FAQs

• Direct Primary Care is a nationwide movement of Primary Care doctors who have divested themselves from insurance companies and their assembly-line model of medicine, in favor of reestablishing the direct doctor-patient relationship. It is like concierge medicine, but without valet parking, and is designed to be affordable for the masses.
• Direct primary care practices offer a membership-based approach to routine and preventive care that can dramatically reduce health care costs for individuals, families and businesses.
• At the core of a direct primary care facility is a medical practice dedicated to providing routine, everyday care, essential for the well-being and ongoing maintenance of a patient’s health. This is where patients go for check-ups, vaccinations, sprained ankles, or frequent headaches.
• Direct primary care providers know their patients. They have talked with their patients in detail, gotten to know them, treated past conditions and know what recurring problems are experienced. If a patient has a chronic illness, like arthritis or diabetes, their primary care provider is already a partner in management every step of the way. And, in the unlikely event of a life-threatening accident or disease, the provider serves as the patient’s advocate, coordinating care across multiple providers, facilities, and prescriptions.

• Consider that our current health care crisis is a byproduct of an overloaded third-party payment system that often expects a doctor to care for nearly 3,000 patients, even though he or she is not reimbursed appropriately for doing so. This process undermines sound medical practice and compromises the quality of patient care.
• Before the rapid growth of employer-based health insurance coverage in the 1940s, Americans paid directly with cash for virtually all of their health care. With the rise of third-party health insurance after World War II, cash payment for medical services declined sharply. Doctors, hospitals, and other medical professionals increasingly were reimbursed through third-party insurance, which often provided “first dollar” coverage. On the surface, this appeared to be efficient, quick, and easy, but it had the unintended consequence of making health care financing largely opaque. This hid the true cost of services, leaving patients with the false impression that their employers paid for their medical expenses, except for the occasional co-pay, deductible, or coinsurance.
• This major transition in American health care financing during the 1940s left physicians to seek reimbursement from patients’ insurance companies. Over time, the third-party payment systems in both private health insurance and public programs, such as Medicare and Medicaid, have become increasingly complex and costly, less transparent, and more economically inefficient.
• In light of these mounting complexities and inefficiencies, increasingly dissatisfied doctors and patients are looking for innovative ways to deliver and receive primary care. Direct primary care has become a viable solution for many Americans.

• NO. We offer a simple membership fee for primary care, with no copays and no insurance. This is quite different than concierge medicine practices like MDVIP. Other terms used for concierge medicine include boutique medicine, retainer-based medicine, and innovative medical practice design.
• MDVIP and other concierge doctors still contract with insurance companies, and as a result are required to collect a copayment, coinsurance, deductibles, and any non-covered service amounts as required by the health insurance contract, plus the retainer fee, and this is exactly why we chose not to go that route.
• MDVIP doctors also have a much higher retainer fee, $1650 per individual or more AND MDVIP also requires an up-front payment in order to join their practices. We are happy to offer the option of a monthly payment plan, and have even waived the $99 enrollment fee for the first 150 patients who join.
• Lastly, MDVIP offices are unable to sell wholesale medications and lab services. We are able to do all of this because we don’t take insurance.
• In summary, the significant difference of membership medicine DPC practices, then, is that we don’t bill for medical visits, we don’t require patients to have the usual, expensive insurance like concierge medicine does, and we provide medications and immunizations at wholesale prices.

• NO. Although it may seem strange, this is actually old-fashioned medicine brought back to life. Author Catherine Sykes calls it “the oldest, new form of medicine.” Doctors carrying a medical bag and coming into a patient’s home was standard into the late 1960s. Watch the reruns of the Marcus Welby. MD TV show. That’s what our grandparents enjoyed. There was a time when patients valued their family doctor, trusted their opinion and called their doctors after-hours to help decide if symptoms needed urgent attention or could wait till the next morning.
• But, medicine became government regulated, and that started the death spiral we’re in. It came in for a reason — there did need to be some amount of administration — but now regulation and administrative tasks have overburdened and frustrated doctors. I’ve accepted the piece of advice from a DPC doc who said, “Be intentional with your excellence, don’t be normal.”
• When you think of medicine as it was portrayed on the Andy Griffith show, the doctor had a clinic in the local town. It’d be strange for him to ask, “What kind of insurance does Opie have?”

• YES. Tiffany Sizemore-Ruiz, D.O., of Choice Physicians of South Florida says, ”Being a good physician is not just about knowing how to diagnose and treat disease. Honestly…that’s what books and studying are for. Being a good doctor entails earning the trust of your patients by being honest and forthcoming. It means knowing how to communicate effectively while still remaining sympathetic. It requires you, first and foremost, to be a human being.” She continues by saying, “It honestly bothers me that young doctors feel like they have to ‘know everything’ to be a great physician. Put down the damn book and go talk to your patient. It’s really that simple.”
• We agree with what she says, specifically that there is no substitute for a doctor whom a patient knows and trusts, and who acts exclusively on behalf of that patient’s own needs and interests. Fortunately, anyone in St. Louis can now have this type of care.
• In their February/March 2018 issue, AARP magazine published an article highlighting telemedicine in St. Louis, in which they turned a spotlight on Mercy’s telemedicine center in Chesterfield. This form of electronic office visits has always been available to all member patients of Direct Primary Care St. Louis.

• YES. According to Daniel McCorry at The Heritage Foundation, an independent think tank, who says, “Preliminary data show excellent outcomes for patients enrolled in direct primary care and a reduction in health care costs.”

• YES. We love that question and we hear it often! Everyone benefits from medical care personalized directly for them. Our practice is committed to preventative health maintenance which is a longterm investment in you! Physicals, i.e., preventative health visits, are not just routine; they are opportunities for early disease detection, much like a state inspection for your car.
• Every visit, regardless of the reason, will give us the opportunity to get to know you better and to build a long-standing relationship over time. As a result, individual care plans can be developed that are tailored to the individual needs of each patient. Traditional medical practices, which are insurance-driven, find it difficult to forge this relationship effectively like we are fortunate to do.

• As you may know from personal experience, many patients will only be able to afford a high deductible plan in the future, in which the insurance won’t cover the first $2,000-$6,000 ‘deductible’ that they spend anyway.
• But with our new membership model of health care, people can maximize the amount of healthcare they get and minimize their cost. Direct Patient Care St. Louis works with our patients directly, who pay a monthly membership fee and get practically unlimited office visits, as well as technology visits using their computer or smart device.
• They never have co-pays for anything in our office, so any procedures we perform in our office are done by the doctor without charge: EKG, PFT’s, biopsies, sutures, splinting, cryosurgery, joint injections, etc.
• Since your membership fee pays for all the doctor’s time spent with you, whether performing procedures or chatting on the phone, you’ll only need to buy the medicine we inject or pay for the pathology report from the lesion we biopsied at no charge. Whenever there is a small supply charge, you will be told in advance how much and what it’s for. Then you can decide in advance if it’s worth it to you — you are always in control of choosing how to spend your own money.
• In addition, we run our own pharmacy out of the office, so we can get medications at wholesale pricing. We can also get labs at wholesale pricing as well, which will be a substantial savings for our patients.
• So in the long run, we actually end up saving many of our patients more than their membership costs.

• NO. And here’s the logical reason why. Young doctors today are refusing to go into primary care medicine, due to the fact that working as a PCP in our broken system demands they see 30 patients per day for 25-35% less than what a specialist earns. On top of that, the average medical school debt of a new graduate doctor is close to $250,000.
• The above factors have understandably contributed to making a shortage of doctors willing to practice primary care medicine. Now let’s add in the fact that physician suicide is higher than it’s ever been, and more and more doctors with 10 or 20 good years left are leaving medicine entirely.
• DPC can’t cause a shortage – the shortage of primary care doctors already exists. “Over the long run, the only way to increase the number of qualified primary care doctors is to make the profession more attractive, both from a professional and financial perspective. It is our current broken system that has caused a shortage of primary care doctors; and if we stay on the old path, it will only get worse.” ~ Dr. Steven Knope, Tucson, Arizona in The Myths of Concierge Medicine

• YES, but slowly. Again, according to The Heritage Foundation, “Policymakers should create a legal and regulatory environment that is less restrictive toward direct primary care. If policymakers will encourage change, innovation, and competition instead of just reacting to the increasingly dysfunctional status quo, the possibilities are endless.“
• Endless possibilities – Wow, think about that for a moment.

• Realistic health insurance carriers can see the writing on the wall. Their current business model become irrelevant once patients understand the facts behind our failing health care system. Some health plans are still trying to insert themselves into this new movement by actively evaluating DPCstyle patient engagement, as plans shift reimbursement away from “fee-for-service” and toward care coordinating value and outcome compensation.
• The only way for players in the health insurance industry to survive is to realize that insurance in every other sector is intended to be used for just one thing: a means of protection from financial loss. More technically known as a transfer of risk, buying insurance transfers your personal risk to an insurance company. So insurance is a form of risk management that is primarily used to hedge against the risk of a uncertain loss, such as cancer, major surgery or even hospitalization. Wikipedia definition of insurance, accessed 02/18/18
• Yet the fact remains – the health insurance industry helped create our current fiasco. They must face the music, realize they are unnecessary for obtaining the routine health care most of us need, and learn to operate like any other kind of insurance people buy in the US.

• You might think so, but that’s not correct. Preventative medicine is now our top priority in medicine. The upfront costs associated with genetic testing, inflammatory testing, etc. pales in comparison to the cost of treating chronic disease.
• Stakeholders are realizing that it is more important to invest in technologies that detect disease at an earlier stage when it is less challenging to treat effectively. So, spending capital now on tailored treatment plans for individuals will save billions in the future.

NO. Let’s look at the facts together:

• A typical physician would need 7.4 hours per day to provide all of the preventive care as determined by the U.S. Preventive Services Task Force. Such time commitment is unfeasible when physicians must spend several hours per day on the clerical work described above. Article published in American Journal of Public Health

• YES. Health care has been cutting reimbursement to doctors for years, which has forced doctors to see more patients in an attempt to maintain a stable income. Consequently, the time doctors can spend with their patients has declined so much that today the average time spent with patients for most doctors is less than 10 minutes. This means that each visit is only long enough to address the bare essentials, seldom more

• NO. Most doctors are not ok with that. Let’s consider the facts. A 2016 survey of more than 17,000 U.S. physicians by The Physicians Foundation found that 48% plan to reduce hours, retire, take a nonclinical job, switch to concierge medicine or take other steps to cut back on the number of patients they see.

• We can’t speak for all docs, but most of us miss sitting and listening to our patients – when the doctor can’t spend time with a patient, she can’t get to know them well enough to truly make a difference in their health. So this lack of meaningful interaction and insufficient time for primary care is eroding the doctor–patient relationship. Practiced this way, medicine is not meaningful or enjoyable anymore.