Direct Pay - What Does It Mean to You as a Patient?

Monica Kemppainen, Ph.D.

If one were to query any practitioner and/or patient if they are happy with our current healthcare system, the resounding response would be:  “No!”  Both practitioners and patients are searching for alternatives.  Upon an extensive literature review, it was discovered that most researchers believe the following models show the most promise, rather than continuing with the traditional medical practice model:
  • Concierge
  • Direct-Care
  • Retainer-Based
  • A hybrid of the above - and/or below - mentioned models while retaining
    insurance-paying patient 

The direct-care model is known by various titles, models, and/or “types” of medicine.  Some examples of these titles follow:  Concierge, retainer-based, direct-care, direct-pay, membership medicine, boutique medicine, cash-only medicine, direct primary care medicine, and/or innovative medical practice design.  For the purposes of this document, we will use the term “direct-care” medicine. 

Our research indicates the following practitioners and/or practices are the most viable for direct-care conversion: 
  • Family Medicine and/or Internal Medicine

What follows is who and why patients are drawn to the direct-care model:
  • Executives and/or other busy professionals with a fast-paced lifestyles who require prompt and responsive care
  • Anyone who desires top-notch healthcare in a calm environment where they can develop a comforting and trustworthy on-going relationship with their Primary Care Provider (PCP)
  • Anyone who believes their practitioner is an important link to their on-going health and well-being
  • People who expect 24/7 access to their PCP via cell or text and/or a nurse during office hours
  • Anyone who expects their practitioner to give them email access and is promised a response within 24 hours
  • Anyone wishing the following:    
    • 1 Executive Physical (90 minutes) per adult/year (blood work is an external charge with a participating vendor);
    • 1 Well Visit (45 min) per child per year (including immunizations)
    • A “Personal Health Program” for fitness and nutrition
    • Online health information access
    • Someone who prefers premium aesthetics-- office and exam rooms
    • Premium referral and scheduling assistance
    • Specialist care coordination
    • Discounts to health clubs, nutritionists, labs, imaging centers, etc.
    • Same-day or next-day 30-minute appointments that are guaranteed to start on time.  If they do not start on time, the patient is compensated
    • Extended appointments, as necessary
    • House calls, as necessary
    • The possibility of meeting electronically--telemedicine is considered because the patient is an established patient and the practitioner is very familiar with the patiens
History
Direct-care medicine got its start in Seattle in 1996 when former doctors for the Seattle Supersonics built a family practice that provided the same kind of highly personalized care they offered to athletes.   

Since 2003 there has existed a professional society of direct-care practitioners known as the Society for Innovative Medical Practice Design (SIMPD).  As of mid 2008, this organization had about 200 members and by late 2008 was growing at the rate of 1 member/day.  In 2009, SIMPD estimated there were over 5,000 practitioners nationwide, most of which were not SIMPD members.  SIMPD offers many member benefits, including but not limited to, national care networks, discounts for direct practice practitioners on malpractice insurance, annual meetings, and many more.  In late 2009, early 2010, SIMPD changed their name to the American Academy of Private Physicians (AAPP).  Their website follows:http://www.aapp.org/
Monica Kemppainen, Ph.D.
Monica Kemppainen is an executive with a background in strategic planning, program planning, program evaluation, and Return On Investment (ROI) investigations. Her passion is to help executive teams make informed decisions. Monica specializes and has diversified experience in merger/acquisition integration, clinical information systems, major business change, interim management, project/program management, business case development, strategy/organization development, and customer relations management (CRM).  Moreover, she is both a patient and/or a practitioner advocate.  
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The following is a breakdown of how many practitioners are considering direct-care medicine, by type and states:

Type
  • Primary care: 7.7%
  • Male: 7.1%
  • Female: 6.4%
  • Specialists: 6.4%
  • Employed practitioners: 4.5%
Selected States
  • Texas: 10.6%
  • Florida: 9.1%
  • New York: 8%
  • California: 6.7%
  • North Carolina: 5.6%
  • Illinois: 5.3%
  • Washington State: 4.8%
  • Pennsylvania: 4.5%
LINK to source > 
According to the AAPP, there was significant growth in the industry in 2012--a 25% increase from 2011.  Direct-care based practices are estimated to be growing by 50% annually.  Most transitioned practices are family practice, primary care, and internal medicine practitioners based on the East and West coast.  Currently, it is estimated that there are approximately 290,000 independent practices that need to be exposed to the benefits derived from the direct-care model.

In a 2012 survey of 13,575 practitioners across the nations, nearly 7% are considering moving to direct-care medicine in 1-3 years.  Moreover, 6.8% of all practitioners are considering direct-care medicine.

How Much Does This Cost and Where Can I Find One?
Most direct-care practitioners are located on the East and West coast.  As the American Medical Association (AMA) does not consider direct-care medicine to be a specialty, they do not track the number of practitioners.  It is believed there are about 5,000 direct-care practitioners US-wide.  Fortunately, the AAPP support these providers.  If you would like to search for a practitioner using their website, it  follows:  http://privatephysicians.com. 
Moreover, you can also use the Patient-Friendly-Payments website to locate more patient-friendly tools.  Their website follows:  http://patient-friendly-payments.com/.  As with all listings, if you would like to add any practitioner that is “patient centric” to the Patient-Friendly-Payments website, please feel free to submit their contact information.

A query focused at obtaining the average fee charged for direct-care medicine follows: 
  • $1,900/year for patients aged 40+
  • $950/year for patients aged 18-39
  • Annual charges varied from $600-$25,000/yr
Another source quotes the following as the average monthly cost to patients who have direct-care practitioners:
Equipped with the above-mentioned information you get to vote with your money and how you opt to spend it.  Do you support the traditional medical model or do you support the direct-care medical model? 

* Direct-Care plans are not insurance and does not replace any health insurance plan.  

If you have a subject you wish to have addressed, please send an outline of the situation with your request to:
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