Why I choose DPC medicine - Part II — The What, the Why and the How of DPC

Some people made lemonade this past year…. Me? I made cake! My blog is wordy, so I’m trying to sweeten it with baked goods…

What is Direct Primary Care (DPC) medicine? I had never heard of it before this past August. It can hard to wrap your head it — took me a while. Briefly, it is a revolutionary, new way of providing medical care, that has grown exponentially over the last decade. The history of DPC is cool, and can be found on other sites (for example: https://dpcalliance.org/ ). DPC medicine strives to be: affordable, accessible, relationship based medicine centered on the concept of a medical home. Because DPC medicine works for patients instead of insurance companies, it is able to keep costs down. Subscription-based medicine is the economic tool that allows DPC medicine to exist.

Here are the two realities of the current, insurance-based medicine.

One: from the patient perspective, insurance doesn’t assure access to care, quality of care and in many cases limits access to care and quality of care.

Two, from the provider’s perspective, the economics of insurance ensure that it is impossible to be a solo practitioner and receive adequate and equitable insurance compensation while running a clinic based on patient-centered care.

INSURANCE IS NOT HEALTH CARE. Insurance companies are companies— they exist only for their own profit. Insurance companies dictate how medical organizations provide care — and now medical organizations can only survive by putting the least amount of their own money into patient (meaning your own) care.

In order to practice medicine that is patient based, then, the medicine provided needs to be paid for by the patient. Think about it…. does the thousands of dollars you spend on insurance each year guarantee you access to your doctor when you need it?

I will use my family as an example of economic mayhem, frustration, anger and complications caused by limited access to a medical home that has been created by the current insurance model.

Last year, my hospital employer helped pay for part of my insurance. Even with help, I paid about $660/month for health insurance for my family. I had a $3,000 deductible. This meant that I had to pay $11,000 per year OUT OF POCKET before insurance kicked in. At that point, I still had to pay co-pays for procedures, for office visits, specialist visits, and penalties whenever Urgent Care center or Emergency Room visits were accessed.

Because my husband needed surgery and imaging early in 2020, we quickly reached our $3,000 deductible within a month. In the fall of 2020, my husband had sudden onset painful swelling in his knee. After three calls and over an hour on hold trying to reach his doctor’s office, he was told to be evaluated at an Urgent Care center. At the Urgent Care center, after waiting a few hours, he received x-ray imaging of his knee, and had a procedure done by a mid-level provider to evaluate the cause of his knee pain. Unfortunately, this procedure introduced an infection into his knee. With worsening knee pain, swelling and a fever, he called back his doctor’s office, and after several calls, and another hour+ on hold, he was redirected BACK to the Urgent Care center for further evaluation and treatment He waited several hours to be seen by a different mid-level provider, and had US imaging done. At this point, he was put on antibiotics and told to follow up with his primary care doctor.

After more time on hold, he was finally able to reach his doctor’s office, and scheduled for follow up with the next available appointment, which was with yet another mid-level provider — his own provider was scheduling several weeks out. He was finally seen for ten minutes by this third provider, who he had never met before — and was told to complete the antibiotics for the infection, and take NSAIDs for the non-infectious inflammation causing the original knee swelling.

Because of how our insurance worked we ended up receiving bills for over $1,000 dollars between separate fees and co-pays for the two Urgent Care Visits, the imaging done at Urgent Care center — charged for both the imaging itself and then separate fees for the imaging interpretation, and the follow up with his doctor’s office and the antibiotics. My husband also experienced extra time out of work, and pain, due to the infection complicating the initial inflammation of his knee.

I spent approximately eight hours on the phone negotiating the insurance system and was able to reduce those bills to about $500.

We were both furious by this whole rigamarole! The current system made him unable to reach his doctor in a timely manner, directed to Urgent Care centers twice, never actually being able to see HIS doctor, and having complications from a missed diagnosis I do not think any one provider he saw did anything wrong — I think every person did the best they could under the constraints they had to work within.

My husband’s story is not unique — you probably have your own, similar story,

Now, if we had DPC care — we would have paid about a $960 annual membership fee for any care he needed for a full year. He would have been able to reach his doctor on the first attempt. He likely wouldn’t have needed imaging at all (and if he did, it would have been under the negotiated DPC rate of $50 for image and interpretation). He would have been directed to a course of NSAIDs at the initial vist - and that would have been the end of it. This is the whole point of DPC medicine — quality care with guaranteed access to your doctor when you need it at an affordable price.

Let’s talk about kids — I’m a pediatrician. Children should receive, on average, 95% (if not 100%) of their care at their pediatrician’s office. There is always the potential for catastrophic occurrences — and this is what insurance should be kept for.

An infant gets seen at least seven times in their first year of life for well visits. On average, infants and toddlers get sick at least 5 - 7 times for the first three years of their life, necessitating acute, unplanned visits. Daycares will not allow children back without having seen the doctor. If they can not get in to see their provider, they then end up at Urgent Care centers and emergency rooms. Most parents with young kids do not have time to wait hours to speak to a human at their doctor’s office — working parents can not afford to have their children not seen. I get this — I have been that working parent.

New parents should anticipate 10 - 12 trips to see their child’s pediatrician during their child’s first years of life.

For people who do have high deductible insurance, one trip to an emergency room, costs more than a full year’s subscription to a DPC practice.

For people with no insurance (and let’s face it, even with the ACA, many people can’t afford insurance), DPC medicine has the potential to save family hundreds, if not thousands of dollars.

For people with decent insurance (like me, last year), DPC medicine can still save hundreds of dollars, while providing access to quality medical care when it is needed.

You get what you pay for in DPC medicine: quality, affordable, accessible, relationship based medicine that provide a true medical home. DPC medicine is medicine, the way it is meant to be practiced.

A choux cake for you for making it to the end of this blog!

Personalized Pediatrics of Maine strives to be the best Pediatric office in the state of Maine!