Answers To Your Questions
Direct Primary Care
There is no catch! When we tell patients about direct primary care, many people are skeptical that it can be so simple. But DPC works because of its simplicity. It’s all about you and your provider. That’s it.
Direct Primary Care is not a replacement for health insurance, but rather a way to limit the role of health insurance to higher dollar items such as surgery, prolonged hospitalization, and expensive medications. Think of your homeowners and auto insurance policies that protect you against unlikely but costly events. Imagine the rapid inflation of your homeowner’s insurance premium you would see if you started using that coverage for routine maintenance like painting, cleaning gutters, or changing out your water heater. Imagine using your auto-insurance to cover oil changes and new tires. Many scholars have written about the administrative waste and expense that creeps in because we use our health insurance for low-dollar items.
Some people, and some businesses, decide to pair Direct Primary Care with a low premium, high deductible health insurance plan that suits their needs. And although it is not insurance, DPC pairs well with health sharing plans.
At Wise Patient Internal Medicine, both Direct Primary Care (DPC) and Concierge Medicine (CM) refer to the same level of personalized primary care that seeks to restore the provider-patient relationship.
The main difference is the price.
Direct Primary Care costs $135/month, and Concierge Medicine costs $120/month. Patients with Medicare MUST choose Concierge Medicine, and as of January 1, 2022, we will no longer offer concierge medicine for Non-Medicare patients.
The care you receive will be the same, but another difference is in the way that we bill: in the Concierge payment model, we will bill your insurance.
Yes, at any time and for any reason, by providing written notice to Wise Patient. Monthly fees will be prorated to the date Wise Patient receives your written termination. Importantly, you will not be allowed to rejoin Wise Patient Direct until one complete calendar year from the date you discontinued your membership.
Yes, but not solely on the basis of your health status or protected status. Per RCW 48.150.050, “…the direct practice may discontinue care for direct patients if: (a) The patient fails to pay the direct fee…; (b) the patient has performed an act that constitutes fraud; (c) the patient repeatedly fails to comply with the recommended treatment plan; (d) the patient is abusive and presents an emotional or physical danger to the staff or other patients of the direct practice; or (e) the direct practice discontinues operation as a direct practice.”
Yes, per RCW 48.150, a direct practice may decline to accept a patient “if the practice has reached its maximum capacity, or if the patient’s medical condition is such that the provider is unable to provide the appropriate level and type of health care services in the direct practice”.
I don’t get it. If I begin to pay Wise Patient a monthly membership fee, how exactly may I save money?
Participating in Wise Patient Direct may or may not save you money. Here are some ways that people have saved money using Direct Primary Care:
- Decreased monthly health costs. If paired with a low premium, high deductible insurance plan, the premium money you save might be much greater than the monthly membership fee for primary care. Still, you will need to envision different scenarios of out-of-pocket costs for medical care you receive from parties other than Wise Patient Internal Medicine, PLLC.
- Major discounts for common lab tests. Under the Wise Patient Direct model, we continue to negotiate substantial discounts from laboratories (and soon to come: imaging companies) for our Wise Patient Direct patients. As a result, some common lab fees can be multiple times lower than what the same lab would charge your insurance company (or you if they billed you directly). When we order labs for you in this way, we present you with an itemized cost at the time we draw your blood and charge the same credit card you have on file for your monthly DPC membership fee. Alternatively, some DPC patients choose to have their labs billed in the traditional way, from the laboratory to their health insurance company. We are fine doing that.
- Less time away from work and family. Under the Wise Patient Direct model, you can optimize the amount of care we provide you via electronic means. Fewer trips to the clinic means less time away from work and family.
- Fewer surprise bills from insurance companies. With Wise Patient Direct, you know up-front how much you are paying for primary care. No more guessing whether the office visit will be billed at a level 3, 4, or 5, if an appointment for a given topic will or won’t be covered under your insurance plan, or what your out-of-pocket cost will be for an office procedure such as an EKG, spirometry, or punch biopsy. Not knowing what something costs before you buy it (or sell it, in our case) is frustrating. Yet that is how insurance mediated primary care currently works!
Yes. Within the introduction to RCW 48.150 is found the following: “Direct patient-provider practices, in which patients enter into a direct relationship with medical practitioners and pay a fixed amount directly to the health care provider for primary care services, represent an innovative, affordable option which could improve access to medical care, reduce the number of people who now lack such access, and cut down on emergency room use for primary care purposes, thereby freeing up emergency room facilities to treat true emergencies.”
Does my DPC membership fee count against my deductible? Not for now, because subscription membership primary care did not exist when the IRS created their list of recognized medical expenses. Currently, there are separate bills in both U.S. House and U.S. Senate that would allow DPC membership fees to be recognized a medical expense by the IRS. The DPC community is optimistic one of these will pass. This would allow, amoung other things, a person to use an HSA account to pay their monthly DPC membership fee. Stay tuned.
While many states including Washington have embraced the monthly membership format to improve the quality and affordability of primary care, Medicare hasn’t had the bandwidth to embrace it yet. Because Medicare is a federal program, the rules surrounding direct primary care are different than those supported by Washington State. For starters, membership medicine seems to run afoul of Medicare’s policy that a practice must submit a specific claim and receive a specific fee for each service rendered. They regulate against underbilling and differently-billing. That said, Medicare has recently put out a request for proposal for how they might best integrate a DPC membership primary care option for their patients. Time will tell, but we are optimistic. For now, because Medicare laws require us to bill for covered services, we can only offer the Concierge Medicine payment model to our Medicare patients for our membership only practice. The Concierge Medicine payment model allows our Medicare patients to participate in membership medicine and provides additional non-covered services such as personal training sessions.