Today, we were featured on Flashpoint on WDIV with Devin Scillian. The conversation focused on Direct Primary Care, and our clinic in Southwest Detroit called Plum Health DPC, which is making healthcare affordable and accessible in Detroit and beyond.
Devin Scillian is the host of Flashpoint, and a highly respected journalist in Detroit, so it was a tremendous honor to be invited onto the program to discuss this important issue. Flanking Devin Scillian was Frank McGeorge, MD, an emergency room physician and the Good Health reporter for WDIV. Dr. McGeorge was brought in to provide an additional layer of insight into health care and ask questions about Direct Primary Care from the lens of a physician/health care insider.
We also discussed our book, Direct Primary Care: The Cure for Our Broken Healthcare System.
Below I will paraphrase parts of the show:
Direct primary care introduction
Devin Scillian: Should your doctor be subscription-based? A new model allows as many visits as needed, for one monthly rate. There was a discussion about new concepts in health care… For some time I’ve been wanting to talk about a new idea in Health Care, it’s called Direct Primary Care. It doesn’t come from your employer, or the government. It’s basically an agreement between you and your doctor - you pay a monthly fee to subscribe to your physician. All the visits that you might need that month are covered. You need medications? Well, they cut a deal on prescriptions, which you would pay out of pocket.
We’ve had a lot of debates about what to do with American Health care - there’s talk about single payer health care and a universal system. Getting less conversation, and we’ll correct that this morning, is the idea of Direct Primary Care, and the Author of a new book Direct Primary Care: The Cure for Our Broken Healthcare System, is with us this morning, Dr. Paul Thomas of Plum Health DPC. And we have Dr. Frank McGeorge, our medical reporter from WDIV Local 4, who will ask better questions than I would.
So you can get rid of health insurance?
Devin Scillian: The first thing I want to get to, is to get rid of insurance and the government?
Paul Thomas, MD: I unequivocally recommend that folks have health insurance, but for your routine primary care services, the costs are much less if you purchase them directly through your doctor. You want to maintain a health insurance plan that you’re comfortable with, and use the free market or Direct Primary Care services to the lower the costs of your meds, labs, imaging services, and doctor visits.
So this is a club, basically? and what is your Pricing like?
Devin Scillian: So, I would kind of use you and your partners like I belong to a club, basically?
Paul Thomas, MD: Yes, it’s a membership model for health care, so you can come in and see us any time you need to. Visits are included in our pricing structure:
Devin Scillian: Unless your in a health plan that I’ve never heard of, this looks really reasonable, much less than you and I are paying, doc (Dr. Frank McGeorge).
Dr. Frank McGeorge: This is a very different way of doing things, clearly, and it does make sense. I have to say, I really applaud what you’re doing, because I think it’s wonderful that you are getting back to the most basic form of providing health care, that is directly to the patient, cutting out all of the bureaucratic nonsense as much as possible. You don’t need a biller and coder in your office, you save that money right off the top, and you pass that savings directly onto the patient.
Biggest concerns about the direct primary care model?
Devin Scillian: So your biggest concerns with it are what?
Dr. Frank McGeorge: Well what’s interesting to me, is that you’re doing what we used to do in Family Practice one hundred years ago, you were the small town doc. Everyone would come to you with all of their problems. But the problem now is that back then you could know all of medicine, but now, medicine is so much more complex. I guess, how do you deal with specialty referrals? The things that are out of your family practice domain.
Paul Thomas MD: The typical scope of a family medicine doctor is 70 - 80% of anything that you might walk into the doctor’s office with. So I can handle 70 - 80% of your concerns, the rest you would typically refer to specialists. Now in my model, we use an e-consult platform called Rubicon, where we can write up your case history and send it to a Board Certified Ophthalmologist or Dermatologist or Cardiologist with a photo or a copy of your EKG, and get a second opinion at no charge to you the patient.
Devin Scillian: No charge to me, because you’ve developed a relationship with these specialists.
Paul Thomas MD: Exactly, it’s an e-consult platform called Rubicon that any primary care physician can use, and I use it because I actually have the time to listen to you fully, to take down copious notes about your condition, and send those over to the specialist and get a second opinion within about 12 hours.
How many patients can a direct primary care doctor handle?
Devin Scillian: Have you figured out where the sweet spot is for how many patients you can handle?
Paul Thomas MD: The typical number of patients per physician in the Direct Primary Care model is 500 - 600 patients. Now, contrast that with the typical family doctor who has to have 2,400 patients, so they’re seeing 1% of their panel each day or 24 patients each day. In our model, when we see 1% of our panel, we see 5 - 6 patients each day. And, that gives me an hour per patient to really sit down with you and understand what you’re going through, and help you through that situation.
What is the pricing like for medications and lab work?
Devin Scillian: You and I have been looking at these price lists (to Dr. McGeorge), because they cut deals on prescriptions and on lab tests. With your trained eye, and the time you spend in the Emergency Room, how does everything look?
Dr. Frank McGeorge: This is clearly the way it should be. One of the things I’ve always rallied against is the opaqueness of how billing and charging is done in the medical care system. Frankly, if you go into hospital A versus hospital B, you don’t know how much you’re going to be charged for any given test because it’s different in each hospital. This (pricing) is great because it’s all laid out in advance and it looks like it’s done, basically, at cost.
Paul Thomas MD: Exactly, because you’re already paying the membership, I want to give you as much value for your healthcare dollar as possible. So, we make all of our prices transparent, and we only charge the cost of the medication, or the lab, or the imaging service so you get the most value out of the service as possible.
Can Direct Primary Care Doctors make money in this system?
Devin Scillian: I don’t know how to ask this delicately, but is this lucrative for you? Do you make a fair amount - enough money? Or are you just messing with the system?
Paul Thomas MD: As the membership grows, as the doctor gets to full capacity, you earn about what you would make as an employed physician, maybe a little bit less. But, we have a saying in the Direct Primary Care movement that nothing pays like autonomy. I can be the physician I was meant to be. And, in this model, it’s really inspiring for other doctors who want to join this movement because you have the ability to practice medicine on your own terms, and not at the dictates of insurance companies or government heath care systems.
The full video can be seen above, and on the Flashpoint website.
Thank you so much for reading and watching,
-Dr. Paul Thomas with Plum Health DPC