Posted by: AtlasMD

December 12, 2013

ACA Homogeneity — Direct Primary Care Doc Closes Up Shop In Wisconsin

We’re disheartened to share the news that Dr. Schupp closed his Madison, WI-direct primary care facility last month. He told the DPC Journal Editor, Michael Tetreault, “I wanted to try something different [entrepreneurial] and had over 100 patients were interested in the first two-months of startup. I was able to cover expenses with just 40 patients.”

Ouch. It’s incredible to hear that Dr. Schupp managed to break even with just 40 patients enrolled. Schupp continued to tell Tetreault, though, that several factors determined his decision to discontinue operation… one of which included the uncertainty of prospective patients related to the Affordable Care Act.

“The Affordable Care Act marketplace presented a lot of problems for my practice,” he wrote. “This is ironic, since a more transparent marketplace would be beneficial for me, but I did not foresee a broken website, a government shutdown and more expensive insurance for many of my patients. The new signups to the practice nearly stopped during the month of October, and people on the waiting list understandably wanted to remain there until the marketplace was functioning.”

The Capital Times reports that Dr. Schupp’s practice “flatlined” after 6 months of operation. However, Dr. Schupp added that it was a rewarding endeavor that he really enjoyed. Schupp admitted, “Straight out of residency here [Madison, WI], we have very few options and most involve working for an HMO in this area.”

In the time that his practice was operating, Schupp said he had attempted to set up deals with over 500 small businesses but “unfortunately [they did] not work… out.”

“Thank you all for putting your faith in me as your doctor, and for joining something so unusual,” Dr. Schupp wrote in an email to his patients announcing the bad news. “Unfortunately, it has to come to an end.”

Schupp gained a lot of interest back in August when he established his direct primary care medical practice. Like our Atlas MD model, he charged patients a monthly fee for unlimited access to his family medicine practice. Schupp’s rates were between $30 and $50 a month to provide primary care (i.e. VERY affordable). By side-stepping the insurance industry, the Cap Times said, “He could operate his practice affordably because his time would be spent on patients, not red tape.”

Schupp is offering refunds to patients owed any service. He’s working with them over the next two months to help figure out a “long-term plan for continued health care” at no additional charge.
According to the Cap Times, “He now plans to take a more conventional approach to his career.”

“At this point, it is unclear where I will end up, but I will either be at an HMO in town or a small clinic in a nearby small town,” he writes. “I will know in about a month, and I will let you know.”

As you know, year one is the most challenging time to get a practice off the ground. In Dr. Schupp’s case, though, he set some hard rules for himself. For one, he told the Cap Times that he wanted to be operating debt-free within his first year of practicing. We applaud his ambition but would encourage doctors to be more lenient when it comes to credit. Enrollment is not a given when breaking ground on a new direct care facility. You need to be realistic about recruitment timing. Which leads to marketing, another important part of launching a practice. How will you communicate to patients that insurance, although status quo, isn’t actually the most logical way to get primary care? We’ve seen many allegories, e.g. auto insurance for gasoline, and others. You’ll need to be able to articulate this idea confidently to inquiring patients.

Location is crucial to starting a direct care practice. We’ve reviewed a list of the best cities and states to practice direct care (and added our two cents regarding them). Also, we’ve built I Want Direct Care so you can determine hot spots for direct care. In Dr. Schupp’s case, he was up against a populace that seemed resigned to the fee-for-service model.

As you know, we also encourage docs to offer wholesale prescriptions through their clinic. The cost-savings are considerable. This is another compelling way to enroll more patients. Check out this overview of state laws regarding Rx dispensing to make sure your state permits it.

Although, we’re severely disheartened to hear that Obamacare’s fickle nature left people on the fence about switching to insurance-free medicine. This seems like a complete bureaucratic blunder. In our administration’s failing to launch its initiative (with more red tape, disruption to current coverage, all out confusion regarding the future of insurance premiums, etc.), one doctor missed his opportunity to positively influence the price and quality of healthcare. In the end, Dr. Schupp has conceded to a status quo practice of medicine, something that, according to both data and stories, leaves much to be desired.