The Medical Practice Playbook
Direct Primary Care: Old-Fashioned Medicine with a New Name
by Amber Deptola, MD
As a first-generation physician, my vision of what a primary care doctor should be came entirely from my experiences as a patient. When I was growing up, I knew a“ primary doctor” or“ family physician” as someone whom you lean on for all health needs; they’ re always there, they know you and your family well and, above all, they visibly care about you and your well-being. By the time I finished residency, health care was different. Due to insurance changes, most private practice physicians had been forced to sell their practices to the health systems. These health systems, under the financial stress of rising health costs and a lack of congruent rise in reimbursement from insurance companies, implemented systems approaches to improve processes of care while minimizing redundancies in staffing and paperwork. These systems approaches to care resulted in depersonalization of the health care experience for patients. New centralized call centers meant a patient call to their doctor was no longer going to their doctor’ s office.
In order to ask questions of their doctor or receive medical advice, an appointment became increasingly necessary. Set RVU targets meant less physician oversight of their own clinic schedules. Appointments became shorter and annual examinations transformed into computer checklists designed to meet insurance regulations for billing. As a result of these changes, the quality of care, continuity of care and access to care in primary care suffered. It became more apparent than ever that health care in this country is a business, and the insurance model we operate under means good primary care is bad for business. As primary care physicians experienced this transition, many have sought new models of care to meet patient needs despite the system challenges. Direct Primary Care is an increasingly prevalent practice model designed to meet the current challenges in primary care.
Direct primary care is a model where the middleman is removed and the health care relationship between the physician and the patient is the priority. While models of direct primary care vary, there are
16 LOUISVILLE MEDICINE