In this time of rising health insurance plans and high deductibles, with the future of the ACA repeal hanging in the Senate’s hands, imagine if you could bypass insurance altogether. What if you could pay your doctor a monthly fee for basic care much like a gym membership? While that may sound like a dream lost to the innocence of the 1950s, a small but growing percentage of U.S. physicians are resurrecting a model of direct pay primary care that provides better patient access with a greater focus on quality of care. It’s driven in large part by physician frustration with third-party payers and overloaded panels, as well as consumer frustration with long waits and high co-pays to see doctors for simple issues.
The concept works like this: Instead of taking insurance, your doctor would charge you a monthly or yearly membership fee for basic visits, tests and medications. For the patient, this means no surprise out-of-pocket expenses; getting seen more quickly and more often, if necessary; and a better relationship with one’s physician. For doctors, this model means they no longer have to take on more patients than they can handle, fewer third-party payment system hassles, the luxury of seeing fewer patients at their own schedule, with greater focus on the patient relationship. Of course, it does not cover catastrophic care, such as hospitalization, or treatment for diseases like cancer, and it may not meet the needs of older and disabled people who traditionally rely on Medicare and Medicaid.
Direct pay healthcare is not a new concept. Philip Eskew, creator of the website Direct Primary Care Frontier, notes that direct primary care traces its roots to the late 1990s and early 2000s when three doctors opted to dump insurance and charge monthly fees to bring some joy back to practicing medicine. And it had the added benefit of allowing patients to know exactly what their visits cost.
Regardless of its challenges, Dr. Bryan Hill, a pediatrician in North Carolina opened his direct pay pediatric practice, Gold Standard Pediatrics, in September 2016 after years of frustration with “corporate administration of a larger health system” and “the volatility of reimbursement issues” in various traditional models of care. After taking some years off
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