Family Medicine / Direct Primary Care / Walk-Ins

The sometimes incoherent
ramblings and rants of an
ordinary family doctor...
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Some of you may be familiar with the term fractional reserve banking. It describes the structure of virtually all banks in existence today.  Laws require that your bank keep about a tenth of deposits on reserve while loaning out the rest. Obviously, if all bank account holders show up at one time to demand their money, the bank cannot cover the demands. This is called a bank run, which was famously depicted in the Jimmy Stewart movie It's a Wonderful Life. I would like to coin a new term to describe our current Healthcare System: Fractional Reserve Medicine.  

The economics that drive healthcare have forced doctors and medical clinics as well as hospitals to chronically over sell their services while under staffing and under resourcing their ability to meet patient demand. Now realistically, all businesses have to make trade-offs when it comes to staffing and hiring. Labor costs typically represent the most expensive element of doing business to the point that adding additional workers can sometimes even threaten the financial health of an organization. Demand for services can wax and wane depending on the season and circumstances, so even the best prepared businesses can sometimes find themselves under staffed for unexpected peaks in demand.

 

However, when you find an industry that across-the-board seems chronically understaffed and under resourced while simultaneously being prohibitively too expensive for most people to afford, you need to start asking questions.  Let's take primary care. Of all medical specialties, primary care needs to be the most affordable, the most accessible, and the most comprehensive. After all, primary care is relatively inexpensive to provide, especially in comparison to hospital care. But let's see what happens in real life.  First, the patient is not the customer but rather the insurance company is. And a patient who doesn’t have insurance usually feels that he or she is treated as a second-class citizen by everyone from the front office clerk all the way to the doctor... even when he or she has plenty of cash to pay for the inflated bill.  Second, the prices for a traditional clinic will always be substantially inflated since those clinics must play the insurance discount game. Since the insurance company will always demand a steep discount from the office charge known as a “contractual”, clinics have no choice but to inflate the price of a test or procedure with the expectation that insurance will demand a steep discount...one that is typically not readily available to patients without insurance.  Third, these clinics must have significantly higher overhead to hire full-time employees that do nothing but manage insurance billing, which is a complex, time-consuming game of coding, dropping claims, then waiting and hoping that they get paid. If they are denied, then the game is played again. Fourth, traditional clinics only earn income when they submit a “superbill.” In other words, they must provide care almost exclusively in the office setting to get paid.  Most physicians who exercise professional integrity will do their best to answer calls through staff members, refill prescriptions, or occasionally provide treatment over the phone, but they are forced to do so hurriedly between patients since their schedules are packed with 30, 40, or even 50 patients in a day. Should anyone be surprised when his or her doctor sometimes appears apathetic, cranky, unconcerned, and even burned-out? Finally, clinics have a habit of scheduling low complexity office visits that may have been handled just as effectively through alternative means precisely because that is the only way of getting paid under the insurance system.  These “visits” provide a buffer in the schedule for the physician when he/she runs over with a more complex patient and pads the bottom line, too. But these visits also eliminate your doctor’s availability when you have an urgent request or need for that office visit. Therefore, you end up going to an urgent care clinic or the emergency department where you may wait a long time and are ultimately billed a king’s ransom. At the end of the day, a traditional primary care clinic can only provide service to a tiny fraction of its total patients at any one time. It must divert and delay care by creating high barriers to patient access precisely because they lack the capacity to provide the promised care to meet demand.  

But at least traditional insurance clinics are cheaper, right?  Insurance copays may create the illusion that traditional medicine is less expensive, but in many cases, the costs before you reach your deductible are still higher than DPC, especially since DPC as a rule does not significantly markup lab and medications.  And isn’t your time worth something, too? Having access to your doctor and spending both quality and quantity time with your doctor without having to wait 1 or 2 hours (or even more!) to do so is something you just can’t put a price tag on.

Isn’t it time you asked for a different, better approach to primary care?  Direct primary care is disruptive innovation that changes the balance of the healthcare landscape back in your favor.  It realigns the incentives of the system away from its own self-serving financial concerns back to the doctor-patient relationship.  The focus goes away from the superbill and “charges” back to simply providing the best care possible. The bill, in fact, becomes a means to end, not the end unto itself.  One visit to a DPC clinic, with its 30 minute to even 1 hour visit duration, lab and medications at up to 95% less, and nearly no wait time can provide far more value than 2, 3, or even 4 visits to a traditional clinic.  Face Value Health DPC provides this innovative, affordable, compassionate care right now, right where you live. You owe it to yourself to give it a try.

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