Hear From the Experts
Most doctors and patients who are used to the fee-for-service model of copays and insurance premiums know what they’ll get when they see their doctor — exactly what their insurance pays for. The Direct Care membership model takes away insurance and offers a new way to deliver healthcare.
Chances are, if you were to survey 100 providers who have made the shift to a Direct Care (DC) or Concierge practice to find out what services they have elected to offer their patients, you might get 100 different answers. Sure, there would be some overlap, but there might also be significant variations based on the provider, the practice size, and location.
To give you insight into how today’s DPC and Concierge providers have chosen what services to offer, we went directly to the source — the providers themselves. In this post, we’ll share their process for deciding what to offer. We’ll also tell you what their patients love, and the types of services that they would like to offer their patients in the future.
There Must Be A Better Way
For the years leading up to opening Good MD in Rochester, New York in September of 2014, Dr. Thuc Huynh worked as a doctor in a rural health clinic. In speaking about her experience of this time, Huynh explained that time was the one thing she didn’t have with her patients. The 5 minutes she said she had to spend with her patients was “not fair to anyone” — not her as the doctor and not her patients.
Like Dr. Huynh, Dr. Zoller and Dr. Greenspahn, who founded Coho Medical Group in Bellevue Washington in January of 2015, knew that there was a better way to practice medicine. Both doctors started their medical careers in hospitals. What Dr. Zoller says of his time as a Medical Director of a hospital, is that it showed him that the patients who end up in hospitals are often “failures of primary care.” This isn’t a knock on doctors, he said, but on the system that has made medication and tests so cost prohibitive that people aren’t taking care of their health until they end up in the hospital.
For Dr. Bruce Jung, founder of The Doc Shoppe in Corbin, Kentucky, his patient panel prior to opening his own Direct Care practice had swelled to more than 2,700 patients. And while he had adopted the motto “doing what’s right (for patients) no matter what model of medicine you’re in,” it had become increasingly difficult to provide patients with the type of care they deserved in the time he had to spend with them.
Following 18 years in a traditional fee-for-service practice, Dr. Rob Lamberts, who founded Dr. Rob Lamberts LLC, said it was time to get off of the “hamster wheel” of healthcare that he’d almost burned out of. His real desire, in starting his own DPC practice, was working for his patients instead of working for the insurance companies.
Step One: Research
Across all of the doctors we spoke to, research was the first step for them to decide which services to offer in their DPC practices.
For Lauren Griffin, the Practice Manager at Radley Griffin MD, an 8-year old concierge practice in Tampa, Florida, she advises doctors to use price point as a good starting point for determining what services to offer. Because patients who are paying higher price points often expect more services, it’s important to start your decision-making process by understanding the time and overhead involved in offering more and how that will impact the number of patients you can see.
After researching other Direct Care practices to see what they offered, Dr. Huynh says that most common among them was unlimited access to the provider through office visits and telemedicine. Within her own practice, Dr. Huynh elected to include in her membership fee office visits, same-day or next-day appointments, 24-hour access to her through text and email, no co-pays, and appointments that start on time (what a concept!). For people in her community who want to meet her and learn more about the Direct Care model or Good MD, Dr. Huynh offers “meet and greet” appointments over tea or coffee.
Make a List
In addition to researching other DPC practices, partners Dr. Zoller and Dr. Greenspahn started the process of deciding what their practice would look like by making lists. The goal of this exercise in list-making was to help them determine the core components of the affordable, patient-centric medical group they wanted to create. Like Dr. Huynh, Dr. Zoller and Dr. Greenspahn offer their patients unlimited office visits, 24-hour access to them through text, email, and video chat, and same day or next day appointments.
Visit Other Practices
Dr. Jung, started his process of deciding what he wanted The Doc Shoppe to look like with visits to established Direct Care practices like Atlas MD. He also visited a couple of smaller, local practices. Like Good MD and Coho Group, The Doc Shoppe’s membership fee includes unlimited office visits, 24-access to Dr. Jung, and same day or next appointments.
Deciding What Additional Services to Offer
Start with Your Strengths
When it came to deciding what additional services to include as part of Good MD’s membership fee, Dr. Huynh says she looked at the types of services she was comfortable doing herself (she’s currently a staff of 1), and the types of services that made financial sense (For more info on pricing your practice, click here). Among the services that made the list were probably incision and drainage, laceration repair, burn care, wart freezing, and point-of-care testing for things like glucose and strep throat.
While Dr. Huynh herself doesn’t do extensive lab testing within Good MD, she does work with the local network of hospitals to help her patients know where to go and what they’ll pay when it comes to lab testing and has found that this allows her to help her patients find the best price possible for the tests they need.
Listen to Your Patients
For Lauren Griffin, the decision to offer additional services, like adding a lab draw station to their office, came from patient feedback.
“We heard our patients saying, I don’t want to go to the lab because it’s an awful experience,” she said.
By offering the lab draw station in their office, Griffin says they are able to create value for their patients.
“It’s just another reason that they love the service,” said Griffin.
Affordability is Key
From the beginning, Dr. Zoller felt strongly that laboratory tests should be available to Coho Medical Group patients at their office. While he decided not to include these services in the membership fee, the prices patients pay for these services are significantly lower than a patient would pay at a hospital. For example, that Dr. Zoller’s patients can get a Complete Metabolic Panel for $4 or a thyroid test for less than $2.
For Dr. Jung, he decided that any test or procedure that costs him less than $10 would be included in the membership fee. It may sound hard to believe, but that decision enables his patients to access close fifty lab tests for no cost. Dr. Rob Lamberts also opted to include certain routine lab tests, like cholesterol, hemoglobin, and urine protein screenings, to offer more value to his patients.
Whether to Include Prescription Drug Benefits
Prescription drug dispensing is another benefit some providers are choosing to offer. While Washington State law prohibits Direct Care practices from including prescription drugs in the monthly membership fee if the duration of the prescription exceeds 30 days, Coho Medical Group dispenses many generic prescription drugs to patients at a cost well below the market rate.
While Dr. Lamberts doesn’t yet offer prescription drug benefits, he says he's considering it. He told us that although he doesn't yet fill prescriptions in his office, he’s extremely sensitive to how much the medicines he prescribes cost his patients.
“Any time I prescribe a drug, I’m looking for the cheapest price,” he said. “We (my nurses and I) are constantly going to GoodRx to try and get our patients the best price on the prescription drugs,” he said.
Vaccinations, Imaging, and More...
Additionally, Dr. Lamberts works with a company called VaxCare, what he called a terrific service for DPC providers, that offers a streamlined process to get his adult patients low-cost vaccinations. For his patients who have insurance, VaxCare will take care of the insurance reimbursement on behalf of the patient.
Lauren Griffin says that another way to add value to a practice is by building relationships with imaging centers. By having these relationships, you can find out where your patients can get the best rate for tests like MRIs.
“Those imaging centers want to develop relationships with you (the provider) too,” she said. “They have their own reps and want to make the process as easy as possible.”
The Services Patients Love
Patients Love the Access
“The truth is, the number one thing (patients love) is access, pure and simple,” said Dr. Zoller. “I’ll get a text message from a patient at 7 o’clock at night, and I’ll always text back.”
Try finding that level of service in a traditional medical practice.
For Dr. Huynh, her patients really appreciate texting and photo messaging. For her, these new ways of communicating have enabled her to respond more quickly to her patients. The photos also enable her to assess the status of a medical condition and see if it’s improving.
A Visible Shift
Dr. Lamberts says that patients can see and feel a difference in his office.
“The amount of joy we (my nurses, my patients, and I) have here in doing what we do, it’s such an incredible contrast to the misery in most medical offices” he said.
What Patients Would Like to See Offered
The Addition of Holistic Medicine
“Some of my patients would like to see me offer more holistic medicine,” said Dr. Huynh.
While she’s very open to this approach to medicine, which she says provides alternatives to the “pill-popping” approach, naturopathic medicine is a completely separate field of medicine and not something she can incorporate at the moment. That said, what she is able to offer her patients is her time. Without excessive overhead and the obsession with productivity, which is characteristic of traditional “fee-for-service” models, Dr. Huynh is able to spend time to get to know her patients and understand their needs.
Referrals to Sub-Specialists
Eventually Dr. Zoller and Coho group hope to be able to offer referrals to sub-specialists who are willing to offer their patients a discount on services, once their practice has grown enough to make financial sense for both parties.
“The sub-specialists are interested, but it’s really about finding that magic number of patients and price,” says Dr. Zoller.
Dr. Lamberts also has his sights set on establishing formal relationships with specialists that enable his patients without insurance, or those with high-deductible plans, to get an EKG or colonoscopy for a negotiated cash-rate. Something else he would like to eventually offer is some type of physical therapy or chiropractic care for his patients who are dealing with chronic pain.
As Direct Care practices grow in popularity, new practitioners have more and more models to look to when developing their own practice. If you're a practitioner who is in the process of deciding what types of services to offer, start by researching local practices in your area. Once you've looked at other models, think about the types of services you feel comfortable providing on your own or with a small staff. And lastly, once you launch your practice, look to your patients for insight about the types of services they would like to see you offer.