Member spotlight: Allison Edwards, MD

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Meet Dr. Allison Edwards, DPC Alliance Secretary Extraordinaire and founder of Kansas City Direct Primary Care (KCDPC).

Dr. Allison founded KCDPC in January 2017, after working her tail off doing locums work to save money and plan her DPC clinic. She was inspired by other DPC physicians in her home state of Kansas and by her own vision for ideal medical care. Dr. Allison believes, DPC is “medicine the way medicine should be done. It's more time with your patients, and having the time to both get to know them and to make plans that fit in the greater context of their life.”

With her colleagues in the Midwest DPC Alliance, Dr. Allison and KCDPC along with 14 other doctor-owned micro practices purchased and waived over 1.4 MILLION DOLLARS (yes, MILLION!) in medical debt. Learn more about that amazing work here:  http://www.midwestdpcalliance.org/debt-relief-pr

Dr. Allison may not admit it, but she is a DPC prodigy. To launch out on her own cash-practice straight out of residency, to grow in great leadership in DPC circles and mentoring roles all while working locums tenens to financially support her practice AND to do all this in under two years--- amazing.

We salute you, Dr. Allison Edwards. Thanks for showing the great work that can be done when one energetic, capable, intelligent, forward-thinking physician believes, “We can do better.”

For physicians thinking about DPC, Dr. Allison recommends:  “many DPC docs are entrepreneurs by default.  So step up!  Channel your inner entrepreneur spirit and hold on for the ride!”

Find Dr. Allison and KCDPC here: https://www.kansascitydirectprimarycare.com

Member spotlight: Peter Lehmann, MD

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Dr. Peter Lehmann has loved medicine since the day he decided to become a physician. He founded Vintage Direct Primary care in January 2016 in Poulsbo, Washington and opened a second location last summer in Kingston, Washington. Offering “modern care with old-time service”, Dr. Lehmann and his staff of 3 keep things personalized, approachable and affordable.

In addition to enjoying the freedom of being his own boss, Dr. Lehmann states DPC affords him so much more time with patients. “I give much more through care than I could ever give in a fee-for-service environment. I refer people out so much less. The days are still long, but I spend my time differently.”

For physicians wondering about transitioning to DPC, Dr. Lehmann recommends doing a lot of research. “You don’t need to reinvent the wheel”. He recommends joining DPC Facebook groups, going to a DPC meeting such as the AAFP’s DPC Summit or D4PC Nuts and Bolts. He states all of the resources are “out there...you just need to PLAN.  The DPC model is simple. The devil is in the details.” 

“Prepare to work your butt off-- for you!”

Learn more about Vintage Direct Primary Care and Dr. Lehmann here:  https://www.vintagedpc.com

Directory & Visitor Services

We are pleased to announce the DPC Alliance Physician Directory. This resource will allow the public or a fellow doctor to easily find a DPC physician in their area, as well as many other things! A few of the unique features of our directory:

INDIVIDUAL PHYSICIANS

Doctors (active DPCA members) will be listed as individuals, rather than by clinic. Information about the respective doctor's DPC practice is included on the profile but we think showing the diverse faces of the DPC movement will be great; as well as provide more information to patients wanting something particular in a primary care physician.

If multiple physicians exist within a DPC practice, our directory will aggregate them by location on the mapper while still providing an individual profile for each.

SEARCHING BY ZIP OR STATE

The search functions are basic now-- allowing a person to look by zip code (e.g. within 50 miles) or by state (e.g. Texas)-- but we are planning on adding more functions here in the future.

VISITOR SERVICES

DPC Alliance members who are logged into their account will also be able to see "Visitor Services" within a fellow doctor's profile. This allows a doctor to look for potential resources (fellow DPCA member) for a patient when they are traveling and need medical attention. Providing this information does not commit a DPCA member to any particular service, and any such arrangements will be done a voluntary, case-by-case, and practice-to-practice basis.

If you would like to see other features added to our directory, please let us know.

Member spotlight: Amy Walsh, MD

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As a former collegiate gymnast, Dr. Amy Walsh knows a thing or two about excellence. After 20 years in medical practice, including working as an employed physician with Duke Primary Care in Wake Forest, Dr. Amy noted that healthcare was becoming so impersonal, complex and expensive that she had to find another way.

In 2015, Dr. Amy opened doctor direct, a direct primary care practice in Raleigh, North Carolina. When she is asked why she chose to open her own independent direct primary care practice, Dr. Amy says “Why DPC? The real question should be WHY NOT?... Direct primary care fixes all [of the problems of impersonal care] and actually does just the opposite.”

Dr. Walsh is a role model for healthy living. She has four children, two dogs and a husband she’s known since she was eight years old. She is a Founding Member and the first Treasurer of the DPC Alliance. While Dr. Amy states she has always believed that a doctor’s best partner is the patient, DPC allows her to live that belief.

“I tell people all the time that opening doctor direct was the best career decision of my life. Truth be told, direct primary care saved my career.”

Learn more about Dr. Amy, and her physician partner, Dr. Kwark here: https://www.doctordirectmd.com

Profile management, directory, discounts, & more!

DPC Alliance members,

We have been hard at work behind the scenes these past few months to put the Alliance in a great position to launch new member services in 2019. I am excited to share some of those with you now…

  • Membership & profile management. We have made managing your membership with us, including profile (personal and practice) & membership dues, a breeze. Members can log in the members area of our website to get started. The first time you will need to request your password using primary email you gave us upon enrollment. For those curious about payment of 2019 member dues, this is where you will management payments.

  • DPCA Physician Directory. Our directory of DPC Alliance physicians is now live! This directory is first by individual physician to show America the faces of DPC doctors nationwide! You can include your DPC practice info on your profile. All of this information is editable on your profile. We encourage you to review this, and also upload a personal photo (under Media section) if you don’t already have one.

  • Member Discounts. A driving force behind the DPC movement is being conscience of costs; both for patients and our own practices. Some may call us “penny pinchers”, but that business acumen is what keeps our prices affordable for patient. The Alliance has partnered with a wide variety of vendors through our Member Advantage Partner Program to give you preferred pricing on their goods & services. One of the most exciting partnerships we have confirmed thus for is with True Health Diagnostics who have agreed to provide our members great client-bill rates nationwide. We have several more in line to launch Jan. 1 so stay tuned for more!

  • DPCA Visitor Services. Many DPC practices have organically helped out fellow DPC patients when traveling, and we want to support efforts like that. So, we are allowing members to include a description of “Visitor Services” on their profile. This information will only be visible to Alliance members who are logged in looking at the directory. If your DPC practice is willing to see fellow Alliance members' patients when they are traveling, please provide those details (services, pricing & policies) in your profile (under Practice section). Providing this information does not commit you to any particular service, and any such arrangements will be done a voluntary, case-by-case, and practice-to-practice basis.

  • Alliance Events. Starting in 2019, we are going to be sharing upcoming DPC-related events on our calendar. Some of these will be familiar conferences that we will be sponsoring, but also some DPCA get-togethers (virtually & live).

  • New Member Application. If you have not yet joined the Alliance, we have made it easier than ever!

Okay, that’s probably enough announcements for one post, but we will be sharing much more in the coming weeks & months. I want to thank all of Alliance members who have put in a tremendous about of volunteer work in to these efforts. If you would like to help us out, we are going to make it easier to join and find a committee very soon.

Have a great weekend and holiday season,

Ryan
President, DPC Alliance

What an exciting first year it has been!

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The Direct Primary Care Alliance was founded by physicians for physicians in January 2018 and in our inaugural year we have grown to more than 350 members. We have spoken and/or been involved in planning every premiere DPC event in 2018 (AAFP DPC Summit, Hint Summit, Doctors 4 Patient Care Nuts and Bolts, DPC Coalition Meetings... to name a few) and have been featured in and provided content for news outlets including Forbes, Bloomberg, NPR, FoxNews, CNBC and many others.

As we round into 2019 and our second year, we have a number of changes and opportunities we would like to share with you. We have negotiated cost-savings benefits for DPCA members including substantial discounts with on-line consulting services, transparent DPC laboratory pricing with True Health Labs, discounts on medical education and much more.  We will be publishing a DPC Alliance member directory so members can find each other and to assist with promoting DPCA clinics nationwide. And we are looking forward to hiring an executive director to help us grow, communicate and add more benefits for our physician members.

In our founding year, the DPCA was supported by generous contributions from our 50 founding members. Moving forward, to grow, to be involved and to continue to advance direct primary care nationally, we will be requiring dues payment from our entire membership.

Our membership for 2019 will be free to medical students and residents and $500 yearly to all other members. We are working diligently to secure benefits and savings in excess of these dues.

We continue to grow and to help physicians, one by one, execute their own vision of healthcare transformation and direct primary care. We are very excited for what's to come and appreciate your input, advocacy and feedback as to how the DPCA can grow into the premiere physician-led direct primary care organization. Thank you again for joining us as we move forward. A very happy holiday season and New Year to each of you!

Leadership announcement

Our sincere thanks to everyone who participated in our recent election of new Advisor Committee members, President and Vice President.

We are excited to announce that our next President and Vice President, with terms starting on January 1, 2020

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Julie Gunther, MD Incoming President

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Vance Lassey, MD
Incoming Vice President


We are equally excited to announce our new Advisory Committee members. Each will serve a three-year term beginning on January 1, 2019.

Kissi Blackwell, MD
Advisory Committee

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Shane Purcell, MD
Advisory Committee

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Josh Umbehr, MD
Advisory Committee

Just gimme the facts

Since launching in early 2018, the DPC Alliance has quickly grown to over 300 members. In this process, we have gathered some valuable information about DPC physicians (or soon to be) and practices nationwide. While this does not represent all DPC practices (estimated at over 900), we believe this is the single largest, broad survey of DPC physicians & practices to date. (Data as of Sep, 11, 2018)  

demographics

  • Average age = 43

  • Average year of medical school graduation = 2004

  • Gender

    • 51.2% female

    • 48.8% male

TRAINING/EDUCATION

  • Degree (post-graduates)

    • MD = 79.4%

    • DO = 20.6%

  • Speciality/scope

    • Family Medicine = 71.9%

    • Family Medicine w/ OB = 5.2%

    • Internal Medicine = 11.4%

    • Med/Peds = 4.2%

    • Pediatrics = 2.3%

STAGE OF DPC PRACTICE

  • Active (open) DPC practice = 197

  • Planning on DPC practice in 12 months = 70

  • Considering DPC practice = 37

PRACTICE DETAILS

  • Monthly fee (average per patient)

    • $50-75/mo = 65.5%

    • $76-100/mo = 14.6%

    • $49 or less/mo = 10.8%

    • $101-150/mo = 5.7%

  • Provides some charity care = 85%

  • Average age of practice = 2 years

  • States of practice = 45

Graphs

Distribution of DPCA member practices by State

Distribution of DPCA members by gender

Distribution of DPCA member practices monthly membership cost

Percentage of DPCA members offering charity care

Specialty breakdown of DPCA members

Ownership breakdown of DPCA members

Retort to a limited understanding of DPC in STAT

Recently, the Direct Primary Care (DPC) movement has attracted a lot of attention in the op-ed pages of reputable publications. Given our swelling ranks, I guess the attention was inevitable. A few of these opinion pieces been have filled with misunderstandings about the DPC model, but Timothy Hoff, Ph.D. healthy policy professor at Northeastern University, recently took his critique of DPC model and physicians to another level in STAT News.

As always, DPC physicians are happy to educate people about primary care and the DPC model, so I will respond to Timothy’s concerns directly and point-by-point.

“Some view it (DPC) as a panacea, others as snake oil. I’m not sure what it is...”

I don’t know a single DPC physician who believes that the DPC model is a “panacea” for all of the problems in the health care system; nor does anybody believe DPC is a replacement for health insurance or public assistance.

Snake oil”? I would expect somebody with a Ph.D. working for an academic institution to use less empty and inflammatory rhetoric. Are you suggesting that DPC practices are perpetrating actual fraud? Or are you just reporting other people believe that?

Timothy, you definitely proved you don’t know what what DPC is repeatedly in this ill-informed opinion. Perhaps you should’ve just stopped there, instead of baselessly attacking it?

“direct primary care is a model for delivering primary care, and only primary care.”

And only primary care? Yes, it is right there in the name...Direct Primary Care.

You then state that primary care cannot care for “more extensive management of a chronic disease”. Sir, you have no concept of what primary care physicians do-- DPC model or otherwise-- around this nation on a daily basis. We care for nearly every common chronic disease you could name (and many you couldn't); as well as provide care for a patient's’ symptoms of uncertain origin, acute needs, and psychosocial problems-- often all at the same visit. I realize you didn’t go to medical school, so if you need a comprehensive list of problems and diseases I diagnosis and manage, I’m happy to provide it for your review.

Sadly, your perspective about the limited role of primary care is all too common. I suppose this view has some validity as the American health care system that has undermined our value for many decades. (If you aren’t familiar with why, I'd suggest you read up on the AMA RUC) This low valuation slowly warped the nature of primary care itself. Too often, rushed primary care physicians are forced in to being a referalist, rather than an actual clinician.

The DPC model has many benefits, but most importantly is that it provides an opportunity and environment for PCPs to provide a higher level of care than is possible with 10 minute visits and juggling a panel of 2000 or more patients.

“the physician or practice will charge the patient extra fees to cover those services (chronic disease management).”

I am not sure where you got such information (I know a few DPC doctors in Boston area and you certainly didn't chat with them), but DPC fees nearly universally cover management of chronic disease without “extra fees”.

At least you recognize-- sort of-- the problems primary care physicians face with “burn out” (I prefer the term moral injury), administrative hassles, and lack of time with their patients; leading to poor doctor-patient relationships. And, you admit that DPC might be a better in those respects; as well as appealing to patients.

But, you must believe improving those issues is not significant enough to be a net positive. I guess it’s easy to downplay this since they don’t affect you personally. Although, I would note that unhappy doctors often provide inferior care to patients.

Besides, would you like your personal doctor to be miserable? As long as they are in your insurance network, maybe that is an acceptable trade-off to you?

“From a numbers standpoint, direct primary care is self-limiting in how many patients it can serve.”

I didn’t realize primary care physicians in traditional models could take on unlimited numbers of patients. What is the first question many patients ask upon calling a new doctor's office? "Are you taking new patients?" They ask because many PCPs in traditional models cannot and do not take on new patients. 

The DPC model is not defined by an exact number of patients per physician, but indeed, most will carry a smaller panel size than a traditional, modern PCP.

If you think caring for fewer patients is inherently a bad or unethical decision, can you please provide us with an exact minimum number of patients (e.g. panel of 2387 or 23 visits/day) so that we can be certain to be in professional good standing with your standard?

Besides, are more patients per PCP better? Would you like your personal PCP or specialist of choice to be responsible for 5,000 other people’s care? or 10,000? Or are those volumes just okay if it’s other people's’ doctor?

“They likely include a disproportionately high percentage of healthier, “worried well” individuals.

This is an enormous amount of speculation for a person in an academic position. You provide zero data to support such a presumption. But, let's consider this from an economic incentive perspective:

The number of factors that lead a patient to choose their PCP is numerous and not exclusive to the DPC model. Ultimately, most patients will voluntarily choose their PCP based on personal preferences. Anecdotally, patients choose DPC practices (versus other options for primary care) for a variety of reasons, but namely for reduced out-of-pocket costs, and/or improved access and experience.

Given the flat monthly fee for services, the value proposition for chronically ill patients-- needing frequent visits and savings on ancillary services (labs, meds, etc.)-- is obviously higher. Given this, the bias for patients seeking care in the DPC model would lean towards sicker patients; not towards healthy people who don’t expect to have great medical needs. Most DPC docs I know report high numbers of patients with chronic illness and unresolved problems. There is some practice level data on this and larger efforts to study demographics and health status of DPC patients are underway.

“direct primary care physician or practice functions as an insurer.”

No, they do not.

DPC practices, functionally and legally (based on 25 state laws), are not “insurance”. The DPC practice agrees to provide a certain set of services (namely the physicians time) to a patient for a fixed monthly fee. While some DPC practices will include services such as EKGs, procedures, less expensive labs, and point-of-care tests, for no additional fees, these costs account for a tiny fraction (< 1%) of a practice’s operating expenses. I doubt you know this Timothy, but band-aids don’t actually cost $50 a piece as is often found in hospital charges. So, appropriately structured, there is no real financial risks to a DPC practice.

If you are worried about practices functioning as insurance, I would take a look at those participating in Accountable Care Organizations (ACO) which are assuming actual financial risks based on total patient health costs.

“The direct primary care model can get expensive for patients, making it a model that caters to the affluent and potentially worsens inequities.”

You have a Ph.D. in health policy, so I’m sure you realize the per capita spending on health care in America is now over $10,000/year. Most of those dollars are sunk in to insurance premiums (often hidden by layers associated with employer-based coverage and taxes), but an increasing number of Americans have high deductibles and "out-of-pocket" (after the premiums) expenses.

In 2017, the average individual plan's deductible was $4,358, and for a family plan it was $7,983. Some large employers are still maintaining low deductible plans (at the expense of lower paychecks for employees) but even those plans are increasingly rare.

If you are keeping tally, many American families now pay $12,000-18,000 (individuals $6,000-12,000) of their own money in a given year prior to their insurance plan picking up a dime of the tab; and they still usually owe 20% of costs after that to some astronomical "out-of-pocket maximum".

But, you may say, "yeah, but at least insurance protects a person from financial ruin." You'd be wrong there too. Studies have shown that 70% of bankruptcies related to medical care debt occur in people with insurance! And many more insured people worry about being able to pay their medical bills. 

In that context, a membership fee of $50-100/mo ($600-1200/yr) for comprehensive, high quality primary care services doesn’t seem so expensive. Many patients who choose DPC are exactly the same people suffering financially under the status quo.

“patients’ paying $1,500 a year in retainer fees”

Perhaps you didn’t have time to research much, but the vast majority of DPC practices are much less expensive than $1500/year. The DPC Alliance has over 200 active practices and over 90% of those practice have fees under $100/mo ($1200/year); two-thirds charge $50-75/mo, but many are less than per person when considering child and family discounts.

“direct primary care model places greater responsibility on patients to know their medical insurance inside and out. They must also become the liaison between their direct primary care physician or practice and their insurance plans….direct primary care shifts a lot of the insurance paperwork and administrative burden onto the patient.”

First, do you have any idea of how much paperwork is traditionally required of patients when they visit a doctor’s office using insurance? Have you ever been? If not, patients are typically flooded with forms upon arrival; every time they go. Subsequent, patients often receive confusing bills and explanation of benefits months after care that even doctors have trouble deciphering. The usual system is hardly devoid of paperwork or administrative burdens for patients!

With respect to DPC, in most cases, a patient chooses DPC in lieu of their options for “in network” primary care services. Patients do not submit DPC fees for reimbursement from an insurance plan. Simply, there is no extra paperwork required if patient opts for DPC.

On the contrary, a DPC clinic is likely the only place that provides patients upfront, easy-to-understand pricing and payment on a wide array of medical services. If a patient does require care outside of the the DPC practice, we can now serve as a stronger advocate for our patients because we are afforded such time. If a patient prefers, they can opt for a network speciality provider when needed as usual-- although many patients will find those things (radiology, medications, etc.) more affordable with a direct pay option. Either way, a DPC physician can be helpful in navigating those options.

“In the very best case, direct primary care could make some doctors and patients feel more connected to each other, and might even help produce a better care experience. But given significant problems with the model, I don’t expect to see direct primary care taking on a significant number of patients across the country any time soon.”

Again, how can you downplay the significance of better relationships and patient experience? If that doesn’t matter, what does?  

“There’s a bit of smoke and mirrors here, as direct primary care tries to convince patients that the rest of the health care system, like hospitals and specialty physicians, doesn’t really exist.”

Huh? I'm not sure if you are being literal here, but...

Compared to our small, quaint clinics, most hospital systems have giant, multimillion facilities, so it’s pretty hard to hide their existence.

“And as long as many patients have to deal with the rest of that system on a consistent basis as they acquire more serious conditions and have constant needs throughout their lives for complex diagnostic and treatment care, direct primary care will be of limited help.”

Timothy, I have seen lots of policy wonks view primary care physicians as less important than their speciality peers, but your disdain is beyond the pale.

Despite your skepticism, the DPC movement is growing in every corner of this country; now over 900 DPC practices, with steady growth year to year. You may not understand why anyone would choose an independent DPC physician over an insurance-managed provider, but frankly, that doesn't matter to our patients. We are showing them the real benefit of high quality, transparent primary care every day.

W. Ryan Neuhofel, DO, MPH
President, DPC Allliance