Monday, January 18, 2016


Direct Primary Care:  Freedom from Technology
Information  technology has limits when it  intervenes  into medical practices.  To escape the tyranny of this technology and its limitations on their freedoms,  more primary care physicians are turning to direct primary care (“Fueled by  Health Law, ‘Concierge Medicine’ Reaches New Markets,”  Kaiser Health News, January 14, 2015).
These new markets include Medicare and Medicaid  Managed Care,  markets   where direct primary  care advocates say they can reduce costs by 20% or more.
Direct primary care (DPC) generally entails  charging a flat monthly or annual fee of $100 a month or $1200 a year or so  for comprehensive care – basic medications,  lab tests and other services,  follow up visits,  and free 24/7 access to physicians by email or phone.
DPC is  about limits of technological intervention and about practice freedom -  freedom from pre-authorization of tests and treatment,  freedom from electronic health records,  freedom from searching for the right ICD-10 code,    freedom to spend more time with patients,  freedom from 50%  overhead costs , freedom from surveillance by 3rd parties,  freedom from online data dictating what one should be paid,  and freedom to exercise one’s clinical judgment based on patient’s needs and choices.
It is not known with precision how many primary care physicians are converting their  traditional 3rd party-bound practices to DPC.   Estimates vary from 2% to 5%, but it is known from surveys by MGMA and the American Academy of Family Practice that 10% to 15% are considering the switch.
It is a tricky proposition to go from a traditional practice to a DPC practice.  It involves paring down a practice from a panel of 2000 patients or so  to a select 500,  navigating Medicare,  Medicaid,  health exchange, and insurer rules;   ignoring antagonistic critics, who claim you are creating a dual deliver system,  that you are sacrificing patient need for personal greed,  that you are contributing to a growing primary care shortage;  that you must take  the economic risks of making the transition to DPC, which is not sure thing.
There is more to the DPC switch than meets the eye.   Basically it  is a battle-cry for freedom,  for freedom to practice in one’s best interest and the best interest of  patients.    It is a hard choice.  Freedom is never an easy choice,  particularly when it comes to  who is to be the master,  technology,  yourself,  your patients,  the insurers, or the government.  "The question is," as Humpty Dumpty said,  "which is to be the master – that’s all.”

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