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The pros and cons of paying primary care doctors direct

By Candice Madsen  |  Posted Nov 15th, 2016 @ 10:33pm

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LEHI — As a self-employed, busy mother of five, Renee Kevern has plenty to worry about. One thing she no longer worries about: walking into a doctor’s office without insurance.

“It is such a relief, because if something goes wrong we can go to the doctor. It is not going to break us,” Kevern said.

Not only will the visit not break the family bank, Renee and the rest of her family can visit the doctor as often as they like because they all signed up for a direct primary care plan.

The pros

Kevern pays a simple flat monthly fee, and that covers all primary care needs including acute care, physicals, minor surgeries, X-rays, men’s and women’s health, pediatrics and chronic therapy. No insurance is involved, but the Keverns must see a doctor who contracts with Zenith Direct Care, Utah's largest direct primary care group, and pay a $10 visit fee. Virtual visits by phone are free.

“If I have three kids sick in one month it doesn’t send us over the edge. I just know what we are going to pay every month and I don’t have to worry about it,” Kevern explained.

Rusty Curtis is a small business owner and uses the Direct Care plan at Cottontree Family Practice in Provo for his family. He also offers the benefit to his employees.

“I’m surprised more businesses haven’t hopped on yet, because it is truly saving us money and enabling us to offer better quality care,” Curtis said.

Patients who sign up for direct primary care usually find they have better access to their doctor.

“They are able to come in when they want to. I can spend more time with the patients,” said Dr. Danny Thompson, whose practice is part of the Zenith Direct Care group.

“We’ve found that with direct primary care it is just like a weight off of our shoulders,” Thompson explained.

That weight — coding and billing — accounts for up to 40 percent of a doctor’s overhead. Under the direct care model doctors don’t have to deal with any of that.

“To be honest with you, it is the biggest frustration overall of everything we’ve had to do,” Thompson said.

The cons

While it sounds like a win for patients and doctors, there are several reasons why direct primary care plans have been slow to take off.

“I’m not going to say it works for everybody. Health insurance is still a good thing for a lot of people, but for a certain subset of the population direct primary care works very well,” said Aaron Thompson, COO of Zenith Direct Care.

The biggest hurdle for people to get over is satisfying the Affordable Care Act (ACA) insurance mandate, Thompson said. Direct primary care plans do not qualify.

Curtis employs less than 50 people, and therefore does not have to offer them medical insurance. He carries a catastrophic insurance plan for his family that meets the ACA requirement.

Kevern signed her family up for a healthcare sharing ministry offered in conjunction with her direct primary care plan. “It’s not an insurance, we just share the cost of healthcare with the members,” she said.

Enrollment with a recognized health care sharing ministry removes the requirement under the health care mandate to purchase health insurance.

Kevern said she pays around $500 a month for her family’s membership in the Direct Care plan and the health care sharing ministry. “I did the math this morning, I couldn’t even believe it. We are way less than half of what we were paying before,” she said.

The future of direct primary care

There are currently only a few direct primary care clinics in Utah, but MedLion, the country’s largest direct primary care company, plans to open in the Salt Lake area within the next one to two years.

MedLion's founder and CEO, Dr. M. Samir Qamar, said the direct primary care model is a throwback to the way people used to visit their family doctor.

“Insurance was reserved for catastrophic needs, and consumers paid their general practice of family physician out of pocket,” Samir said.

He believes most Americans today think health insurance means health care.

“To separate the two as concepts becomes challenging when we as a society have gotten use to using health insurance for everything,” he said. “I think in the era of deductibles getting higher and higher, the burden of finding more affordable options being placed on consumers, and more and more employers trying to find value for what they have to pay in benefits, you are going to see direct primary care take off.”

There is a proposal before Congress that would allow people to use their flex spending accounts to pay for direct care monthly memberships.


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