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  • Writer's pictureDr. Aaron Rosenberg

Why Direct Primary Care

Many people believe that insurance is going to save them money on health expenses, but when they interact with the healthcare system, they are surprised to find that they are being charged by the healthcare system for things that they thought would be covered.

Take for example laboratory tests. Many insurances leave patients to pay "coinsurance" of anywhere from 20% to 50%. Some insurances pay a limited amount for labs per visit ($50 for example) and the patient must pay the rest. Some pay a portion or only allow certain screening labs to be covered. It happens all the time that doctors order labs that are not covered and patients end up paying. Labs bill patients with insurance their highest rates. Then the patient is on the hook for a substantial portion of the lab work that was ordered.

Why do they do this? Because they can get away with it. It is simple economics, if the market will pay it, they are happy to laugh their way to the bank. The actual cost for the lab to run a test is often hundreds of times lower than the price they charge. You read correctly...hundreds of times higher. They are happy to pass on a 600% markup if insurance companies and patients will pay it.

Direct primary care (DPC) clinics, like Rosenberg Medical Clinic, negotiate the absolute lowest prices directly with comercial laboratories to get your tests done at close to cost. It would often be less expensive to just do a test here and pay for it in full than to pay your portion of the test when billed through insurance at an enormous markup.

Many DPC offices also offer discounts on imaging services, and we are currently negotiating with local vendors to get our patients the best prices on these services.

Another significant difference in DPC is that DPC doctors spend much more time with their patients. Primary care clinics at large health systems must see many patients a day to remain profitable. They sometimes operate at a loss, and the hospital system makes up for it by using primary care as a point of contact to refer patients to specialties that can bill higher rates for specialist visits and through the ordering of expensive, in-house tests. This means that they want to churn patients through their primary care offices as fast as possible. To be profitable, these practices must see many patients per day. A typical employed primary care doctor has between 2,000 and 2,500 patients. Direct primary care doctors have on average 500-600 patients on their panel. This allows for longer visits and more attention to detail. It allows for a relationship to form that is humanistic and based on caring, respect, and a true understanding of an individual's unique circumstances.

DPC visits start on time and are allotted an appropriate amount of time. At our clinic visit times start at 30 minutes. Of course, if the patient wants to have a shorter visit and that is appropriate, that is fine as well, but we make sure that everyone has time to be evaluated appropriately and feel heard.

Another important benefit that DPC practices can offer is access to steeply discounted medications. We dispense medications in-house and pass on wholesale pricing that we get to our patients. We do not seek to make a profit on this service, rather we view this as a way to add value for our members. The prices that we can get our customers on prescription medications are often more affordable than their insurance copay for the same medication.

A terrific way DPC can add value is by reducing the need to see a specialist. This can cut down on expensive copays and specialist fees, reduce unnecessary tests and referrals, and save patients time, while drastically improving convenience. Here at Rosenberg Medical Clinic, we partner with RubiconMD, a virtual consultation service. This service allows us to send anonymous case information to specialists from over 140 medical specialties and subspecialties and receive rapid and actionable advice on how to manage patients from a specialty perspective. RubiconMD's data demonstrates that their service eliminates the need for over 70% of referrals to see a specialist. A specialist visit can cost up to $500, but we provide this service free of charge to our patients. Unlimited virtual consultations are included. Patients often have to wait months to see a specialist. A specialist from RubiconMD usually responds within a few hours.

DPC doctors offer direct access to the doctor all the time via text or email. We offer our members access to our direct messaging app Spruce Health, which allows patients to stay in touch with our office anytime. Have you ever needed a refill on the weekend and can't get your doctor's office to respond? We eliminate this problem by allowing constant contact with our team.

The goal of DPC is to provide affordable, comprehensive care, which cuts down on provider referrals and overall healthcare costs, while restoring the doctor-patient relationship. We strive to address all the healthcare needs possible in-house, while requiring our patients to interact with the healthcare system outside of our office as little as possible. If it sounds like we would be a good fit for your healthcare needs, please feel free contact us. For information on pricing, or to sign up, please go here.

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