A new model for primary care

MARY REICHARD, HOST: Coming up next on The World and Everything in It: a new model for primary healthcare.

Americans spend a lot of money on medical care. In 2017, U.S. healthcare spending topped $3.5 trillion according to the federal government. And experts say around half of that money goes for unnecessary tests, treatment, and administrative costs. That adds up to as much as $1.8 trillion in waste.

MEGAN BASHAM, HOST: Costs are rising and the aging population needs more healthcare. But doctors are working less and retiring early. Healthcare has become industrialized, making it less enjoyable, some feel, as a career. Many cite that as a reason for high rates of doctor burnout. And that industrialization raises costs.

But a new model for primary care offers a prescription to fix both problems. WORLD Radio’s Leigh Jones explains how it works.

LEIGH JONES, NEWS EDITOR: When Steven Manning graduated from medical school and finished his residency, he moved back to his hometown. Williamston, North Carolina, had a few other family doctors but not a large practice. So Manning partnered with the local hospital to open one.

Things went well for the first few years.

MANNING: Probably beginning in the third year of my contract with the hospital, um, things began to change and I began to really see the drive was volume and revenue.

Like most physicians working in a fee-for-service model, Manning was expected to see as many patients as possible.

MANNING: For me that equaled, you know, seeing 25 to 30 patients a day, having all the documentation due for those patients, and really feeling exhausted by the time my day was done. And it got to a point where I didn’t really enjoy coming to work, and I began to think there’s gotta be a better way to do this.

Late one night, sitting in his office doing paperwork, Manning had an epiphany.

MANNING: And I kind of had this God moment where I begin to think this is not where I want to be. I have a wife and at that time, two kids, and I should be home right now. I should not be in this office.

As he sat there, Manning suddenly remembered the name of a doctor who spoke to his residency class about a new practice model called direct primary care. It’s like a subscription service that covers most basic medical needs without insurance.

So Manning called him up. He described the conversation as a breath of fresh air. A year later, Manning opened a new, independent practice. That was almost five years ago. He now says he can’t imagine practicing medicine any other way.

MANNING: If someone told me that I could not do this model, I would seriously consider doing something else besides medicine. It’s, it’s that good. It’s that refreshing compared to what I would get in the insurance-based model.

Manning charges his patients a set monthly fee. They see him as often as they like during office hours and can call, text, or email any time. Manning sees far fewer patients each day, but he spends at least 30 minutes with each one. His appointments often include conversations about spiritual needs, something he rarely had time for in his old practice.

That emphasis on the doctor-patient relationship is what drives most family doctors to open direct primary care practices. Better relationships lead to better care. But they have an ancillary benefit: lower costs and less waste.

Jay Keese is executive director of the Direct Primary Care Coalition in Washington, D.C. When talking to lawmakers, Keese emphasizes those cost-saving benefits.

KEESE: In direct primary care, you’re paid by the patient or by the employer on the patient’s behalf to take care of the patient and you’re going to do things differently than you would if you were ordering procedures and labs and drugs and other things without regard of how they were being paid for.

Keese insists health insurance should be structured more like car insurance, which doesn’t cover regular maintenance.

KEESE: And we think that the model of taking the primary care services that we ought to be emphasizing people use every single day, paying for them upfront and allowing those benefits to be reached in a relationship that’s built between the doctor and the patient, you know, is a better and more efficient way to do it.

Keese estimates employers can save as much as 20 percent on healthcare costs by partnering with a direct primary care practice to provide the essential health benefits required under Obamacare. They can then cover other medical needs with a high deductible insurance plan.

Despite the cost savings and other benefits for doctors and patients, direct primary care still accounts for a very small piece of the overall healthcare system. Keese estimates about 1-thousand practices across the country operate under a direct primary care model. He expects to see slow but steady growth as the model becomes more widely known.

But he admits it’s not for everyone. Doctors need an entrepreneurial attitude and some affinity for risk.

KEESE: And so for those that want to do it, it’s been very rewarding. But it can be difficult too. It can be years before you get a patient panel size that matches what you want your income to be.

And Steven Manning says it can be hard to convince patients to give direct primary care a try because it’s so different from what they know. But it’s catching on in Williamston. So much so that Manning just brought in another doctor to open a second office in a neighboring town.

MANNING: And we’re both looking at our practice going, okay, how do we make this more of a ministry and how do we share with patients about Jesus and really make it all about Him in what we do every day. And I couldn’t imagine doing that outside this model.

Reporting for WORLD Radio, I’m Leigh Jones.

(Photo/Creative Commons)

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