Is Direct Primary Care the Wave of the Future

Is Direct Primary Care the Wave of the Future

by Susan Neuhalfen

With medical insurance becoming harder to navigate (and afford), doctors are scrambling to find new ways to provide quality healthcare for their patients. One of the newest ways to do this is a medical model called Direct Primary Care.

Direct Primary Care is medical care without insurance. DPC facilities charge patients a monthly fee that covers different services. For some, a monthly fee covers any and all visits and consultations, even over the phone. For others, it also includes lab and blood work. DPC facilities do not have to answer to insurance companies, so many of the same the rules don’t apply.

Argyle Family Medicine is a DPC facility. Dr. Becky Gomez said that she schedules an hour for her patient appointments now because she isn’t under the same pressure to see a certain amount of patients per day as she was with insurance companies.

“I don’t need a huge staff because scheduling is simple and we don’t have to hassle with insurance,” said Dr. Gomez, an internist and Argyle resident. “They can call for consultation over the phone which, with insurance, would need to be an in-patient visit.”

The simple fact is that insurance companies don’t pay doctors unless they actually SEE the patient. That’s why a doctor won’t diagnose over the phone or just write a prescription without first seeing a patient. Also, insurance dictates that doctors see a particular number of patients within a certain amount of time, so hour-long appointments just aren’t feasible.

For the most part, Direct Primary Care is about wellness and preventative medicine. Doctors like Gomez also provide minor procedures and handle chronic disease management such as diabetes.

Argyle resident Phil Loftis and his wife are both small business owners. They, along with their three kids, are all patients at Argyle Family Medicine. Like most, his insurance coverage has doubled in price but has become virtually unusable.

“From a financial standpoint we save money and the level of care is ten times better than with insurance for three kids,” said Phil who owns Sigma Signs. “Insurance is there in case of a catastrophe but it’s extremely convenient to go through Becky (Dr. Gomez) for our regular family needs.”

DPC patients still need health insurance to cover hospital emergencies and to meet the Affordable Care Act criteria. Since ACA was enacted, catastrophic insurance (high deductible, used only in case of emergency) is not as affordable as it used to be.

The argument against DPC is that patients will forgo insurance altogether especially those who are younger and don’t get sick often. The problem comes when something bad does happen and not only will they owe the medical bills, but the government will fine them for not having insurance.

The other concern is that the more doctors turn to DPC, the less doctors there will be to fill the insurance gap. With insurance, well over 60% of doctor’s office costs are administrative, which is why DPC doctors can survive on the monthly cost alone. Many of the DPC doctors say that they don’t make as much money, but the trade off is worth it.

“Insurance is getting so hard to deal with as a doctor,” said Gomez. “It makes it hard to focus on the patient when so much of your time is spent with paperwork.”

DPC is growing in the North Texas area and facilities are popping up in Frisco and Roanoke with another to soon open in Flower Mound. It’s whether patients find the additional cost worthwhile that will determine its survival.

“Having insurance doesn’t necessarily mean you have healthcare,” said Gomez.

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