CRESTWOOD What if you could toss out the red tape, mindless clicking in the EMR, piles of paperwork associated with insurance coding and billing, and other administrative requirements associated with medical practice – and simply see patients at your own pace? What if you had more time for communication, education, research, and your personal life? Would you be a happier person and thereby a better doctor?
It sounds almost too good to be true. But two primary care physicians in Crestwood have left their traditional practices to help pioneer a new model – direct primary care – that is promising just that.
The physicians, Molly Rutherford, MD, owner of Bluegrass Family Wellness, and Tracy Ragland, MD, owner of OneFamilyMD, are quick to note that direct primary care (DPC) is different from concierge medicine, in which practices can carry very expensive annual fees and may still bill insurance. While each DPC business is unique, Rutherford and Ragland share a business model as well as office space. For an affordable monthly fee, $50 for adults age 26–45 for example, patients get unlimited access to their physician, routine office-based tests and procedures, and wholesale-priced medications and labs, without the hassle of billing insurance.
Says Rutherford, “If you can afford a smartphone, you can afford this.”
“It’s all about the patient-physician relationship,” says Ragland. “It’s better primary care for the masses.”
The Breaking point
Rutherford, who is from Virginia and did her training there, was looking for a place to practice that would satisfy her desire to practice rural medicine and her husband’s desire to be a city police officer. She landed in Carrolton, Ky., for five years before joining Paige Primary Care Center in LaGrange, a patient-centered medical home, to be closer to her family. However, she found the pressures of patient volumes and coding, the focus on data, and the subsequent transition to electronic medical records (EMR) to be “toxic” and disruptive to patient care. “I was questioning whether I made the right decision to go into medicine,” she says.
Then Rutherford read about Josh Umbehr, MD, owner of Atlas MD in Wichita, Ks., who was modeling a DPC approach. She consulted Umbehr and decided to make the transition. “If you don’t have financial security, it’s hard to make the jump,” she concedes, but Rutherford had the advantage of being dually board-certified in family practice and addiction medicine and knew her addiction practice would help balance the financial risk.
Although Ragland was happy with her group practice and partnership, she was becoming increasingly dissatisfied with the traditional healthcare “system.” An internal medicine and pediatric physician with Internal Medicine and Pediatric Associates in Crestwood, she had become increasingly involved in physician advocacy, looking for ways to improve her caregiving experience, but she found, “Every solution seemed to create more problems.”
Rutherford and Ragland have known each other for a long time, and in fact, Ragland is Rutherford’s physician. When Ragland learned of the DPC model and also consulted with Umbehr, she thought, “I’m either going to do this, or I’m not going to do medicine anymore.”
Rutherford leased their current space in May 2015, and Ragland began practicing there in July 2015.
The Direct Primary Care Model
In Bluegrass Family Wellness and OneFamilyMD’s model, patients buy a monthly subscription, which ranges from $10 for children to $100 for adults age 65+. That subscription includes:
An annual wellness exam
Unlimited office visits (an average of 30 minutes long but up to an hour or more for complex issues)
Unlimited technology visits and 24/7 access to the doctor via phone, email, text, and Skype
Before and after-hours visits
Work site visits and house calls if necessary
Minor in-office procedures
Routine lab work (Additional labs provided at wholesale prices.)
An in-office pharmacy that provides medications at wholesale prices
Kentucky is one of 44 states that allows physicians to dispense medications. Ragland estimates they carry 85 to 90 percent of the medications their patients need, mostly generics and no controlled substances, and save their patients a significant amount of money, sometimes enough to cover the cost of their monthly subscription.
The patient volume for both physicians has changed drastically, dropping from 2,000 patients to closer to 300 each. Ragland says she does not plan to have many more than 400. Both physicians employ just one assistant each. No other office staff is necessary since they are not filing insurance, and they have the time to make patient calls themselves. When someone is out sick or on vacation, they cover for each other and share assistants.
When asked how the 24/7 access affects their work-life balance, Rutherford says, “I prefer it,” explaining she was always doing notes and thinking about work after hours anyway, and now she spends less time in the office. “We’re doing what we’re trained to do, not coding,” she says.
Ragland, who gets one to two after-hours calls per week, concurs. “It doesn’t feel like work. I would much rather meet someone in the office at 8 p.m. to listen to a wheezing child after a pleasant day,” she says. And, she points out that when she was on-call in her group practice, she was responsible for over 6,000 patients, not just her 2,000.
While the direct-care approach works in a primary care setting, it might not work in a practice where services are more expensive and specialized. That is what insurance should be for, says Rutherford, to cover non-routine care, expensive procedures, and hospitalizations. Both practices work with insurance specialists who can help patients find lower cost, high-deductible plans coupled with Health Savings Accounts that complement their DPC subscriptions.
The next step for the two entrepreneurs is reaching out to small businesses that are self-insured, a demographic that established DPC practices throughout the United States are helping save 20 to 30 percent or more on healthcare spending. In addition, unions and state Medicaid programs are trying DPC and seeing substantial benefits. “Spending a little more on primary care saves drastically on avoidable emergency room visits, advanced imaging, hospitalizations, and more, no matter who is paying the bill,” says Ragland.
In response to critics who say DPC physicians are selfishly making the primary care shortage worse, Ragland responds, “What is the best way to get more doctors interested in primary care? Show them they can do what they went to school for, take great care of patients, and find a work-life balance on their own terms. We can be a real part of the solution – more primary care doctors, better patient and employee satisfaction, and much less spending by individuals, businesses, and governments on healthcare.”
WHAT IS THE BEST WAY TO GET DOCTORS INTERESTED IN PRIMARY CARE? WE CAN BE A REAL PART OF THE SOLUTION.
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