model. Thus, they’re not (only) in Kansas anymore.