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Direct Primary Care Puts the Focus on Patients

August 10, 2017 - 2:01pm CDT

By Mike Brake

Doctor A, a family physician, arrives at his office shortly after 8 a.m. on a typical day. He has 27 patients scheduled today, and by noon he’s seen 16 of them, spending at most 20 minutes with any one patient. He’s also fielded or made a dozen phone calls and signed stacks of insurance forms. He gobbles a quick lunch at his desk as he processes more paperwork and returns more calls.

Three patients with sinus infections call to be worked in that afternoon, so it’s 5:20 before Dr. A sees the last of them. He spends the next 90 minutes on paperwork and phone calls, in one case debating for a half hour with insurance bureaucrats over the pre-authorization of an MRI for one patient.

Doctor B also has a family practice, but he’s one of at least 15 fellow physicians in Oklahoma who have adopted a revolutionary new practice model called Direct Primary Care (DPC.) He’ll see just six patients in the office today and quickly return calls from a half-dozen others. He won’t handle a single insurance form and he’ll be done with office hours at 4:30, in time to make an actual house call for a shut-in elderly patient.

Dr. Jeffrey Davenport, one of those 15 Oklahoma DPC physicians, practices in Edmond and says the DPC model is “one that is really gaining steam over the last four or five years.” A second family practitioner has recently joined his practice, and he said he frequently hears from other doctors seeking to escape the paperwork monster that modern medicine has become.

Here’s how Direct Primary Care works. Whereas the typical primary care doctor (like a family physician, internist, or pediatrician) might have between 2,500 and 3,500 patients on his or her panel of people who call them “my doctor,” a DPC physician limits the total patient load to between 600 and 900. Each of those patients pays a fixed monthly fee.

Before embracing the Direct Primary Care model, Dr. Davenport says, insurance paperwork was “the bane of my existence. I was exhausted. My wife and kids wondered when I would come home at night.”

For Dr. Davenport, that amounts to $10 monthly per child in a family, $50 for adults up to age 49, $75 up to age 64, and $100 for those over 65 (on the theory that the older one is, the more medical care one requires). So a typical family of four might pay $120 monthly.

In return, he provides any and all primary medical care at no additional cost. He files no insurance, so there are no copays involved. He spends the time needed with each patient—sometimes up to an hour or more—and promptly responds to phone calls, emails, or text messages from patients who are given his direct cell phone number, 24/7.

When patients need lab work, Dr. Davenport can usually draw the sample in his office and submit it to a local lab, then bill the patient at a fraction of what the same test would cost from an outside source. He also maintains a stock of frequently prescribed medications, purchased wholesale, which he can dispense as the patient leaves, often at a fraction of what he or she would pay at the neighborhood pharmacy.

It’s no accident that the name above the door at his Edmond office is “One Focus Medical,” the focus being on the patient and not the medical/insurance bureaucracy that impedes and bogs down traditional medical practices.

Of course when patients need specialized care, like surgery or major tests that a primary care office cannot provide, they must revert to the traditional fee-for-service/insurance-based model in their dealings with that provider. That’s why Dr. Davenport urges patients to continue to carry major medical insurance. But, he notes, “85 percent of medical insurance claims are for basic primary care services. Direct Primary Care can help medicine break its unhealthy addiction to insurance in most cases.”

He said some businesses are also exploring the DPC model as a simpler and less expensive way to provide health services to employees. A business with, say, 40 employees could carry major medical insurance on them and their dependents and then enroll them in a DPC practice at considerably less in combined expense than it costs to fund more traditional comprehensive medical insurance.

Dr. Davenport said it was serendipitous that he discovered the DPC model. A 2003 graduate of the University of Oklahoma College of Medicine, he completed his residency in family medicine in Kansas and then practiced both independently and as an employee of the OU physicians network. He soon found paperwork, especially that associated with insurance, “the bane of my existence. I was exhausted.  My wife and kids wondered when I would come home at night.”

Dr. Davenport noted that Medicare required doctors to answer four questions on every patient’s paperwork one year, nine the next, and 13 in the year following.

“What is it going to be next year?” he wondered. “I had already begun to ask myself, sitting in that office at 6:30 or 7 at night, could I really do this for the next 30 years?”

Then in 2013 he attended a national medical conference and while waiting for a technical session, quite by accident, stumbled into a presentation on the Direct Primary Care model. He returned home to research it and on April 1, 2014, he became the first primary care doctor in Oklahoma to implement it in his practice.

Many of his patients eagerly followed him from his previous fee-for-service, insurance-based practice to his DPC office, he said, while some were reluctant (since few patients are familiar with the new DPC model). But he said patient response has been good.

“This model puts the patient first,” he said. “They love it.” He noted that one patient who needed frequent lab studies for thyroid issues had been paying $600 per test. When she joined his DPC practice she paid no copays for office visits, and he was able to trim her per-test expenses to $27.

Dr. Davenport was also instrumental in winning passage in 2015 of model Oklahoma legislation that prohibited insurance regulators from treating the monthly DPC fee like health insurance. Similar legislation is pending at the federal level.

Not only do patients in a DPC practice have faster, better access to their doctor, they also experience better health outcomes as well. A study in the American Journal of Managed Care found that DPC patients were less likely to be hospitalized, with 56 percent fewer non-elective admissions.

While the DPC model is tailored to primary care physicians and could not be applied to specialists like surgeons who tend to see patients only once in their lives, Dr. Davenport said it could easily be adapted by specialists in fields like cardiology, gastroenterology, or pulmonology, where doctors also tend to carry a longer-term patient panel.

As he described his experience with DPC at 11 on a Friday morning, his office waiting room was empty, the last morning patient having left after a cordial, relaxed chat with her doctor. He would have time before his first afternoon patient to review his chart and to return a few phone calls.

Meanwhile at an unrelated medical office to the north, patients of another physician were shuttling in and out of a crowded waiting room like cattle, hoping they wouldn’t have to wait more than 45 minutes for their 13 minutes with the doctor. When they arrived the very first thing the receptionist said was “Insurance card please!” They devoutly hope they won’t need the kind of tests or procedures that require a long wrestling match with their insurance carrier.

Different models, different doctors, but similar patients, all hoping for quality, personal medical care. They’re getting it from the DPC model.

Mike Brake is a journalist and writer who recently authored a centennial history of Putnam City Schools. He served as chief writer for Gov. Frank Keating and for Lt. Gov. and Congresswoman Mary Fallin, and has also served as an adjunct instructor at OSU-OKC.