The average healthcare insurance CEO makes millions in bonuses. The average family in RI makes $63,870. Yet insurance companies have multiple roadblocks in place to decrease what they cover for the average patient.
As primary care doctors, whether we practice in our model of direct care at Direct Doctors (monthly membership), or a traditional fee for service model (you pay per visit, usually billed to insurance and then a copay requested from you), all PCPs have to jump through insurance company hoops.
For example, if I see a patient of mine who has injured their knee and it seems pretty certain to me they have torn something that likely requires surgery (and won’t get better with just therapy and ibuprofen), my job as the physician is to recommend and order for an MRI. If a patient does not have insurance, or has a healthshare like Liberty, I can send that order directly to the imaging facility and the patient can pay the cash price, which in our experience is from $400-700.
We all know and admit there are a lot of problems in U.S. Healthcare. It may not always be clear what they actually are, or better said, what the actual root causes are. It’s clear to many that when you call to see your doctor, you can’t get in quickly; when you look for a new PCP taking patients, you wait 6 months for your new visit; when you want to see the doctor you signed up for, you see a PA instead; when you want to talk to your physician, an RN or MA gets on the phone instead.
But why is that? What has happened to the era of house calls, general practitioners who cared for your whole family and swung by when the kids were home with Scarlet Fever? Why don’t doctors take care of you like they used to?
Every year we release a blog about the open enrollment season and things folks should think about when purchasing health insurance. Most of the information is consistent this year, though I’ve updated things a bit below:
Whether you purchase your insurance through the state, government, employer or directly from the vendors, this can be a daunting process. There are often many choices, with slight differences that are difficult to decipher. Beyond that, because price transparency is such an issue in healthcare, it is often hard to plan or budget for future costs when there is no way to find out how much these services actually cost! Below, I’ve tried to outline a couple tips while going through this process.
Nothing is free!!: Many patients get a large portion of their health insurance paid for by a third party (employer, government, etc). This creates the notion that health care is cheap or free in certain situations. Please remember that although you may not pay much in monthly premiums or out of pocket costs for your insurance, your employer is likely paying an exorbitant amount for health care services you may not even use. This cost has gone up considerably in the last few years
When some people hear about Direct Primary Care, they automatically think of concierge medicine and assume they cannot afford it. DPC skeptics will tout that membership based care is only for the uber wealthy and will leave those well off behind. However, did you know that only 3% of Direct Primary Care patients would classify as "Upper Middle Class" or above nationally.
The average deductible on an employee’s insurance plan has risen 49% since 2011. That means more and more patients are finding themselves with less and less “coverage.” When your deductible rises (in an effort by your employer to control healthcare costs), your out of pocket expenses go up if you use the healthcare system at all. Often along with a higher deductible, come higher copays for specialist visits and sick visits with your primary care doctor. You go from paying very little “out of pocket” to having to cover every expense up to $2000-$6000 or more of what you need each year.
Have you ever tried to get a new patient appointment with a primary care doctor? This is an exceptionally hard task these days. According to Merritt Hawkins, the average wait time for a new patient appointment with a primary care doctor is 24 days, up from 18.5 days in 2014. In Rhode Island, the wait is much longer. We’ve heard of patients quoted a six month wait period before they can see a doctor as a new patient!
Nowadays almost everyone texts. But, if you ask your friend whether or not they can text their doctor, you will probably get a confused and befuddled stare back. The question you should be asking is, “Why can’t you text your doctor?”
At Direct Doctors, and Direct Primary Care practices like ours across the country, texting is common. We organize our practice so that we do not overbook ourselves with patients. We do this by cutting out the insurance and staffing middleman so that our time and your money goes directly to the doctor-patient-relationship. When primary care doctors like us aren’t overworked and overwhelmed all the time with seeing 25 patients per day for 7-10 minutes each, we can take time to answer your questions by text, email, private portal, and cell!
Did you know that 89% of primary care doctors spend less than 25 minutes with their patient per appointment. Just think about that for a second. The vast majority of primary care physicians have less than a half an hour to spend with each of their patients. And I would argue
most of those are actually less than 15 minutes. So even if a patient sees his PCP every 3 months, they spend a grand total of 1-2 hours with their primary care physician over the entire
For every two doctors in the US, there is one health insurance employee - over 470,000 in the U.S. - and you wonder why your insurance premiums keep going up?
If you take a minute to think what your interaction is like with your health insurance, you can easily understand why companies like Blue Cross Blue Shield have so many employees. When was the last time your doctor could order an MRI without having to get an official “OK” from an insurance company employee? When did you pick up your brand name medication at the pharmacy without it being denied by insurance the first time? How long did it take you to get through to the right “department” when you called to ask about coverage?
The red tape and multiple layers are there for a reason - to decrease utilization and lower costs. If doctors were able to use their clinical judgement and order your knee MRI because your injury requires it, then insurance companies would have to pay for every MRI that was ordered. By denying them the first time, many doctor’s offices are likely to say it isn’t covered and send you back to the drawing board. This means, your busy doctor doesn’t have time to work on the authorization, leaving you without the test he thought you needed. Who wins? It’s not the patient and I don’t think it’s the doctor. It’s the insurance company who successfully saved $1000s on the price of that MRI.
We wanted to start a blog series to relay some interesting facts about Direct Primary Care now that we’ve been open almost 5 years! Given our practice “birthday” is coming up this summer… did you know that the estimated Direct Primary Care patients per capita in the US has risen over 500% since 2014.
When we opened Direct Doctors in August of 2014, there were approximately 200 or so DPC practices in existence. Though we are still the only practice of our kind in Rhode Island, the direct primary care model has exploded in other areas. Today, there are over 1,000 DPC practices around the country! This is fantastic growth for an alternative primary care model that is so different from what patients are used to in traditional insurance based practices.
Lauren Hedde, DO and Mark Turshen, MD are Family Physicians and Founders of Direct Doctors, Inc. a Direct Primary Care Practice.