Moving to a new city can be really, really tough – especially if you don’t know anyone and aren’t moving here with a spouse, partner or family. Two things that make moving tough? Finding new friends and finding a new doctor!
We ran into the doctor problem when we moved to Spokane, but after much research, we found a really awesome, unique option that works for us called direct primary care. I’m always wary to say “one thing” works for everyone, but direct primary care comes awfully close. It’s good for single people, good for couples, good for families – and in some cases, good for seniors as well (for example, if you’re over age 65, you may have better prices for health care using other means than direct primary care).
Unfortunately, direct primary care isn’t very well known yet, so we’re going to talk about what DPC is, how it works and its cost, and where you can find direct primary care (DPC) options in Spokane.
What is Direct Primary Care?
Direct Primary Care (DPC) is a broad term for a payment model used by a variety of healthcare providers that attempts to avoid third parties outside the provider and the patient, by cutting out middle parties such as insurance companies and other in-office administration. Instead of fee-for-service payments, patients pay directly to their doctor or the DPC provider, usually in a flat monthly, quarterly, or yearly rate.
Part of the purpose of DPC is to help patients have quicker and more frequent access to their physicians, both face-to-face and on the phone. By paying a “membership fee,” patients can access all of the services that their doctor provides without having to worry about whether their insurance will cover it.
Ideally, this would help to build trust between the provider and the patient, as patients can be more confident when coming forward with their health concerns, and physicians are held directly accountable to their patients. The simplified payment structure can make healthcare simpler for both parties.
This video, though in cartoon form, breaks down the concept behind DPC:
How is Direct Primary Care Different from Concierge Care?
Concierge care was just starting to take off in Phoenix when we moved (or, at least we had just found out about it when we were about to move), so when we moved here, I thought direct primary care = concierge care. It turns out, there are a few differences between DPC and concierge care.
Concierge care locks one into a year-long commitment, whereas most DPC agreements are monthly and can be dropped at any time. With concierge care, costs are a little higher, so one can access screenings that may not be covered by traditional insurance or government programs. With DPC fees, one is usually given unlimited visits.
One big difference is that DPC providers usually do not accept insurance and are therefore “out-of-network”, meaning they might not have their referrals to specialists recognized by insurance companies. Another is that the average age of concierge care members is significantly higher, as DPC providers do not accept Medicare.
Additionally, there are many more concierge services available than DPC providers, as DPC is a relatively new concept that is found more in rural areas where access to physicians is more limited.
How Much Does DPC Typically Cost?
Often, DPC costs around what a cell phone bill might cost: $70 per month. In Spokane, at Family Care with Dr. Donald F. Condon, M.D., care for an individual costs $75 per month with a $125 enrollment fee.
For a couple, Family Care’s rate is $140 per month with a $200 enrollment fee. For a family of four, service can be secured with $200 per month, and additional children can be added for $40 per month. Monthly fees for the first calendar month are waived.
At other DPC providers, rates can vary based on the age of the patient, such as at Direct Primary Care in Spokane. For example, with Direct Primary Care in Spokane, costs can range from $29/mo (for ages 0-26) to $109/mo (for ages 60-64) with prices in between.
Also, prescriptions can sometimes be lower through a DPC provider.
How Does DPC Work with Insurance?
While insurance is still needed to cover major medical costs for services that DPC providers can’t offer, the membership fee is all one needs for the preventative and basic care with a DPC provider. Many physicians will recommend that patients do get some high-deductible health insurance to cover emergencies, more complex health issues, and serious illnesses.
Another option outside of health insurance is a medical cost-sharing network, which can sometimes be joined with membership fees similar to those of DPC. Direct Primary Care in Spokane has seen people use medical cost-sharing networks, like Sedera, or use their own insurance (employer-provided) in conjunction with using DPC.
Some DPC providers say that they can get specialists to give DPC patients similar rates as they would get through insurance, as the specialists are grateful that there is no need to involve a third party.
How Do Doctors Make Money with DPC?
One of the biggest questions we had when we were considering direct primary care was: how long can this stay in business? It seems like doctors would take a pay cut by providing direct primary care. On one hand, many doctors who choose to change to DPC do so because they want to see the industry changed. Insurance regulations have helped to create a stressful atmosphere that can lead to physician burnout, and DPC is a way out of that that can help doctors focus on patients.
On the other hand, it looks like the direct primary care model may not only be less stressful, but financially sustainable as well. According to Harvard Medical School’s Center for Primary Care, the Medical Group Management Association (MGMA) conducted a study that concluded the DPC model is economically sustainable for doctors/providers.
DPC physicians hope that as more people switch to DPC, more kinds of care can be added and revenue can continue to increase. They also hope that employers can start to see the benefit of DPC over insurance and will start putting money normally allocated to insurance plans into DPC for their employees.
Why Would I Pay More Money to a DPC Provider In Addition to What I Pay Monthly to My Insurance Company?
This is a great question – if you’re paying for insurance monthly, why should you pay more to a DPC provider? Wouldn’t you get the same service by your regular family doctor?
The short answer is: if you’ve found a doctor in Spokane who you like and can see on an as-needed basis, the prices are reasonable (or are covered by your insurance), then DPC might not be for you.
But if you’re struggling to find a doctor here, or you find your doctor unresponsive/unconcerned about your needs/dismissive of you… then you might find a monthly payment for direct primary care better fits with your lifestyle.
Direct Primary Care in Spokane
DPC can be found in Spokane at a place named exactly that: Direct Primary Care. They can be found at 212 East Central Avenue #360 and provide plans that are priced based on age. You can visit their website here: https://mydpcclinic.com/ or give them a call/text at (509) 553-0565.
Additionally, Dr. Condon provides DPC at 9631 North Nevada Street, Suite 202. You can visit his site here: http://www.doctorcondon.com/ or call him at (509) 467-1100.
Should You Try Direct Primary Care?
Now, we can’t say for 100% that DPC is right for everyone, nor would we! Health care and medical coverage is very personal, and everyone’s situation is different. However, direct primary care might be for you if:
- You’re a small business owner and are getting crushed by ACA/Obamacare costs
- You have a high deductible health plan (HDHP) through your job but want to see a doctor for check ups, physicals, etc.
- You wish you could spend longer than 20 minutes with your doctor – direct primary care gives you anywhere from 30-60 minutes with your provider
- You want to be able to talk to your doctor/provider when you need to – Direct Primary Care in Spokane has an app that you can text at any time to ask questions, request an appt., etc.
- You don’t get sick that often, but when you do, you don’t want to go through the hassle of talking to 2 different billing and scheduling people and being put on hold/re-scheduled to the next day
- You want a return to the “better days” of doctor care when doctors knew who you were and billing was straightforward, not a labyrinthine process
Have more questions about Direct Primary Care? Here’s another video explaining how it works.