The Nashville area now has a handful of doctors who have made the leap to a different kind of business model for medical care.
They join a growing number of physicians nationwide, who say they’re fighting the health insurance system — by bypassing it.
Family doctors says it’s actually closer to how they practiced medicine before insurance.
Known as Direct Primary Care (DPC), physicians promise to see patients as often as they need, for a flat monthly fee. Many DPC patients are uninsured, like Rodrigo, a construction worker in Nashville. (Editor’s note: WPLN is not using Rodrigo’s last name because he’s undocumented.)
Through DPC, he pays $75 dollars a month, for unlimited hour-long visits with his doctor. He also gets anytime access to his physician via text or phone calls, “so long as I don’t call about an ingrown toenail at 11 p.m.,” he says in Spanish, with a laugh.
Rodrigo has been in the U.S. for 15 years, he says, but this is the first time he’s had his own primary care doctor. Until now, his main options were free clinics or the emergency room. In fact, that’s where he was diagnosed with diabetes, racking up a $3,000 bill that he’ll be chipping away at “little by little, through a payment plan.”
Managing his diabetes, however, may be a lifelong expense. So when he found out about Direct Primary Care, he called it a “godsend.” Now his doctor gets him his diabetes medication for less than four dollars a month.
His doctor, Fernando Dorrego, make it clear that he’s not running a charity: The Cuban-born internist says DPC doctors “just cut all the intermediaries, and we get medication directly from big distributors.”
Doing The Math
The number of DPC practices has grown significantly in recent years, though there are still fewer than 700 nationwide. However, advocates are encouraged that lawmakers across the country are starting to study or adopt regulations favorable to the new model.
Critics warn that DPC doesn’t cover things like MRIs or major surgery. But Dorrego says at least he’ll help his uninsured patients find the cheapest options in the area.
Meanwhile, he says, he can treat the vast majority of common health problems, perform PAP smears and put in stitches. And for blood work, he only charges what the labs charge him, which can be a fraction of the usual markup.
The difference in price, according to Dorrego, is overhead. “I would include insurance there but God knows how many other things,” he says. “You just have to see the headquarters for one of those insurance companies. The salary for that many people has to come from somewhere.”
As does Dorrego’s own salary. Which is why he was initially skeptical about Direct Primary Care. It’s been around for two decades, but he only heard about it a couple of years ago, when a practice opened up in Mt Juliet.
Dorrego thought: “Oh my God, this is crazy, how is he going to do this? This is not going to work.” He figured that doctor would go broke in a couple of months.
Then Dorrego did the math. To stay afloat, he says, typical practices need thousands of patients, because nearly half their revenue goes to battling with insurance companies.
Dorrego realized his business could flourish with 650 patients. So he left his job at a TriStar hospital and opened a DPC practice in MetroCenter this summer. He’s currently plateaued at around 50 patients but expect his practice to build slowly.
A ‘Welcome Medical Revolution’
Often, doctors who make this switch say they’re looking for a change of pace anyway.
Including Vidya Bansal, a pediatrician who started her own DPC practice this summer. She charges $50 to $125 a month, depending on the age of the child, and only does house calls.
One of her first patients was 2-year-old Ely Walters. Bansal says seeing the toddler in her own home works out for both of them.
“If she were not able to do some of the things that I observed her to do in her room, in a place where she doesn’t feel like this is a doctor in a white coat and a scary person,” Bansal says, then she wouldn’t be able to pick up as many clues about Ely’s development. In Ely’s home, “I’m just a friend playing with her.”
Bansal says she’s finally practicing medicine the way most pediatricians would love to, but it took opting out of the insurance-based system to do so. Previously, she was one of many primary care doctors feeling burned out from having to see dozens of patients a day, for just minutes at a time.
It wasn’t always this way in the U.S. Health insurance only emerged in the 1940s, and initially for high-cost services, like hospital stays and ER visits. Today, it dictates virtually every aspect of medical care, which helped DPC arise as an alternative.
And it’s not just for the uninsured. Ely’s mom Camila *Walters is herself a physician and professor at Vanderbilt University Medical Center. She says she has great coverage, but she works 80 hours a week. For her, being able to schedule a house call for her children was simply more convenient.
“Just the fact that I can have [Bansal] come over, text her any time, call her any time, that kind of access, you can’t get anywhere else,” says Walters. She and others say it can even be cheaper than using their existing health insurance.
For Walters, DPC is a welcome medical revolution. During one of Bansal’s house calls, she says, “The power is gone from patients and the power is gone from doctors.”
From the floor of Ely’s room, while checking on her patient’s ears with a panda-shaped otoscope, Bansal pipes in: “Amen.”
Walters says DPC is trying to take back that power by simplifying health care and avoiding some of the bureaucracy.
“We’re trying to skip all those people,” says Walters, “and just have a physician and a patient, doing what’s best for the patient, and charging a reasonable amount of money for that care.”
*Correction: The original article used an old last name. We regret the error.