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STEP AWAY FROM THE VEHICLE
Mary G. Barry, MD
Louisville Medicine Editor
[email protected]
I
t’s hard to believe that I have read something encouraging about primary care,
but I did: in the Dec 29 issue of TIME
magazine, the elusive light at the end of the
primary care tunnel flared briefly.
David Von Drehle reported on what is
called direct care, where people like me
throw insurance companies overboard and
charge the patient directly – but not the
$$$$ concierge fee, the regular working stiff
fee. Patients pay the doctor a sliding scale
fee, which varies - based on age roughly $50
to $100 a month in one practice in Wichita,
and $65 a month for people in Dr. Garrison Bliss’s pioneering Qliance practices in
Seattle. Patients still need to carry health
insurance to cover diagnostic tests, trauma,
surgery, major and emergent illnesses, specialists’ fees, expensive medications, etc. So
they end up paying twice, unless – as is beginning to happen with Qliance, in business
since 2007 – large self-insured companies
factor in the Qliance cost to the employee
benefit fee schedule. This year, Qliance partnered with an insurance company to offer
a plan for individuals on the state health
insurance ACA exchange, and their staff
take Medicaid patients. Emerald Care, a
nursing home in Wapato, Wash., pays $75
a month for each employee to have a direct care primary doctor. Mike Hoon, staff
director there, said, “I had staff coming to
work with colds and flu and not going to the
doctor because they didn’t have $30 or $50
bucks to get in the door. It’s made access a
whole lot easier, and it’s got them going to
the doctor when they need it.”
For their monthly fee, patients get what
is trumpeted as same day sick visits (what
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I and my partners do already) and specialty-care coordination (what I and my
partners do already) and some house calls
(nope) and Skype and e-visits (nope) and
unhurried, in depth preventive visits (can’t
say my visits with patients are unhurried
but I sure hope they are comprehensive)