Direct Care Doctors

SPOTLIGHT (Calif): Coastside doctor offers cutting-edge medicine the old-fashioned way

A few of Page’s patients have dropped their insurance plans altogether, a move she doesn’t recommend.

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By Kaitlyn Bartley

A Coastside crisis seven years ago prompted Dr. Lorraine Page to adopt a new method of providing patients with primary care that’s becoming a rising trend among doctors nationwide.

Instead of handling insurance billing herself, Page eschews an office and dealing with reimbursements altogether. Now, she simply bills her patients directly for her time when she visits them in their homes.

“It’s very personalized; it’s true family practice,” said Page. “It turns out to be something I truly enjoy.”

Although she may be among the first, Page is by no means the only doctor to stop dealing with insurance altogether. Some doctors offer concierge medicine or retainer medicine, while others provide direct primary care, and Page says she hasn’t really put a label on her own billing model. But the number of doctors nationwide who are choosing to bypass the headache of handling insurance claims has increased, although it remains a small percentage of doctors overall. Nationwide, around 3 percent of members of the American Academy of Family Physicians currently practice with a direct primary care model of delivery, double the number of doctors who did so just two years ago. The rate of direct pay doctors may still be low, but a decade ago they were nearly nonexistent: in 2005, there were fewer than 150 doctors in the country who provided direct primary care nationwide, according to a Government Accountability Office report.

Page was forced to adjust her care model seven years ago with the Coastside Family Medical Center where she practiced in Half Moon Bay closed with no advance notice. The clinic’s 8,000 patients were left suddenly without doctors. “To fill in the gap, I started seeing people at home, and that’s how this got started,” said Page. “It’s worked for me.”

Page now charges patients depending on how long appointments take. “I set a timer at the start of the appointment,” she said. “Kind of like an attorney bills by the hour, but I’m a lot cheaper.” If Page’s patients have a preferred provider organization health insurance plan, they can be reimbursed for out-of-network care.

But even for those who have insurance plans that don’t accept out-of-network care, many of Page’s patients have plans with such high deductibles that they won’t be reimbursed for primary care regardless. “They still pay for their primary care, and people aren’t minding to do that as much.”

A few of Page’s patients have dropped their insurance plans altogether, a move she doesn’t recommend.

For Page, the advantages of the new billing system are both holistic and economic. Her overhead costs have fallen from well over 50 percent of her revenue to less than 10 percent now. “I just have my car and my gas and my supplies,” she said. “What was kind of enlightening to me the first year I started doing this was I don’t need an office. Most of what I do is talking to people, diagnosing, and advising,” she said. “Everything I need, I can do mobile.”

And her patients appreciate that mobility, says Page. “I’m getting more young families because I can see their kids in their home after school,” she said. “And it doesn’t make sense for sick people to go to the office.”

Sidestepping the hassle of insurance billing isn’t without its critics, though. Some detractors say that if a patient drops his or her insurance plan in favor of direct pay or concierge medicine, it can pull the wealthiest or healthiest patients out of the insurance pool, leaving behind the sickest and poorest — forcing their premiums to rise. Others say that the current shortage of primary care doctors who accept insurance will only be exacerbated if they see only wealthier patients who can afford to pay out-of-pocket.

And there’s one patient population that Page doesn’t currently see. She doesn’t see low-income patients on Medicare or Medicaid, and “that’s one population I have a little guilt about not taking care of unless they can afford it,” said Page.

But Medicare and Medicaid don’t reimburse for home visits unless there’s a valid reason why the patient can’t get to the doctor, she said. Page says she has a hard time imagining that Medicaid will ever change its stance toward house calls, “just because of the bureaucracy of it. Things change so slowly in medicine,” she said. “I’m not going to wait for the system to change. I’m just going to do what I can now to take care of people.”


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