AAFP Recognizes Benefits, Creates DPC Policy
By Sherri Porter for AAFP News Now on American Academy of Family Physicians, May 14th 2013.
Around 10 a.m. one recent morning, Atlas MD, a family medicine practice in Wichita, Kan., fielded a call from a frantic parent whose 14-year-old son had just been bitten by a dog. As a direct primary care (DPC) practice, Atlas gives its patient “members” unlimited 24/7 access and a bevy of in-office procedures at no additional fee. The rate for children is $10 a month, and today was the payoff for this family.
“We got him into an exam room by 10:15, washed out, sewn up and on the way home by 11 a.m.,” said Doug Nunamaker, M.D., who spent two years as a hospitalist before joining the practice full time in 2012. He calculated that if the child had been treated at the local emergency room, his $680 bill wouldn’t even have included the physician’s fee.
“That one episode was worth five years and eight months of membership for that child,” said Nunamaker.
AAFP News Now recently visited Atlas MD to get a first-hand look at direct primary care, a practice model in which patients pay a monthly fee for unfettered access to their physicians and a wide variety of primary care services.
CURE FOR NATION’S PHYSICIAN SHORTAGE?
Providing quality health care at a lower cost and at a relaxed and reasonable pace makes every day at the office a good one for Atlas MD co-founders Nunamaker and Josh Umbehr, M.D.Welcome to the world of direct primary care, where, as Umbehr puts it, “We work with insurance, not for insurance.” The practice does not accept insurance but encourages all patients to obtain major medical coverage. “Patients will always need insurance for expensive medical care — like surgery — but in combination with a clinic like Atlas MD for everything else,” said Nunamaker.The FPs pride themselves on having found a way to cut the red tape that has some physicians looking for the exit door. “We’re going to lose docs in their 60s who could work another 20 years,” said Umbehr, who started the practice fresh out of residency.
On March 18, Nunamaker traveled to Topeka to testify before the Kansas House Insurance Committee. He told lawmakers, “I want to make one thing very clear; whether on a state or national level — whether you’re covered by insurance or not — you won’t be able to find a provider regardless of your coverage because we’re going to be anywhere from 50,000 to 100,000 short (on doctors) by 2020.”
Nunamaker said he and his partners are undeterred by charges that DPC practices are selling out traditional patient care for profit and lifestyle issues. “We’ve tried to create something that’s reproducible to help foster change. If we can get past this ‘You’ve abandoned us’ mentality and show that we’re trying to provide a model to save family medicine — if we can get that message out there — then we will have succeeded,” he said.
CREATING A DPC NETWORK
Erika Bliss, M.D., of Seattle, has been immersed in the DPC model since 2006. She’s one of the founders of Qliance
Medical Management, and now, as president and CEO, she oversees a network of DPC clinics in the state that benefited from millions of dollars in start-up funds from private business.Bliss, an FP who carves out 25 percent of her time for direct patient care, said that the Qliance clinics had grabbed the attention of payers, purchasers and the government. “Large purchasers of health care (corporations) are saying ‘This makes sense — you work hard on things that matter, not cranking out a bunch of visits and billing for them.'”Insurers recognize the potential for this model, as well, and some are looking at insurance plans that work with DPC clinics and keep costs and premiums down, said Bliss.
In Wichita, the Atlas MD physicians recalled a small 50-employee company with which they contracted last year. During those 12 months, employees filed zero claims with the company’s major medical plan because all employee health care needs were handled by Atlas MD.
As for Bliss, she’s no longer tethered to fee-for-service billing and doesn’t experience those uncomfortable mental pauses in the middle of a patient exam to consider if one more element would bump the visit to a 99214 level CPT code. “That’s a very destructive thought process,” said Bliss. “As a physician, it’s hard to have all that noise in your head; it leads to mismatched incentives.”Bliss pointed out that a clause in the Patient Protection and Affordable Care Act
may help support growth of the DPC model. “The law states that if a direct primary care offering is coupled with an insurance product — and that together they meet plan standards — then a state has to let that entity participate in the state exchange,” said Bliss.
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