Direct Care Is The Blue Collar Bootstrap Solution To Our Broken Healthcare System

Yes, it’s true. More and more primary-care and family physicians are launching concierge practices for middle- and lower-income patients. It’s not an April Fools jokes. We literally saw 5 more docs enter the field just this week!

And yes, we’re limited in scope now. But we are radically reshaping how American families get their medicine.

“We’re running a business that’s profitable and caring for patients the way we’ve been trained to care for patients,” says Dr. Jonathon Izbiciki, owner of Izbicki Family Medicine in Erie, Pa. “We have our voices back, and we’re masters of our profession. There’s nothing better than that.”

We’ve fought hard to change the preconception — no-insurance — or “retainer” or “direct-care” — approach is exclusively reserved for the wealthy. Not true. Specialists or physicians who catered to deep-pocketed patients have in the past charged a lofty monthly “membership” fee, and in exchange, provided “luxury” amenities like same-day appointments, little to no wait times, more time with the doctor and consultations by phone, email, Skype or even text-message.

However, minus the shiny marble floors and fountain in the lobby, we provide many of those services — for about $50 per month. In short, in Direct Care, we offer the same concierge medicine services at a mere fraction of the cost.

“We’re like the blue-collar concierge,” Izbicki says.

About 6 percent of physicians were in concierge or cash-only practices last year – up from 4 percent in 2012, according to the health information website MedScape.

“That number’s growing rapidly,” says Mark Pauly, a professor of health care management at the Wharton School at the University of Pennsylvania.

“They think this is a more noble way to deal with a patient population than trying to run everything through insurers,” Pauly says. “It’s a way to keep it affordable and keep it accessible.”

Izbicki and his brother, Dr. Harry Izbicki, embraced the retainer model in September. For years, they’d worked under a traditional insurance model, first as employees of another practice in Erie, and then at the doctor’s office they opened in April 2010.

And get this: they found the work relentless.

“My office hours would start at 8 o’clock in the morning, and I wouldn’t get home until 8 o’clock at night,” Jon Izbicki says. “I’d see patients from 8 to 5, and then be at the office another three hours doing paperwork or typing up my notes.”

The reason, he said, was patient volume. Insurance companies essentially keep their reimbursements at a fixed rate, so one of the few ways to keep up with rising overhead — from salaries and taxes to medical malpractice insurance — was to see more and more patients.

“The system is built to be a production line,” says Dr. Aly Cohen, an internist and rheumatologist in Monroe Township, N.J., who plans to switch to a retainer model July 1. “It’s just an unsustainable model.”

We’ve been comparing cash-only medicine to fee-for-service for years now. Look at the numbers. When you cut the red tape, you improve the quality and efficiency of care.

In fee-for-service, primary care doctors see an average of 2,500 patients. The Izbicki brothers were no different. At their peak, they’d see about two-dozen patients a day each, with consultations often just 15 minutes long. Doctors at other practices, might see even more patients — sometimes as many as 30 or 40 a day.

“The quality of care starts to go down, or the people’s perception of care starts to go down, they don’t feel safe, and the trust between patient and doctor starts to slip,” Izbicki says.

However, here at Atlas MD, our doctors see about 600 patients per day. And we see them for AS LONG AS THEY NEED TO BE SEEN.

We realized that insurance paying for primary care is akin to using car insurance to try to pay for gasoline. It’s something that’s otherwise fairly affordable until you try to pay for it with insurance: Your premiums would be much higher because they wouldn’t know how much gas you would need, they would tell you where to get gas, and you’d have to preauthorize trips out of town.

Here at Atlas MD, members who are 20 to 44 years old pay $50 a month, those 45 to 64 pay $75 a month, and those 65 and older pay $100 a month. Children and teens up to 19 years old cost just $10 a month. A typical family of four pays about $170 a month.

The membership covers most primary care procedures, from physicals and EKGs to strep tests and stitches. The doctors will even do house calls at no extra charge. Medicine or lab-work, meanwhile, carry wholesale prices: $5 for heartburn medication, for example, or $6 for a prescription to treat migraines. Blood work that might cost $30 out of pocket under an insurance plan instead costs just $2.

We can order-in medicines because the clinic’s income is based on membership. We don’t need to make money dispensing medications. Seriously, we can get 1,000 Prilosec pills for $55, and we can dispense them to patients for a couple dollars. It’s significantly less expensive, easier for everyone involved, and smooths out the kinks of a complex, costly healthcare system.

For preventative measures that are free under the Affordable Care Act, like vaccines and colorectal screenings, Atlas MD and Izbicki Family Health help make arrangements for their patients, such as through referrals to local in-network clinics or hospitals.

We strongly encourage our patients to take out high-deductible insurance for emergency coverage in the event of a catastrophe. Buying an insurance plan, though, doesn’t mean patients end up paying double on top of their membership fees.

In fact, between the hefty copays that patients would otherwise have to cough up at a doctor’s office under a high-deductible insurance plan — or the lower copays but higher premiums they’d be charged for more comprehensive coverage — patients stand to save money or break even under the low-cost retainer model.

“The average number of doctor visits per person per year is three to four,” Pauly, the Wharton professor, explains. “Imagine, in the standard insurance world, that the doctor would charge $150 per visit. If we did four visits, that’s about $600 a year, or $50 a month. There’s economic logic to that.”

And plenty of other benefits come with the retainer model, too, proponents say. Doctors immediately save tens of thousands of dollars that they’d previously spent on insurance billing, they have more time to focus on patient care, they get to buy medication and order lab-work at bulk prices, and they get to end their days far earlier.

“I get home by 5 or 5:30 at the latest,” Izbicki says. “My paperwork is complete. I leave smiling, I’m happy, I’m not grumpy and irritable. My life has gotten a lot better. I feel like a professional, that I’m doing what I signed up for.”