Your Heart Health in a Heartbeat – Episode 7
* You can either read the transcript or watch the video at the bottom *
The direct care experience
Recently, a young man called my office wanting to be seen. I spoke with him for a few minutes to better understand his concerns and plan for his visit. It turned out that his girlfriend had been hearing a pulsating, “wooshing” sound whenever she would lean her head on his chest: woosh, woosh, woosh…Obviously, there was a concern that this had to do with his heart. He was otherwise feeling well and was able to exercise without any difficulty.
He came to our clinic a couple of days later and, in the span of 2 hours, he received a full consultation, a 12-lead ECG, a cardiac echo (an ultrasound scan of the heart), and a treadmill stress test. At the end of the 2 hours, I was able to give him a firm diagnosis: one of his heart valve is leaking severely. I was also able to provide a treatment plan: on the basis of all the tests we did, I knew that he was not at risk of immediate complications. For this particular valve leakage, the recommended approach is to simply examine the heart periodically and monitor for symptoms, rather than proceed with surgery which may not be needed for years.
I was able to educate him about his condition, describe what he might expect in the future, and answer all his questions. This is direct care. Let’s now contrast this with what he might have expected to receive if he had gone through the usual channels.
The usual care experience
Under the usual way of getting care, he would first have had to see a primary care physician. If he already had one, he might get an appointment within a few days. If not, it might take 2 to 4 weeks to get an appointment as a new primary care patient.
Presumably, the primary care physician would hear his heart murmur and refer him to a cardiologist. The physician would also presumably order some cardiac test ahead of the visit with the cardiologist.
Now, it’s fair to estimate that a non-urgent appointment with a cardiologist takes at least 3 to 4 weeks. In San Francisco, many cardiologists are booked for at least 6 weeks and some of my colleagues have waiting times of 3 months for non-urgent appointments. And I believe that is also the case in other parts of the country. What’s more, if the cardiac tests were not all properly ordered by the primary care physician, the cardiologist would need to order the additional tests and ask the patient to come back for a follow up. That could take an additional 2 or 3 weeks.
So, it’s fair to estimate that it might take a minimum of 4 to 6 weeks—and likely more—for this patient to get a firm diagnosis and treatment plan.
Now, let’s talk about the financial aspect.
Under usual care, if the patient is insured, his insurance would be billed for the primary care visit, for all the cardiac tests, and for at least one, or possibly two visits with the cardiologist. I think it’s fair to estimate that the bill to the insurance company would be a minimum of $2,000, but possibly a lot more. On occasion, I have seen echocardiograms alone get billed to an insurance company for $2,000 or even $3,000. So, the total care bill could have been quite hefty, possibly several thousand dollars.
If the patient has a high deductible insurance—which is increasingly the case among Americans—he would be on the hook for the entire deductible, which might be $1,500 or $2,000 or possibly more. It could be very expensive. And if the patient does not have any insurance, it could be catastrophically expensive (he might get billed at a “retail” rate).
In the direct care system (in our clinic), the patient was billed $875 at the end of the 2-hour visit. That included the full consultation and all the cardiac tests. Not only that, but the patient knew ahead of time how much it would cost. From my phone conversation with him ahead of his visit, I could anticipate what tests would be needed, and all our fees are transparently listed on our website and they are firm. There is no unpleasant surprise for the patient.
This is direct care: $875 for a visit that takes 2 hours and can be booked within a few days, versus several thousands of dollars over multiple visits over a span of several weeks or months.
And this is not a unique case. All patients who come to Athletic Heart of San Francisco get a similar timely treatment for a reasonable price.
And this is not unique to our practice. Direct care is a movement that is growing around the country.
The direct care movement
Direct care is booming among primary care physicians where it is called direct primary care. These are very qualified physicians who have said “enough is enough” with the non-sense of spending the whole day filling out paperwork and dealing with bureaucracy and insurance claims.
Direct primary care physicians want to serve patients directly and do it for a very affordable fee. They are able to spend more time with patients, and are accessible to them by phone or email, even after hours. Some direct primary care doctors also provide medications and lab tests to patients at a deeply discounted wholesale price. The benefits of direct primary care are tremendous.
Direct care is also growing among specialists, especially among surgeons who also say “enough is enough” with the non-sence of insurance and paperwork. So long as the surgery can be done in the outpatient setting on a non-urgent basis, the surgeons provide excellent treatment for a variety of conditions (orthopedic, ear-nose-and-throat, etc.) for a transparent fee that is frequently much less compared to what would otherwise be billed through the hospital-insurance system.
I hope this has been helpful to you. The information may be helpful to someone you, so please share it. If you live in the San Francisco Bay Area, consider the direct primary care clinic we have recently launched.
Here are links to some helpful websites that can tell you more about different aspects of the direct care movement:
- DPC Frontier: Tons of information about Direct Primary Care and a national mapper of DPC practices
- The Surgery Center of Oklahoma: Dr. Smith is a pioneers of direct surgical care
- The Wedge of Health Care Freedom: A non-profit organization that puts patients in touch with direct care doctors
- The Association of American Physicians and Surgeons: Information about direct pay and cash-friendly practices
- The Free Market Medical Association: For businesses and health care organizations interested in learning about or joining this movement. The FMMA promotes transparency in health care.
- The Self-Pay Patient: A website by Sean Parnell, author of The Self-Pay Patient book. The website encourages self-pay patients and helps them navigate the health care system.
- Dr. Accad’s DPC practice: our direct primary care practice for the SF Bay Area
Here are links to some news reports about the direct care movement.
- TIME Magazine: What When Doctors Take Only Cash?
- Forbes: Could Millenials Make Direct Primary Care Mainstream Medicine?
- TIME Magazine: Medicine Is About to Get Personal
- New York Times: Doctors Shun Insurance, Offering Care for Cash
- Jefferson Public Radio: Another Way to Pay the Doctor – Direct Primary Care
Thank you very much for your interest,