A Direct Primary Care membership model is an exciting and promising new way for the average person to get really great primary care. Better access to providers, shorter wait times and happier providers and staff. Primary care and urgent care make up most of the care that most of us get–but yet insurance companies usually only pay 1% of the average patients premium toward primary care.
“It is a very promising and good model,” said Dr. Arnold Milstein, a professor of medicine at Stanford University and head of the Stanford Clinical Excellence Research Center. “It is speedy and economical, and these practices are making themselves available to working people.”
A bookkeeper from a Safeway store is enrolled in a direct pay practice through her union. She feels that direct primary care has been a dramatic change from traditional care. “I have never waited longer than five minutes in the waiting room,” she said. “And I don’t feel like I am being rushed.”
The monthly membership fee does not cover anything beyond primary care. Typically employers or patients can combine direct primary care with higher-deductible insurance plans, needed to cover hospitalizations and visits to specialists.
“Health insurance is supposed to protect you against risk, like car insurance does,” said Dr. Bliss. “We don’t insure our cars for tire changes and tune-ups.”
So why not take insurance or Medicare? Unfortunately, without a change in federal law, doctors who contract directly with patients cannot treat Medicare patients. Direct primary care doctors tend to be those who have opted out of Medicare and can charge whatever they want, but they cannot bill Medicare for reimbursement, nor may their patients.
“Our doctors do have to drop out of the Medicare system, because there are laws that don’t allow physicians to charge rates lower than Medicare rates,” Dr. Qamar said. “We think we can save money for the Medicare program and improve quality by preventing downstream admissions.”