Dr. Erin Chambers of Healing Hope Family Medicine in Erin, Tennessee opened a Direct Primary Care clinic to reduce paperwork and lower cost for patients.
Anyssa Roberts | USA TODAY NETWORK – Tennessee
Subscription model allows patients to work directly with doctors, leaving insurance for crisis situations.
After more than 10 years in outpatient medicine, Dr. Erin E. Chambers was burning out.
She was buried under mounds of paperwork, which took hours to complete, and she felt she needed to reevaluate how her role as a doctor fit with her role as a wife, mother and woman of faith.
In her search to balance her life, she discovered “direct primary care,” a medical model that’s revolutionizing the health care industry.
DPC, as it’s known, is just what it sounds like: direct care between the doctor and the patient, removing health insurance companies from the process. The result, which is spreading across Tennessee, is less paperwork for physicians and less expensive, more personalized care for patients.
Earlier this month, Chambers opened her own DPC clinic, Healing Hope Family Medicine in Erin. Patients pay a monthly membership fee between $30 and $55 for unlimited access to a physician, a free annual physical, a flu shot and lab tests.
Because there’s no paperwork-heavy insurance involved, she said, physicians are able to keep lower administrative costs, and they can spend more time with patients.
When she was first introduced to the concept three years ago, Chambers was skeptical.
“It seemed too good to be true,” she said. “(My husband and I) really went through it with a fine-tooth comb before deciding to open our own clinic.”
A ‘slow tsunami’
During that time, she spoke to Dr. Josh Umbehr, who has been operating a DPC practice for seven years in Wichita, Kansas. Although DPC is a minority in healthcare, he describes the movement from insurance-paid models as a “slow tsunami” that is bound to catch on.
In Tennessee, there are about 16 clinics operating exclusively as DPCs, according a nationwide data collected by Direct Primary Care Frontier, a DPC advocacy group.
The site shows about 660 practices nationwide, including in Knoxville, Jackson and Franklin, though none are shown so far in Nashville, Memphis or Clarksville.
Umbehr and Chambers tout it as an affordable alternative for patients who may have high insurance deductibles and premiums.
“Not that (insurance is) bad, but it’s a great tool we’re using the wrong way,” Umbehr said.
Dr. Erin E. Chambers asks patient Michael Hopkin to open his mouth to check during an appointment on August 30, 2017. (Photo: Erica Brechtelsbauer/The Leaf-Chronicle)
Insurance is useful for catastrophic events, he said, but instead of treating every checkup, lab test and prescription like a catastrophic event, primary care is better handled like having a Netflix account or gym membership, where a person pays a monthly fee then uses as much or as little access as is needed.
“You know, if they tried to sell you car insurance that was this expensive, you would laugh them out of your office, but we continually buy expensive insurance that’s not working,” he said.
Umbehr says DPC can actually be beneficial for insurance companies because it has potential to lower administrative costs for filing. And because DPC won’t cover every medical procedure, insurance companies will still have surgeries or specialist procedures to make money from.
Getting quality care
Chambers said that while the Affordable Care Act insured millions of Americans, it only gave the illusion of increased access. While physicians are buried under paperwork, they are less capable of facilitating a closer patient-doctor relationship.
Suzanne Hopkins left her previous primary care provider in Clarksville to visit Chambers in Erin. She was fine with her insurance plan, but she didn’t feel cared for by her previous physician.
For example, Hopkins once arrived on time for an appointment but was not seen for over an hour. When the physician finally saw her, she was being rushed through, and she was asked questions that had nothing to do with her issue, she said.
“I have great insurance through my work, but all of that doesn’t mean a lot if it doesn’t feel like you’re getting quality care,” said.
The average DPC clinic visit lasts 35 minutes, compared with eight minutes in the traditional model, according to a research study. And clinics generally offer email, phone or online video visits.
“DPC is for anyone who wants to have a good, strong relationship with their primary care provider,” said Alex Tolbert, founder of Bernard Health, a company that provides non-commissioned, expert advice on health care.
How payments work
Currently, DPC fees cannot be paid by Medicare or Health Saving Accounts. All membership fees have to be paid out of pocket.
Last year, the Primary Care Enhancement Act of 2016 was introduced to allow such payments, and without a tax penalty.
Although all DPC clinics have a membership payment system, and additional costs for tests or medicine shouldn’t exceed the price of the membership fee, each clinic differs slightly in offerings.
Most DPC clinics do not offer hospitalization, surgery or pregnancy and delivery services; although a few do, said Dr. John Meigs, president of the American Association of Family Physicians.
People with chronic illnesses, such as hypertension and diabetes, still qualify for DPC clinic memberships. And using a DPC clinic could actually lower the cost of their prescription medications, Umbehr said.
Dr. Erin E. Chambers checks patient Suzanne Hopkin’s eyes during an appointment on August 30, 2017. (Photo: Erica Brechtelsbauer/The Leaf-Chronicle)
He said insurance companies pay retail price for medicine through pharmacies, while doctors can buy wholesale and distribute at a lower cost. Some prescriptions will still need filling at a local pharmacy, but most DPC doctors can find a generic alternative, Meigs said.
Specialists and lab work are also generally outsourced, however, some clinics might arrange for discounted fees in exchange for on-site payment, he said.
It is still recommended that DPC patients have insurance for catastrophic events and services DPC clinics won’t cover, Meigs said, such as injuries that require emergency room treatment or severe illnesses.
The future of DPC
Many physicians and healthcare professionals are optimistic about the growth and expansion of DPC.
“Direct primary care is kind of going back to the doctor-patient relationship and putting that priority number one, and then your insurance companies — your third parties — are out of the picture,” Chambers said.
Healing Hope Family Medicine is accepting patients and has partnered with the HOPE Pregnancy Center in Clarksville to offer pregnancy counseling. Healing Hope will conduct a free pregnancy test for women without a membership.
For more on Healing Hope Family Medicine, go to www.healinghopefamilymedicine.com or call 931-289-4325.
To locate a DPC near you, go to www.dpcfrontier.com/mapper.
Visual Journalist Erica Brechtelsbauer contributed to this report. Reach regional features reporter Anyssa Roberts at 931-217-1827 or email@example.com.
Where are the DPCs?
DPC Frontier, a direct primary care advocacy group, lists “pure” DPCs in the following 16 Tennessee cities:
- Chattanooga: 1
- Erin: 1
- Franklin: 2
- Jackson: 1
- Johnson City: 1
- Kingsport: 1
- Knoxville: 3
- Lebanon: 1
- Maryville: 1
- Murfreesboro: 1
- Pulaski: 1
- Spring Hill: 2
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