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.
“Health” Insurance companies have begun moving into the realm of delivering, or even more specifically - rationing, “healthcare” more and more over the past 10-20 years. Once upon a time, the doctor made the medical decisions for a patient - he or she knew the patient well, weighed risks and benefits, had a conversation with the patient and chose the best course of action. Today, the doctor’s role has been diminished in large part due to the interference of insurance companies.
If I want to order an MRI of my patient’s shoulder (of course following clinical guidelines on timing and indication) I cannot just send an order and have the patient get the MRI. Nowadays, I have to ask permission first. When I call the insurance company, I am usually sent to a “third party” - a company who handles prior authorization requests for that insurer. When I finally connect with a person (which often takes more than 30 minutes) I have to play a game of cat and mouse, answering questions in just the right way so that the non-medical-person on the other end checks off the right boxes that allows the automated system to determine whether my medical order for my patient is “approvable.”
Last year around this time, I wrote 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.
Well that’s a novel concept, isn’t it?!? I was reading an article today in the Wall Street Journal about the rising costs of healthcare and how deals between hospitals and insurance companies are contributing to the problem. Try reading this piece… doesn’t it make your head spin? Hospitals do this and try to block that, and insurance companies do this and switch plans and so on and so on. In the end, none of these decisions and maneuvering are really about patient care. They are strictly about market share, controlling health care utilization and profits. Too much of our current healthcare system places multiple barriers in between doctors and patients. Additionally, many medical decisions now are based solely on insurance coverage and their “protocols,” and not what is best for the patient.
If you’re someone who travels a lot for work or pleasure, or you just happen to find yourself on the rare trip, you may imagine a scenario where you fall ill and need care. You’re away from home and from your primary care doctor. You’re in an unfamiliar location where you don’t recognize the local medical options. This is a scenario many of us have experienced or at least have known someone who has.
What do YOU do when this happens? The most common answer is that you go to the local emergency room or urgent care. This may be fine OR it may result in a big bill or in care that is disjointed from your typical doctors. Disjointed care sometimes leads to patients being prescribed medications that cause side effects or interfere with existing medications or issues, which renders them in worse shape in the long run. If you don’t need to see a doctor at a more emergent setting, you may be charged a larger copay for having gone there instead of to primary care (even though you couldn’t get back home to do it!).
Doctor Google is great. When you’re in a pinch. No one is available to answer your medical question. You just can’t wait until Monday at 9am to call the office. If you could wait, you know you’ll be put on hold and won’t get a call back for hours - if you’re lucky. You know if you do get a call back, it will likely not be from YOUR doctor. So, why not just Google?
So let’s say you’re young and relatively healthy. You can’t remember the last time you went to a doctor for anything. You are not on any prescription medications and do not require many routine screenings at your age. You also have a busy career that makes the slog of a traditionally inefficient practice impossible to deal with but cannot imagine paying a monthly fee for a Direct Primary Care Practice… why would you do that?
Well I can think of a few reasons, actually. I bet if you think back over the past couple of years, something came up at one point that required a visit to a doctor. You probably went to an urgent care or ER since you had no established primary care doctor. It may have been for a laceration that needed a few stitches, or an ankle sprain while playing sports on the weekend, or a bad cold that you just could not shake at home and needed to be seen. All of these things can easily be handled by a primary care doc who is easily accessible and can see you that day. Without that access however, many patients have no choice but to visit a much more costly health care setting and spend hundreds to thousands of dollars on a one time visit fee. For this same cost, you can get several months to a year of direct access to your personal doctor. Many of our younger patients have high deductible plans. So even if they do not utilize our services frequently, they often save money by avoiding expensive health care costs.
A common theme in medicine is that many patients worry about their health. For patients, this can take many forms. Some patients avoid the doctor, deciding “what I don’t know won’t hurt.” Others worry for days or months leading up to their check-ups, worrying their doctor will “find something bad.” And, still others go in to see their doctors much more regularly in hopes of getting answers to their questions to help calm their fears.
Lauren Hedde, DO and Mark Turshen, MD are Family Physicians and Founders of Direct Doctors, Inc. a Direct Primary Care Practice.