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DPC: Subtracting the Guesswork and Adding Back the Relationship

This week my partner, Jackie Hone, was seeing a new patient who had driven an hour seeking her help in sorting out his health situation. She spent an hour seeking to undo the damage done by miscommunication from multiple encounters in varied medical settings. Her patient had been left confused, upset, and almost ready to give up. He was uninsured and prior to his current problem had been quite healthy and had no primary care physician. But following his recent shoulder surgery he experienced a concerning post-operative symptom, was sent to one ER, transferred to a second hospital, had his diagnosis changed several times, was admitted for a 4-day hospital stay, and was finally discharged still lacking a definite diagnosis, plan, or prognosis. Of course his medical bills are staggering from all of these encounters. He was left pondering, “If medical care costs so much, why is it so poorly delivered?”

Most of us somewhere along the way have had a frustrating medical experience: maybe we received only a fleeting explanation about a procedure, medication, or treatment being recommended. Or perhaps we received a surprisingly huge bill after the dust settled on our medical care. Or we had follow-up questions but couldn’t reach anyone to answer them. Maybe all of these. So, is that just the way it increasingly has to be, or is there a better way?

Having a relationship with a physician who knows us in times of health and sickness is valuable. Likewise having a doctor who can be reached in an emergency is huge. And having a physician’s office that can help us navigate complicated medical tests and specialists to anticipate and manage costs is something for which most can only wish. But maybe these things are not impossible to achieve.

My partner and I believe that a return to direct agreements between doctor and patient is the first step toward providing this experience as the new normal in primary care. I am referring to the medical care model known as Direct Primary Care (DPC). It is so named because patients deal directly with their doctor to form an agreement defining what services and care will be provided for a known and affordable monthly membership fee, rather than billing for services through the middle-man of insurance. One recent joiner to DPC had calculated that his medical cost for primary care would only be about 30% under DPC compared with what he had paid for primary care coverage by insurance the previous year.

Now that Dr. Hone has been practicing a DPC model for the past seven months, we can report that patients in this model are very satisfied with their care, are able to communicate efficiently with our office, and can be seen when needed. Their visits are not so rushed, their wait times have been reduced, and cost is highly affordable due to the reduced overhead from not having to jump through the countless hoops of insurance companies.

The basic fee, not much different than a cell phone contract, covers all basic primary care including normal labs, physicals, maintenance visits and sick visits. Any procedure or lab not included in the membership agreement is offered at a low cost compared to insurance rates, and is discussed in advance with the patient. The lower patient volume in DPC allows more “face time” with patients which translates to better communication all around, the chance to be heard by the doctor and ask questions, and the efficiency of handling more than one complaint at a visit. Because payment is based on a monthly fee, rather than an office visit, communication by phone and email is welcomed rather than discouraged (as it often is in an insurance-based model). Finding the right catastrophic coverage that provides for unforeseen emergencies, imaging, or specialists, is important to complete the picture.

Of course there are still a few folks who have great insurance and may not need Direct Primary Care to help healthcare be affordable and personal. But for many patients we have found that it works wonderfully, saves them time and money, and improves their overall healthcare.

In light of all this Dr. Hone and Trinity Medical are celebrating the Grand Opening of her new office next to Sonic at 1515 E Lamar Alexander Parkway on Thursday, August 11th from 11:00-1:00pm. If you have a few minutes, check it out and find out a bit more about how Direct Primary Care really can be a better way.

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