Direct primary care is the free market applied to health care

When I share information about Direct Primary Care with others, I’m often met with fierce resistance and disbelief. I’ve even been told that I’m full of, well, you know what!  So today, when I saw this interview with Dr. Josh Umbehr of Atlas M.D. I couldn’t wait to share it!  Dr. Umbehr shares with us the highlights of Direct Primary Care and how the revolutionary healthcare model is changing the way Americans receive their primary care.

Dr. Josh Umbehr on the Rapid Growth of Direct Primary Care

“Direct primary care is the free market applied to health care. It’s medicine finally taking the best elements of other business models such as Amazon Prime, Netflix, and Hulu and applying them to an industry that’s ten or fifteen years behind the rest of the world in terms of business structure. It brings a very high-value, low-cost model to the masses.”

Here are some of the highlights of Direct Primary Care and how it saves money for the masses and fixes access to care, by far the most agregious problem in the healthcare systems of “every other developed country”, as well as in America. (Quotes below from Dr. Josh Umbehr in his interview by Tim White of the Objective Standard)

  1. Direct Primary Care brings a membership model to healthcare: “We charge $10 per month for kids, or $50 to $100 per month for adults, based on age.”
  2. Direct Primary Care lowers the cost of health insurance, because it removes the cost of basic care from insurance, saving insurance for the catastrophic claims it should be used for: “Direct primary care makes insuring the routine 80 percent of your health care unnecessary.”
  3. Direct Primary Care lowers the cost of procedures, prescriptions, labs and x-ray: “My best example is an EKG—it costs thirty-six cents, so we do it for free. The coffee in the waiting room costs more than that.” “Just as Amazon can use its size, technology, and resources to find the best prices for me, we can do the same for patients when it comes to medications and labs. We can get those things wholesale at giant savings, sometimes up to 95 percent off.”
  4. Direct Primary Care saves money for the chronically ill and those who might need high tech imaging such as CAT, PET or MRI: “A diabetic patient may have trouble getting his A1c testing covered because it’s expensive. We can do that test for $2.25. It’s $150 at most other places. A diabetic can get a thousand pills of Metformin—more than a year’s supply—for $11.” “We may not have in-house the orthopedic surgeon who does the surgery, but we can certainly do the MRI that the surgeon will need. Instead of $3,000, we do it for $300.”
  5. Direct Primary Care provides quality healthcare: “There’s “cost-effective” health care, which would say, “Don’t do mammograms until you’re forty-five or fifty,” depending on what guideline you use. Well, if you have a family history of breast cancer and you’re worried about it, you might start doing mammograms at forty. Some people will say you’re not cost effective, but I say, “That’s what the patient wanted, and it’s $75 for a mammogram through a direct primary care provider. She can comfortably afford it, and it buys her peace of mind—that’s quality care.”
  6. Direct Primary Care provides value to its patients: “The nausea medicine Zofran, prescribed to pregnant women for morning sickness, is around $120 for thirty pills. We get it wholesale for $2.65.” “Doctors can order brand-name newborn diapers wholesale for $0.02 per diaper. We can get a case of 240 diapers for even less at $3.77—it sells for $38 on Amazon.” DPCs resell wholesale items like diapers and prescriptions to their patients at cost; they do not mark them up.
  7. Direct Primary Care routinely saves patients thousands on emergency or urgent care.  Consider this tweet from a Dr Janice M Hudson, MD.

In conclusion, we as Americans can do better than “other developed countries”, and what makes us different is freedom.  If the government would allow us to buy wraparound insurance to protect us from unforeseen catastrophes, healthcare in America would once again become affordable for the masses, freeing us from waste so that we could use money saved to protect those who are truly in need.




Cost of Treating Type 2 Diabetes via Direct Primary Care

I asked my friend, Dr. James Brook, who also happens to be a Direct Primary Care Physician, to give me some feedback on the cost of treating a person with Type 2 Diabetes, so I could share that with my readers.  He kindly obliged with the following, frank, yet witty response:

“I commonly hear that health care is beyond financial reach for patients with chronic disorders, like diabetes, without either insurance or a government program.  People say that free market medicine may work for a healthy person that gets a sinus infection once in a while, but not for those needing chronic care.  In reality, I see plenty of those people.

Take a typical patient with type 2 diabetes, high blood pressure, and high cholesterol.  Those disorders put people at risk for heart attacks, kidney failure, etc.  Controlling these illnesses at the level of family practice helps to reduce the rate of those catastrophic outcomes.  Type 2 diabetics are actually not very expensive for a direct-pay family practice doctor to treat.  I was claiming that the typical diabetic pays me $250 – 300 per year.  I was wrong.  I apologize.  The number is actually lower.

Last year, I averaged $227 per year for these patients.  The labs are not expensive.  A comprehensive metabolic panel, complete blood count, and thyroid stimulating hormone level together are $17.  A HgbA1C is $10, a lipid panel is $8, and a urine dipstick for protein at my office is $0.  I charge for these tests at my cost, rounded to the nearest dollar.  I charge by the time that I spend, plus lab costs.  I make my money on the time I spend.

I supply meds to some patients also.  A fairly aggressive regimen for a diabetic with high blood pressure and cholesterol problems could consist of metformin 850 mg thrice daily, glipizide 10 mg twice daily, lisinopril 40 mg daily, hydrochlorothiazide 25 mg daily, and simvastatin 40 mg daily.  If I supply all those, 6 months at a time, I would charge the patient $280 per year.  Just so you realize I am making a living at this, all those meds cost me $98.  The total of office visit fees, labs, and meds is then $507 per year, for a typical diabetic with high blood pressure and high cholesterol.

The best treatment, of course, is for a patient to exercise, watch the diet, and get in shape.  Then they can get off their meds and have better probabilities.  I am occasionally able to influence them to do that, but not often enough.  I harp on it at just about every visit, to the point of being a pest at times.  Just to put my money where my mouth is, and have a bit of fun, I put a sign on my wall offering a $15 discount to any patient that beats me in a pushup contest.  But until they get in shape, they can afford my medical care for their chronic conditions, without having money confiscated from somebody else’s paychecks to do it.

My method for arriving at the numbers:  I looked at my financial records, and found all the patients I treated for diabetes in the first 3 months of 2016.  I then removed any for whom I did not provide care for the whole year, such as a patient who moved.  I then added up the total they paid me for the year for their diabetes visits.  These visits sometimes included care for additional issues, such as plantars fasciitis. ”

If you are interested in finding a Direct Primary Care Physician in your area, simply follow the Affordable Health Care links to the right of this webpage.

Cash Pay Labs with Transparent Pricing!

Apparently, if you live in Arizona, you can walk into a DAT (Direct Access Testing) lab, and order your own tests, at a fraction of the cost of having to go through your doctor to receive doctor’s orders!   Of course there are advantages and disadvantages to doing this.  Price is the obvious advantage, but some doctors are concerned that confusing test results could lead to anxious patients, who are unable to properly interpret their test results.

What do you think?  Should patients be empowered to order their own lab tests?