Why DPC?

A few weeks ago our friend Dr. Jim Blaine offered me the opportunity to write an editorial for the upcoming issue of the Greene County Medical Society Journal.  I'll share it with you below:


On November 2nd, 2015, nine months from being just a thought or an idea, my wife Melissa and I opened Ascent Direct Primary Care in Nixa, MO.  At times, it has been like getting on a roller coaster that rapidly accelerates and decelerates then turns you upside down and leaves you there for awhile.


Why did we get on this ride?  The practice of medicine has changed.  I wanted to be a doctor to get to know my patients, to listen to them, to work through complex problems and to help motivate them to healthier living, and I wanted to make a suitable living doing it.  I’ve always practiced that way.  I didn’t get into medicine purely for data collection.  It isn’t enjoyable hurriedly clicking boxes like a surveyor, playing the coding game for insurance reimbursement, while half-listening to a patient for five to ten minutes then rushing to the next room.  It doesn’t feel like quality to me or to the person who came to me for my expertise.


While the current healthcare climate is fraught with frustrations including access problems, administrative and regulatory burdens, lack of cost transparency and overspending, it is the perfect environment for sparks of innovation and change.  Patients and providers alike seem to be reaching a tipping point.  Many recognize something’s got to give, and are ready to try something new; disrupt the status quo.


I am excited about the positioning of direct primary care to address some of the issues, provide some unique, though strangely familiar solutions, and reinvigorate the healthcare industry both nationally and right here in southwest Missouri. 


Let’s start with the access problem.  Direct primary care medical homes limit the total number of patients one provider will take on to remain accessible to the patient population the medical home serves.  Doctors with too many patients are unable to get patients in when they need to be seen, unable to handle simple things over the phone, and are unreachable outside of business hours.  This pushes patients toward emergency rooms and urgent cares when that level of care may not be necessary.  Some of the larger direct primary care networks have cited decreases in urgent care and emergency room visits of fifty to sixty percent compared to traditional medical practices.  Patients are able to access a more appropriate level of care and cut costs at the same time.  Some might argue that taking on less patients per practice will only worsen access issues.  I truly believe as doctors are able to spend the appropriate time with patients and patients get back the experience they desire and expect with their doctors, goals will align and satisfaction goes way up for both.  This increases the demand and will attract new physicians back to primary care in the long-term, as the profession begins to look attractive again.


Administrative and regulatory burdens do not disappear entirely.  Doctors have to learn to run a business in direct primary care.  You won’t escape prior authorizations.  But you have time to tackle those tasks because you are not spending your time and resources coding for insurance and clicking boxes in an EHR to document for the sake of documenting.


One of the greatest frustrations in healthcare is the overspending and lack of cost transparency.  Insurance premiums continue to rise, along with deductibles, at an alarming rate.  Explanations of benefits will continue to confuse, patients and providers are often completely unaware of the costs of medical care.  This is where direct primary care gets really exciting.  Practice overhead drops dramatically when you don’t have to throw all the resources at billing and coding for insurance reimbursement and the staff required to carry that out.  The savings get passed directly to patients and the physician can still make a very reasonable living.  Patients know what they are paying for and how much they are paying for it.  No explanation of benefits needed.  The direct financial relationship also adds a level of accountability for both the patient and the provider.


I won’t pretend to think that direct primary care is the solution to all of our nation’s problems with the healthcare system, but it sure takes and amazing crack at a lot of them.  There are still hurdles.  We need collaboration with insurers to provide products that mesh well with direct primary care; that offer lower premium options that cover the big stuff, the unforeseen surgeries, hospitalizations and true emergencies.  We need collaboration with specialists and with the larger hospital systems to provide patients with necessary screenings and care at an affordable rate.  I believe there is potential for that sort of collaboration and that it is beneficial for all sides and for the health of our community.


In our first five months of operation at Ascent Direct Primary Care, we have been able to do some really cool things for our patients, invest more time in their lives and their health, save them hundreds of dollars, often in a single office encounter, and completely surpass their wildest expectations of the doctor’s office experience.  I’m enjoying the ride.