Published: Tuesday, June 9, 2015 at 6:01 a.m. | Last Modified: Monday, June 8, 2015 at 10:25 p.m.
A newly opened clinic in a small office plaza near a busy Gainesville intersection marks the local arrival of a growing national trend in health care.
Opened in May behind the CVS Pharmacy on Northwest 23rd Avenue and Northwest 43rd Street, Celebrate Primary Care has patients pay a monthly membership fee to cover their visits and works without involving or billing insurance companies.
The clinic was started by Della Tuten and Lisa Magary, advanced registered nurse practitioners, who met some 10 years ago as graduate students at the University of Florida College of Nursing and vowed to one day start their own practice.
“What we are trying to do here is to take a business model that has worked in other areas of the country and in Florida and bring it to Alachua County,” Tuten said. “We want to provide better access to primary care for people who are uninsured or have insurance but want better access.”
The treatment model is known as direct primary care.
Industry expert Michael Tetreault, the editor in chief of the trade publications Concierge Medicine Today and Direct Primary Care Journal, said this model is a “cousin” of the more well-established concierge medicine, where patients pay monthly fees to access their doctor or health care provider.
The main difference, Tetreault said, is that direct primary care clinics avoid insurance so that providers deal directly with patients without the additional administrative tasks and costs.
He said his group estimates that there are now some 5,000 concierge health care practices in the country and about 300 direct primary care practices.
Tetreault said the concierge and direct primary care models have grown more common in the wake of the Affordable Care Act because patients are now “more conscious and aware of what they are spending on their care and looking for more affordable ways to access quality health care.”
With the number of patients limited to fee-paying members and the administrative tasks associated with filing claims with insurance companies out of the way, the clinics sell themselves on fewer appointments per day, longer one-on-one time with patients during appointments, access that includes practitioners who respond to texts and phone calls during weekends and flexible schedules for appointments.
The clinic’s cozy waiting room is furnished with a small light green love seat and two paisley, upholstered chairs. Behind the counter, where the clinic’s medical assistant and works, a board lists the more than 50 primary care services — including physicals and treatment for diabetes, hypertension, headaches, PAP smears, some wounds and infections, arthritis, allergies, cold, pneumonia and flu — most frequently requested.
Traumatic injuries, broken bones and care for diseases like cancer are beyond the scope of services offered at the clinic.
The board also displays the monthly fees for the clinic’s patient-members: $25 for children to age 19; $50 for ages 20-50; $75 for ages 51-64 and $100 for ages 65 and up.
The clinic also has sought out and secured contracts offering discounted prices on many lab tests and on many of the medications that advanced nurse practitioners are allowed to prescribe in Florida.
While state law does not allow nurse practitioners to prescribe medications listed as controlled substances, the state does allow them to open their own practices, provided that a doctor signs off on the treatment protocol they have filed with the state.
In a state where some 800,000 residents have no coverage because no form of Medicaid expansion went through the Legislature, clinics like Celebrate Primary Health Care fill a need by providing affordable access to the uninsured that keeps them out the emergency room for routine health issues, Magary said.
The clinic is also trying to target small businesses with less than 50 employees that are exempt from the Affordable Care Act requirement for companies to get insurance coverage for their employees.
Those companies’ owners may find the purchase of coverage for employees too costly but may still want to provide them with some form of access to primary care, Tuten said.
Magary said the clinic also serves people with insurance who may want to avoid co-payments and out of pocket deductible costs.
Gainesville resident Amanda Copley, 39, has insurance through her job but also pays the fee to go to Celebrate Primary Care. During a Friday morning appointment, Copley, who has the inflammatory disease lupus and arthritis, said she has paid less for some lab tests than she would have had she used her insurance.
She said she also likes the flexible schedule for appointments, the longer stretches of face time with a practitioner during those appointments and the quick response to phone calls or texts sent during the weekends.
Copley said she sees some similarities to an old country doctor from a classic television show.
“It kind of reminds me of Little House on the Prairie when you call the doctor and he comes and sees you … because I don’t always get sick from 9 to 5,” she said.
Tuten said while the clinic does not work through insurance, they do not want to compete or serve as a substitute for insurance coverage. She made a comparison to automobile insurance, which covers significant costs such as damage from a crash but not oil changes and other routine maintenance.
Currently, she said the clinic was working with a firm to try to work out an agreement where members can purchase catastrophic or high deductible health insurance plans they may need if they face significant hospital bills for an injury, disease or other serious medical condition.