Who else has enrolled in Direct Primary Care?

[Denverite]

First a link for those unfamiliar with the model - this has been posted on the forum before in other health threads:

https://www.dpcare.org/

I enrolled recently and made a first visit to the practice. So far, so good. What I observed/discovered was:

1. The office is quiet and relaxed. I was the only person being seen at the time of my appointment - the small waiting room was empty. Quite the contrast to my experience with a typical Primary Care office which has multiple patients in the waiting room, ringing telephones, multiple employees going here, there everywhere, and typically a wait regardless of your appointment time.

2. The actual visit with the Doctor was also different. I was seen immediately and he did not seem to be in a rush. He told me he had previously worked for one of the larger health groups in this city and oversaw 4,000 patients (!). He is limiting his DPC practice to 500 patients. We had a lengthy discussion about my health background, current issues etc.

3. The Doctor is more accessible and can typically make same day appointments if there is a time sensitive issue. It is also easier to connect on the phone - no *%$^& stupid recorded message system to navigate through (and then wait.)

4. The monthly fee ($65 in my case) covers all visits in a given month. Same fee if you see the Doctor once or 20 times.

5. They are also able to get substantial discounts on medical services ordered by the Doctor including lab tests and radiology procedures. Hopefully won't need those but nice to know they are there if necessary.

One other difference is they do not participate in standard health insurance. The practice agreement states "Patient acknowledges and understands that the Practice is not a participating provider in any governmental or private health care plan." They also do not participate in Medicare. DPC is not health insurance.

Liking the look of this so far but too early to pronounce it a success. Anyone else enrolled and care to share their Direct Primary Care experiences?

 

[REWahoo]

Here are a few threads discussing concierge medicine:

http://www.early-retirement.org/forums/f38/concierge-practices-75179.html
http://www.early-retirement.org/forums/f38/concierge-doctor-83870.html
http://www.early-retirement.org/forums/f38/concierge-medicine-88075.html

 

[Dawg52]

Not available in my area.

 

[Denverite]

Here are a few threads discussing concierge medicine:

http://www.early-retirement.org/forums/f38/concierge-practices-75179.html
http://www.early-retirement.org/forums/f38/concierge-doctor-83870.html
http://www.early-retirement.org/forums/f38/concierge-medicine-88075.html

Thanks. Concierge medicine is not the same as DPC though.

http://www.physicianspractice.com/p...en-concierge-medicine-and-direct-primary-care

 

[braumeister]

I considered it about a year ago when I was looking for a new doctor. I'm very glad that you found someone good that you're pleased with.

Unfortunately, my experience was negative. When I went to the initial interview with the doctor closest to where I live, I was surprised as soon as I walked into the office by a display in the center of the waiting room. Proudly featured, under glass, was an article from some newspaper or magazine that stressed the virtues of avoiding red meat, all fats, etc., according to the AHA guidelines. I strongly disagree with that, being happily LCHF myself, so I immediately became wary.

Looking around, I saw that just about everything else in the office was something praising the doctor himself. When I was ushered in to his office, I had to pass through another corridor with his photos, mementoes, awards, etc. on both walls. Then during the interview, he hardly let me get a word in edgewise as he talked about his career and how he "managed" the health of his patients.

When I brought up a couple of points about the cholesterol hypothesis, he vigorously assured me that anything I might have read against it was wrong. He had access to "the real medical literature" that ordinary mortals can't ever see, so he "knew" what was right. I eventually managed to escape, but he still insisted on pointing out individual items on his "I love me" wall as he escorted me out.

So I had a bad taste in my mouth, just because of this one guy, and I went another, similar direction to find a doc I liked. I'm with the MDVIP system now, your basic concierge plan, and I'm happy with it.

 

[REWahoo]

Thanks. Concierge medicine is not the same as DPC though.

Thanks for the clarification.

I'd not heard of DPC and a quick search shows only a few DPC practices in my area.

 

[Denverite]

I considered it about a year ago when I was looking for a new doctor. I'm very glad that you found someone good that you're pleased with.

Unfortunately, my experience was negative. When I went to the initial interview with the doctor closest to where I live, I was surprised as soon as I walked into the office by a display in the center of the waiting room. Proudly featured, under glass, was an article from some newspaper or magazine that stressed the virtues of avoiding red meat, all fats, etc., according to the AHA guidelines. I strongly disagree with that, being happily LCHF myself, so I immediately became wary.

Looking around, I saw that just about everything else in the office was something praising the doctor himself. When I was ushered in to his office, I had to pass through another corridor with his photos, mementoes, awards, etc. on both walls. Then during the interview, he hardly let me get a word in edgewise as he talked about his career and how he "managed" the health of his patients.

When I brought up a couple of points about the cholesterol hypothesis, he vigorously assured me that anything I might have read against it was wrong. He had access to "the real medical literature" that ordinary mortals can't ever see, so he "knew" what was right. I eventually managed to escape, but he still insisted on pointing out individual items on his "I love me" wall as he escorted me out.

So I had a bad taste in my mouth, just because of this one guy, and I went another, similar direction to find a doc I liked. I'm with the MDVIP system now, your basic concierge plan, and I'm happy with it.

Thanks and sorry to hear of this experience. The medical field is certainly not devoid of narcissists. Sounds like you found one.

 

[Jerry1]

Not exactly with a DPC but, Two doctors I see do not take insurance. One is my holistic doctor. I see him twice a year for $125 each visit. The other is a dermatologist and she’s about $50 for a typical visit. She has a sliding scale that you pay before you see the Dr. Both are much nicer experiences. The dermatologist is pretty much an in and out visit once a year with possibly a small snip or freeze of some offending skin issue. I’m maybe in the office a total of 20 min to a half hour. None of it is wait time for the dr. When it’s my appointment time, a nurse takes in my information and once she’s done, goes and gets the dr, who actually comes in within a couple minutes. Good deal compared to the previous dermatologist where I’d wait in the waiting room only to be brought back to the exam room only to wait more. Total visit time, never under an hour.

Holistic dr is about the same. Wait time increases later in the day because he takes time with his patients but it’s never been bad. He’s an MD, so he’s not just someone who peddles voodoo medicine and he’s done a great job getting me feeling much better than when I first met him. Off all medications doing well. If I didn’t have him or needed someone to supplement his services, I would definitely look into a DPC or concierge type service.

It is very different to talk to a dr that is not encumbered by your insurance rules.

 

[Tree-dweller]

I’m approaching the end of my first year with my DPC doc. My experience so far is similar to yours: immediate accessibility, relaxed waiting room for the few minutes I might be waiting. My costs are more than yours, about $80/ month, and that will rise this year as I’ve turned 65. I’m not sure whether I’m going to re-up for a second year yet. Considerations: the immediate accessibility was awesome...for the handful of times I needed it. I don’t think I’ve even communicated with his office for the last 6 months, other than the Christmas card I got, but I know that could change in a heartbeat. I’m now on a Medicare plan now too, so I have to evaluate whether dpc services supplementing that is worth it (it would cost a little over a grand for the year).

 

[Sojourner]

One other difference is they do not participate in standard health insurance. The practice agreement states "Patient acknowledges and understands that the Practice is not a participating provider in any governmental or private health care plan." They also do not participate in Medicare. DPC is not health insurance.

So then I assume you need standard health insurance in order to cover any non-routine care outside the DPC doctor's office? If so, DPC sounds like a way to purchase a high level of individualized, thoughtful attention and care from your primary care doctor for ~ $700/year. Seems a tad expensive to me for what it is, but I'd probably think differently if I needed to see my doctor more than once or twice per year.

 

[braumeister]

I think there are just two main advantages to either this or a concierge service.

First, you can get a same-day appointment with your own doctor (not whoever happens to be on duty) when you need it, which can be pretty valuable. The alternative would be going to an urgent care clinic, so seeing a doctor you know is much more comforting. Avoiding a long spell in a crowded waiting room is a corollary benefit.

Second, when you do see the doctor, your appointment will last as long as it needs to. The alternative would be to rush through things and perhaps miss an important point. You also (in most cases) get a comprehensive annual physical exam and lab work.

If those two things are worthwhile to you, then it's a good option. I've been doing this for the last six or seven years and I'm very happy to spend the money for it, even though I seldom need medical attention. When I started, it was only about $30/month, and my current plan is over $100/month, but I feel as if I'm still getting good value for the money.

Of course, this just applies to primary care. For specialists, your regular insurance or Medicare still applies and you're just like anyone else. However, I've been extremely pleased with all the specialist referrals I've been given by my primary docs.

 

[REWahoo]

I think there are just two main advantages to either this or a concierge service.

First, you can get a same-day appointment with your own doctor (not whoever happens to be on duty) when you need it, which can be pretty valuable.
...
Second, when you do see the doctor, your appointment will last as long as it needs to. The alternative would be to rush through things...

Seeing this made me realize we have something close to a DPC/concierge benefit without the expense. We've almost always been able to get a same day appointment with our primary care doc and only once do I recall feeling like she was rushed during an appointment.

Of course this could change at any time, but since neither DW nor I have any chronic health issues, at least not yet (fingers crossed), her services work very well for us.

 

[Denverite]

So then I assume you need standard health insurance in order to cover any non-routine care outside the DPC doctor's office? If so, DPC sounds like a way to purchase a high level of individualized, thoughtful attention and care from your primary care doctor for ~ $700/year. Seems a tad expensive to me for what it is, but I'd probably think differently if I needed to see my doctor more than once or twice per year.

Correct. The practice agreement also states "we strongly encourage the patient to maintain health insurance during the term of this membership to cover services that are not provided under this agreement."

In my case, I'm also a member of Liberty Health Share, a healthcare sharing ministry. They reimburse part of the DPC membership payments. Not sure how much - I've not yet filed a claim. They request that is done only once per quarter, so I'll be filing my first paperwork at the end of March. So my net cost may be closer to $300 - $400 per year.

Part of the value proposition depends on your priorities. In my case, I HATE the waiting and overall environment of standard insurance-based Doctor's offices. Avoiding those is one of the main reasons the extra cost to me is worth it.

 

[OldShooter]

We are in a concierge program, too. It is inside a large health care organization so they are able to expedite for us when seeing other docs, sorting out billing questions, etc. The docs will monitor care (like a project manager) as when DW had a hip replaced. We have never needed it, but if needed they will also make house calls. We're on a first name basis with everyone in the office.

What we found when looking is that "concierge" is a big umbrella with lots of different programs. Some take insurance (ours does) and some do not. Part of the issue is with Medicare, which prohibits providers from upcharging patients above the Medicare reimbursement. So the legal beagles have to craft these things very carefully or the program must simply refuse Medicare.

We really like the program we are in.

 

[Another Reader]

I wonder how you can use a DP or concierge practice in conjunction with Medicare and a Medigap supplement. The billing system seems to be based on the caregiver submitting a bill with the correct service code on it. Do you pay the primary care doctor directly and then have the lab, specialists, and hospital bill Medicare and the Medigap policy?

I saw an article that mentioned concierge practices in the Bay Area charge $40,000 to $100,000 a year. Seems a little pricey, although this is Silicon Valley. The only DP practice in the South Bay is in Woodside and the fee is $500 a month. Totally worth it if they can diagnose a problem in one or two visits, rather than dealing with the increasingly Kaiser-like problems with Palo Alto Medical Foundation and its' parent, Sutter Health.

If anyone has health issues and has used one of these models with Medicare/Medigap, I would be interested in your experiences.

 

[braumeister]

I wonder how you can use a DP or concierge practice in conjunction with Medicare and a Medigap supplement. The billing system seems to be based on the caregiver submitting a bill with the correct service code on it. Do you pay the primary care doctor directly and then have the lab, specialists, and hospital bill Medicare and the Medigap policy?

No idea what is typical, but the programs I'm familiar with will bill Medicare in the normal way and accept what Medicare pays them. The membership fee you have paid up front to the practice is essentially for the access, and is not applied to the specific medical services you receive. Also, keep in mind that this is for primary care only, and doesn't apply to specialists, hospitals, etc.

 

[RonBoyd]

Seeing this made me realize we have something close to a DPC/concierge benefit without the expense. We've almost always been able to get a same day appointment with our primary care doc and only once do I recall feeling like she was rushed during an appointment.

Of course this could change at any time, but since neither DW nor I have any chronic health issues, at least not yet (fingers crossed), her services work very well for us.

This describes exactly our experience. I, personally, have never needed a same-day appointment but DW has twice.

Furthermore, I visit my PCP every two months for INR testing at a $10 copay -- I do this rather than test myself solely as an excuse to visit him. (The test results have not varied in over ten years.) I have never felt rushed. In fact, our visit is mostly spent discussing non-medical things.

We have Medicare Advantage at $135 a month (each) and don't see how DPC would be useful to us... unless I am missing something.

 

[OldShooter]

Our concierge program just bills the insurance/Medicare Advantage. Totally invisible and seamless unless there is a coverage glitch, then it's the usual battle.

Re cost, for one ours is $3K/year and $5K/year for two. They just bill our credit cards quarterly. No commitment. If we wanted out tomorrow they would refund any prepayment balance.

Ours, like @braumeister's is strictly for the primary care internists. They will recommend the best docs for particular situations and sometimes can expedite but there are many in this large organization that don't even know that the concierge program exists. Probably they keep it a little stealthy because they don't want newspaper stories about the rich getting better health care.

Like @braumeister's, again, under the contract the fee is strictly for access and service (we even have reserved parking near the door). It cannot be additional payment for services because that runs afoul of Medicare rules prohibiting upcharges.

 

[Scuba]

Seeing this made me realize we have something close to a DPC/concierge benefit without the expense. We've almost always been able to get a same day appointment with our primary care doc and only once do I recall feeling like she was rushed during an appointment.



Of course this could change at any time, but since neither DW nor I have any chronic health issues, at least not yet (fingers crossed), her services work very well for us.

We do too. Our PCP is over 65 though. Whenever he retires, I don’t think we will find another one like him.

 

[marko]

So then I assume you need standard health insurance in order to cover any non-routine care outside the DPC doctor's office? If so, DPC sounds like a way to purchase a high level of individualized, thoughtful attention and care from your primary care doctor for ~ $700/year. .

Exactly.

I've been with DPC for about 3 years now and have mentioned it on this forum a few times.

It does get confused with concierge services which, as noted are not the same thing.

In my case, it is age based so my monthly is $135 a month. I only see my doctor maybe 5 times a year but he can--and does--spend as much as an hour with me. As I've gotten older, more and more little arse-aches have surfaced and I like the idea of getting more than my allotted 15 minutes with my caregiver.

I also Skype/text/email him if I need something that might not require a F2F. I get a reply directly from him (not a nurse) usually within a hour or so.

I've had nothing but good experiences as the DPC doctor was my prior doctor in a large organization before venturing out on his own with this.

Seems that the hardest thing for people to get over is that there is no insurance/Medicare billing of any kind.

Next time you to go your PCP note how many people are working in that office simply to deal with insurance; all that cost goes away.

 

[Denverite]

Exactly.

I've been with DPC for about 3 years now and have mentioned it on this forum a few times.

It does get confused with concierge services which, as noted are not the same thing.

In my case, it is age based so my monthly is $135 a month. I only see my doctor maybe 5 times a year but he can--and does--spend as much as an hour with me. As I've gotten older, more and more little arse-aches have surfaced and I like the idea of getting more than my allotted 15 minutes with my caregiver.

I also Skype/text/email him if I need something that might not require a F2F. I get a reply directly from him (not a nurse) usually within a hour or so.

I've had nothing but good experiences as the DPC doctor was my prior doctor in a large organization before venturing out on his own with this.

Seems that the hardest thing for people to get over is that there is no insurance/Medicare billing of any kind.

Next time you to go your PCP note how many people are working in that office simply to deal with insurance; all that cost goes away.

Right. At one of my previous insurance-based Doctors in Denver, they had a staff member whose job was filing and following up on insurance claims. You could overhear her calls to the insurers while waiting for my appointment.

Her "conversations" often sounded more like arguments - "we didn't file under that code, we filed under this code. The amount you should have paid was this much, you paid that much" etc.

My DPC Doctor has one employee. Quick and efficient service. BTW, my DPC Doctor was also part of a large organization prior to setting up his own practice.

Many Doctors are also frustrated with the pre-authorization process required by health insurance carriers. They watch their patients suffer while the insurer decides if the Doctor's prescription is "medically necessary." That is part of the reason many are considering leaving the profession. Check this out:

http://healthmedicinet.com/i/50-of-...-theyre-sick-of-dealing-with-health-insurers/

 

[marko]

.

Many Doctors are also frustrated with the pre-authorization process required by health insurance carriers. They watch their patients suffer while the insurer decides if the Doctor's prescription is "medically necessary." That is part of the reason many are considering leaving the profession. Check this out:

http://healthmedicinet.com/i/50-of-...-theyre-sick-of-dealing-with-health-insurers/

That's exactly why my PCP went DPC. He was so frustrated by having to be "working for insurance instead of my patients". He also limits his patient membership to 650, down from the 2500 he had on his list as part of a large outfit.

 

[braumeister]

Right. At one of my previous insurance-based Doctors in Denver, they had a staff member whose job was filing and following up on insurance claims. You could overhear her calls to the insurers while waiting for my appointment.
...
Many Doctors are also frustrated with the pre-authorization process required by health insurance carriers. They watch their patients suffer while the insurer decides if the Doctor's prescription is "medically necessary."

This is so true. I saw a great example last year. My doc wanted me to get an expensive test (stress echocardiogram), and I agreed that it would be useful. He walked me out to his outer office and explained what he wanted so they could put the proper code into the order.

For the next ten minutes or so, I watched as two of his people worked the system. One of them was typing away on her computer while talking on the phone with the testing hospital and an insurance person. The other was sitting right next to her, typing away on another computer. They were both looking up medical billing codes and trying to find one that would guarantee acceptance.

After about five tries, they called the doctor back and told him it was proving difficult. He just said "I really want him to have this; please keep trying."

I asked how much it cost, and offered to pay for it myself if necessary. The staffer rolled her eyes and said "Oh, it's really expensive, probably at least $1,000." They told me to go home and not worry about it, so I did.

The test and interpretation actually billed over $5K. It was covered so no problem for me, but I got to see how difficult the problem can be.

 

[marko]

The test and interpretation actually billed over $5K. It was covered so no problem for me, but I got to see how difficult the problem can be.

They billed $5K but probably got the original $1K after all the deductions and adjustments etc.

An ambulance billed my brother's insurance $1475 for a 3 mile trip. I called the ambulance company and the lady said: "Oh, we don't expect $1475, we bill them that much so that we can get the $400 we really expect after adjustments. If we billed them $400 we'd only get $50".
(I forgot the actual numbers but it was something like that)

 

[braumeister]

They billed $5K but probably got the original $1K after all the deductions and adjustments etc.

You're close. They actually got about $850. What a strange system we have!