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.”