SWAMPSCOTT, MA. – The average patient visit with a primary care doctor today lasts less than 20 minutes. Now imagine having unlimited time to discuss your medical needs, same-day appointments, 24/7 access to your doctor via cell phone or email, without co-pays, deductibles or insurance issues.
A new healthcare model — direct primary care, or DPC — aims to make this vision a reality by offering affordable, personalized care for a flat fee.
DPC is a growing healthcare alternative currently provided by more than 4,400 U.S. physicians, including Marblehead doctor Jeffrey S. Gold, M.D., who is the first DPC practitioner in Massachusetts.
DPC doctors typically do not accept traditional health insurance; instead, their patients pay a flat annual or monthly fee (usually less than $135 per month) that covers all office visits and an annual physical exam. Testing, labs and ancillary services are usually charged at a reduced rate since they are conducted in-house.
For example, a cholesterol test could cost $3 with DPC compared to $90 with a traditional health insurance plan.
With this membership-based approach, a patient can see his or her doctor as often as needed to meet medical needs. Today, nearly 50 percent of a primary care doctor’s workday is spent outside of face-to-face patient visits. DPC proponents say this model strips away overhead and billing complexities so doctors can provide one-on-one care. Instead of standard 2,500-plus patient rosters, DPC doctors may only see 600-800 patients in their practice.
Dr. Gold, a longtime Swampscott resident, is opening his new DPC practice, Gold Direct Care, in early 2015 after seven years with a major hospital system. He says it’s important to understand that DPC plans are not insurance and only cover primary-care services. While DPC can serve as a stand-alone benefit, supplemental insurance such as a PPO, Medicare or a major medical plan is strongly recommended to offset specialty care or procedures, hospitalization, or emergency healthcare costs.
“The reality of today’s healthcare system is that insurance-related administration consumes a huge portion of a doctor’s day, which can negatively impact patient care,” Dr. Gold says. “A transition to direct primary care made solid sense to me. I no longer deal with reimbursement complexities so I’m freed to practice medicine the way it was intended, and my patients benefit by getting better medical care with no unexpected out-of-pocket costs.”
With the introduction of the Affordable Care Act, or ObamaCare, DPC practices are positioned to alleviate the strain on the healthcare system due to the 30 million Americans who will now have healthcare coverage. In fact, DPC plans can even be a cost-effective and accepted alternative to ObamaCare when combined with a wrap-around catastrophic insurance policy, its proponents say.
The benefits of direct primary care span beyond individuals and providers — employers are also acknowledging the value of DPC as a means to increase employee health, reduce absenteeism and save money. A DPC plan can be combined with a company’s group plans or self-funded group plans to offer additional coverage. When paired with a wrap-around insurance policy, often a high deductible plan, employers can offer what amounts to first-dollar coverage in a plan for up to 20 percent less than the cost of a regular PPO-style health plan.
“DPC is a win-win for everyone,” Dr. Gold says. “Employers save money, doctors obtain financial stability and a patient-centered focus, and individuals and families get top-notch, attentive primary medical care for a very reasonable cost.”SOURCE: http://cambridge.wickedlocal.com/article/20150216/NEWS/150217317/2002/LIFESTYLE/?Start=2#sthash.OyHJwGHp.dpuf