1. What is direct primary care (DPC)?
DPC is a financial agreement made directly between you and the medical doctor. It cuts insurance out of the the equation in relation to the doctor’s services. No copays are collected, and the doctor doesn’t rely on insurance reimbursement to get paid. Average monthly cost nationwide is around $100 to $120 dollars per month, but it varies with the individual practices and the services that are provided. Some do home visits, others may offer minor surgical procedures or specialty testing. All DPC model offices offer non traditional office hours and direct access to the doctor, even after hours.
Private insurance is recommended for vaccinations, specialty services, hospitalization, and some lab work / testing.
2. I am not rich. How does this differ from “concierge medicine?”
Concierge Model practices require a monthly or yearly fee that is generally much higher, but they also bill insurance for services. If you are interested in this model, I encourage you to look into it further on the Internet. I have no plans to deal directly with the burdens associated with insurance ever again, so I have not spent a lot of time familiarizing myself with concierge medicine.
3. What are some of the benefits of a DPC model practice?
More time with your Pediatrician: Because I do not have to see a certain number of patients per day, I can schedule visits based on the needs of the patient, or the complexity of the problem. I can get to know your child, your family, and can spend time on issues that often can’t be addressed in practices where you only get 10 to 15 minutes per visit with the MD. Visits can be more relaxed, and I get to evaluate your child much better when I can interact with them by playing ball or with toys that they bring with them, or even just watching them explore the room.
More access to your pediatrician. This means that you have direct access to me, via a “just for members” phone number and email address, linked to your child’s chart. You can call, text, send pictures or videos when it suits your needs. No call centers, no leaving messages with staff and waiting for an answer when the MD has a spare moment to reply … usually via another staff member. If I am not available at that moment, I will either let you know directly, or have my nurse contact you. Generally I am quick to answer, especially texts, but if I am with a patient in the office, there will be an obvious delay.
More access also allows me to provide advice, reassurance, and monitor medical conditions, often without needing you to bring the child into the office. Follow ups from the ER or a previous visit can be just a text or email in many cases. I also can help you determine if you truly need to take your child to the ICC or ER. In the non DPC world, it isn’t always the doctor providing advice, and often, if there are no appointments available, you would be directed to the ICC or ER. Remember, MD’s that rely on insurance to get paid only make money if your child is seen, and the MD can document via a note why their services to the patient should be considered valuable. And if you have a copay for all visits, multiple visits definitely add up!
Availability and Flexibility: This varies between practices, but most have the ability to offer same day appointments, and even early morning or early evening time slots. Some may see patients on weekends and holidays, depending on the situation.
Some examples of how this can benefit busy families:
• For first time parents , imagine being able to text, email, or call the MD directly with questions and concerns, instead of being asked to make an in office appointment?
• Families with more than 2 kids can schedule well checks ups for all of their kids on the same day. In non DPC practices, usually the limit is 2. So if you have 3 or more children, you would have to make at least 2 separate trips.
• Last minute sports physicals can usually be accommodated. Most parents are quite familiar with the “by the way, I want to try out for “X” sport, and I need to turn in the form today before try outs” scenario. Sports physicals truly deserve more attention than what can be done at a store based clinic or ICC, by providers who are not trained in Pediatrics. And if they can be done by an MD that knows your child, it generally is a much more pleasant and informative visit.
• For patients with ADHD or anxiety , an office visit is not required for every medication dose change or discussion about the treatment plan. Updates can be via text or email, making it much easier to catch problems before they become overwhelming.
• I can offer my college age patients weekend appointments, or telehealth visits to save them from going to the campus healthcare facility and seeing a provider that doesn’t know them or their history. Patients can “age out” when they are ready, not just at an arbitrary age of 18 or 21 years.
• Parent only consults can be offered, after 5 pm, or even on a weekend so that childcare options are more abundant, and no one misses work. Insurance does not reimburse for visits where the child is not present, so these type of visits cannot be done in the non DPC world.
• And lastly, kids absolutely love to develop a medical need after “regular office hours” or right before a big event! What is it worth to get confirmation that a rash is not contagious without having to make an appointment? Or advice and reassurance that you don’t need to rush them to the ICC or ER in those situations?
Upfront Pricing: Patients know the amount of the monthly fee, and the flat fee (if any) for additional services that may be provided. The fee doesn’t vary based on the services you receive. No surprises.
Currently I have no plans to limit the number for visits, calls, texts, or emails. Most of the onsite labs will be included in the monthly fee. If it is cheaper to obtain your prescription medication through me, you will know the cost before it is collected. I also now can determine the cost of the patient portion (after insurance pays) prior to ordering. A recent example:
16 year old with United Healthcare:
Labs to be drawn: CBC, CMP, Ferritin, TSH, Free T4, Lipid Panel, Vit D
Patient portion would have been $185 (again, AFTER insurance paid their part)
Cost using our DPC lab rates: $34
4. How do costs and payment work for DPC?
The monthly fee for this office ranges between $75 and $90 per month. (See Pricing Page) This is lower than most, and I hope to be able to keep it that way. No copays are ever collected. There are no additional fees at the time of service, since payment for any medication dispensed on site is added to the next monthly bill or charged to the card provided. Cash or Check payment is also an option.
In general, fees are based on the patient age, type of practice, and number of family members on the plan. I offer additional savings when fees are paid every 3, 6, or 12 months instead of monthly, or if they are paid in cash or by check. Family plans also are available.
HSA can be used for monthly fee payment.
The monthly fee covers all — or most — typical primary care services. These include:
- Preventive care (routine screenings and well child visits) including vaccinations.
- On site laboratory tests. Send out labs will be billed to insurance, unless our cost is lower and family prefers to pay out of pocket. (This is important with insurance plans increasing their out of pocket costs and decreasing services covered)
- Management of chronic conditions (including medication refills and paperwork)
- Acute-care visits (like for strep throat or the flu) and on site screening tests.
- Consultations with parents only (which for pediatricians are not billable unless the child is present when insurance is used)
- Procedures like vision / hearing screens, wart removal, wound care, nebulizer treatments, tympanograms, and splinting of injuries.
The monthly fee doesn’t include visits to specialists, urgent care, or the hospital. Prescriptions are also not part of a DPC financial agreement. But some non controlled medications may be available at a significant discount through the DPC office.
DPC usually cost less than health insurance premiums, but it can be associated with some financial risk. This is due to the lack of coverage for other health-related expenses, like hospitalizations or surgery. To prevent medical bills you can’t pay, DPC is typically paired with one or more of the following options:
- A high-deductible health plan (HDHP): This covers services like surgeries or catastrophic health issues. It also covers emergency-room treatment or hospitalization. An HDHP is one way to prevent financial devastation if you need emergency or extensive care.
- A health savings account (HSA): Anyone enrolled in a HDHP is eligible to contribute money to a HSA. You make contributions before income tax is deducted from your paycheck. This lowers your amount of taxable income. You can use your HSA on health-related expenses, such as prescriptions, copays, and deductibles. Other expenses, like medical equipment, may also be covered.
- Prescription coverage or coupons: These can be used with both DPC and insurance plans. Example is GoodRx, but there are others. Manufacturer coupons also may be available.
5. Can I participate if I have Medicaid?
Unfortunately, in Kentucky you cannot. This is due to wording in a bill that was passed several years ago. KY is only 1 of 2 states that doesn’t allow doctors to opt out of Medicaid, yet it allows them to opt out of Medicare. This is frustrating, and a huge drawback when I was pondering opening a pediatric DPC practice. I plan to add information about this should anyone want to write to the governor or lobby on behalf of the children of Kentucky. In my opinion, not allowing families on Medicaid to participate in DPC practices isn’t fair, since having Medicaid does not equate to being “poor” or undeserving of more individualized care. Foster parents, guardians and grandparents raising family member’s children, parents in pre-professional schools (medical, dental, various trades) and the self employed often rely on Medicaid for at least part of their children’s lives.
6. What are your office hours?
At least initially, our office hours are “by appointment.” This is because I want to be able to offer non traditional hours when they are needed. For example, if I determine that your child needs to be seen, and it happens to be a Saturday afternoon, I may be able to see them that day, or decide that it can wait until Sunday or Monday, depending on the circumstances. For well visits that need vaccines or certain testing, we are limiting those to when my nurse is able to be on site. Currently that tends to be on Tues, Thursday, and Fridays. But if you let us know your circumstances, we generally can accommodate.
7. Can I schedule an appointment just to meet the doctor and get an idea if she is a good fit for me and my family?
Absolutely! For new patients I encourage this, because the basis of a beneficial doctor- patient relationship is communication and trust. When it is a good fit, everyone is happy. When it is not, why waste your time? There are lots of good pediatricians in this area, so you have options. This gives you the opportunity to ask questions, see the office, and generally get a “feel” for my style and practices.
There is no charge for these “Meet and Greet” visits.
To arrange this, go to the Contact Us page and send a message, or call the office number, 502-698-8483.
8. What do you mean by “basic / routine vaccinations are required?” Are there any exceptions?
I believe in science, and in vaccination. The evidence that vaccination has decreased damage and death from certain diseases is impressive, and there is a lot of it. I now am old enough to have witnessed this in real time, specifically with the development of a vaccine for Varicella (Chicken Pox) and Haemophilus influenza. But truly, when it comes down to it, I have been involved in the care of of children who are permanently damaged or have died from vaccine preventable diseases due to vaccine refusal, and I cannot add to the scars they have caused to my heart. So if you are completely unwilling to vaccinate your child, for whatever reason, we are not a good fit.
Having said that, I also believe that parents truly want the best for their children, but get a LOT of mixed messages and advice, particularly in the last 10 years. This is where having a strong doctor – patient relationship is invaluable, and the flexibility of a DPC practice can make compromises possible.
For example, I have parents who do not want to get multiple vaccines at a single well visit. They prefer to get one that day, and the rest at some interval (often 2 – 4 weeks) before the next well visit. So the child is following the recommended schedule, but the shots are spaced differently. Larger offices tend to frown on this b/c is it more likely to result in errors and missed vaccinations, but we have the ability to keep track and offer the multiple appointments needed to make it happen. And while there is no supporting data showing a benefit of giving vaccines this way, the end result is agreeable to all parties, so why not?
I am open to discussing alterations to the vaccine schedule, as long as they are reasonable, and don’t decrease the efficacy of another vaccine. The history behind the development of vaccines, the reasons for pairing certain ones, and giving them on a certain schedule is quite interesting, and a lot more complex than most people understand.
If your child has a true documented medical reason that they cannot receive a particular vaccine, like an immunodeficiency syndrome, that is okay. In fact, these are the kids we want to protect the most via herd immunity,
On the “recommended but not required” list are Covid-19 (currently a hot topic anyway), annual influenza, and HPV. Rotavirus also can be skipped, particularly if there is an immunocompromised caregiver. Again, I have no concern about the safety of these vaccines, particularly when you look at the risk of complications from having the natural disease vs side effects from the vaccine. But I understand some of the reasons for hesitation and concern, and am open to discuss them.