OCT. 3, 2015 | WILLIAMSTON, MICH — Dr. Bill and Dr. Mike make house calls. They say they have the luxury of time with their patients. They’re available after hours. Patients visiting the office are greeted by the doctors, who walk them to the exam rooms and conduct the blood pressure or other tests themselves.
Sound like a flashback to a simpler time? No, it’s a newer model called direct primary care and supporters predict it’s the face of the future.
The heart of the model is this: No insurance is involved. Instead, patients pay a monthly enrollment fee of $50 to $65 a month, and $10 per child of an adult patient. In exchange, patients get well visits, checkups for chronic conditions and care for all the illnesses, rashes, injuries and aches and pains that send you to your doctor.
“We’re putting the Marcus Welby back into a system that had Marcus Welby taken away,” said Dr. William Mangan, referring to a hit TV show, “Marcus Welby, M.D.” The series about a kindly family physician aired from 1969 to 1976.
Drs. William and Michael Mangan, father and son, converted their traditional practice in Williamston to a direct primary care office in July. It’s a model that’s growing across the country, and supporters say the dollars saved by bypassing bureaucracy and paperwork make health care both affordable and high quality.
The Mangans appear to be the first in mid-Michigan to launch a direct primary care practice but others are soon to follow, they said. They are passionate about the movement and are sharing their insights with other doctors. They know of three other doctors making the change or considering it.
Mangan said he was weighing a career change after 22 years practicing medicine, as insurance codes controlled more and more of this work.
“I couldn’t in good conscience continue the assembly-line medicine I was being forced to practice,” he said. He had about seven minutes per patient instead of the 30 or more minutes needed.
When Mike Mangan joined his father’s practice after he finished his residency in 2012, he also was disheartened.
“It was very misaligned with how I dreamed about practicing medicine … That was disturbing, and it wasn’t something I was willing to settle for,” he said.
He found others using the direct primary care model and convinced his father it was the way to go.
In fact, William Mangan, appearing relaxed during an early morning interview at his office in jeans and sandals, said it’s given him renewed passion for his profession.
About 10 percent of the Mangans’ former patients moved with them to the new model. It’s now about half old patients and half new. The goal is to have 800 patients per doctor — about a third to a fourth of the number needed to make it in a traditional practice.
Patients are advised to get high-deductible insurance policies to cover major illness or injury.
The Mangans didn’t want to say how many patients they have, but they have room for more. If they reach 1,600 patients, they will consider adding another doctor.
A reader had already told me about the Mangans when I heard directly from William Mangan after a column ran last month on Joanne McCloskey, a Haslett woman upset with a second “facility fee” for a routine doctor visit. The fees are allowed because McCloskey is on Medicare and her doctor’s office was purchased by a hospital system, McLaren Greater Lansing.
Mangan said no facility fees or other such complications exist at his office. And, without the insurance requirement that face-to-face meetings take place, the doctors are free to Skype, text or talk on the phone with their patients.
William Mangan received his medical degree from Michigan State University College of Osteopathic Medicine in 1992; Michael followed in 2009. Their practice is called the Family Health Center of Williamston.
Ed and Sue Kaiser of Williamston are longtime patients. They were skeptical of the new model at first, but now embrace it. They’ve even found a way to pay for it by dropping their Medicare prescription coverage for Sue Kaiser. She said she’s able to get her medications cheaper through the doctor office than paying for the prescription coverage.
“Basically, this is not going to cost me any more money that it would before,” Sue Kaiser said. Added her husband: “I’m a skeptic, and I had some skepticism about the promises versus what would happen. I’ve been very, very happy.”
Mike Mangan says it’s simple and legal for doctors to dispense prescription drugs other than narcotics and sedatives.
A survey last year by the 70,000-member American Academy of Family Physicians reported that 2% of doctors surveyed are practicing direct primary care.
“I would say it’s an option with a lot of growing interest,” said Dr. Robert Wergin, chair of the AAFP’s board of directors, based in Leawood, Kansas.
He said doctors are finding more satisfaction with the model. “They have big smiles on their faces,” he said.
One doctor tracking the model has a website with just nine direct primary care practices in Michigan. The map doesn’t include the Mangans. All of the others are in southeast Michigan.
Michigan was the seventh state to pass legislation, early this year, to make it clear that direct primary care model is not an insurance product that would put it under insurance regulations. Now, some 17 states have passed such laws, Wergin said.
State Sen. Patrick Colbeck, R-Canton, sponsored the legislation.
“This is a complete revolution,” he said. “It’s gotten to the point where there’s so much of a Rube Goldberg system around health care, there’s so much fat to trim, it’s low-hanging fruit.”
The Michigan Association of Health Plans, representing health insurers across the state, doesn’t oppose direct primary care but urges patients to be aware that it’s not going to cover a fall from a ladder that shatters a leg or care for a major heart attack.
“You just have to realize what you’re getting and what you’re not getting,” said David Waymire, spokesman for MAHP.
Also, no insurance products exist that carve out primary care, so there’s no existing wraparound policies that recognize the direct primary care model, Waymire said.
William Mangan said one of the biggest criticisms is that because the direct primary care practitioner serves fewer patients, such practices won’t help alleviate the predicted shortage of family doctors. The Mangans believe it will reinvigorate the profession and attract more to it. Also, with more quality care, patients will be healthier.
“I truly, in my heart, believe we are moving in the right direction, a direction that is good for patients, good for doctors coming into the field and good for the country,” William Mangan said.
“It’s a movement. We need to improve our profession and make family medicine a desirable field again,” Mike Mangan agreed.
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