Category: Uncategorized

Episode 22: Pediatric House Call Only DPC–with Dr Kortney West


Quote
“Don’t overthink it too much, just do it [about a pediatrician going solo]. There’s always going to be questions and there’s always going to be ‘what ifs’. And if I had thought about it too much I probably wouldn’t have done it.”
~Dr. Kortney West, A House Call Pediatrician
Resources

Summary
DPC has traditionally grown via family medicine practices, yet as DPC grows, more doctors are finding niches for direct care, such as being house call pediatrician. In Episode 22, Dr Kortney West, a pediatrician out of Baton Rouge, LA, discusses her experience doing exclusively house call pediatrics. In the interview they discuss how housecalls have provided an added level of convenience to her patients, how avoiding the clinic has made the venture more financially feasible and how this has only been possible via a DPC arrangement.

Time Stamped

[2:37] What was your motivation for starting a direct care practice as a house call pediatrician?

[3:20] Why did you get started with house calls?

[4:51] Can you tell us a little bit about your patient population? How old are they? Where do they live? How often do you see them?

[6:04] Do your patients find it more convenient for you to come to them?

[7:45] How does the decision to not take a fee for service or join an insurance network play into being able to spend more time with patients?

[8:57] When you left the big hospital system and went on your own but had joined an insurance network, would you have been able to provide the convenience of house calls for your patience?

[9:41] Since you’re not in an insurance network how do you handle providing vaccines which most insurance companies will reimburse?

[10:11] For parents who want to pay cash what have been some of the prices for vaccines?

[10:52] How has the house call model been able to help you keep your overhead costs low in fulfilling your own personal goals?

[11:46] What questions would you advise a pediatrician who’s thinking about going solo consider?

Dr Kortney West

Guest

Dr. West is a native of Lafayette LA and moved to Baton Rouge after her residency. She founded West Pediatrics after working at a major hospital system as a employed pediatrician for two years and now provides pediatric care exclusively via house calls.

Episode 21: House Call Only DPC—with Dr Marguerite Duane and Dr Matthew Haden


Quote
“I don’t feel so limited by the confines of an office or a health care system that limits me to ten or fifteen minutes to take care of these [difficult] patients with very complex health care needs.”
~Dr. Marguerite Duane
Resources
Modern Mobile Medicine
Hint thread on ‘DPC Without an Actual Office’
Facts About Fertility
Dr. Matthew Hayden’s Profile
Dr. Marguerite Duane’s Profile
Summary
Parents with children, elderly homebound, and mobility impaired individuals are a few of the many patients who struggle to get to the doctor’s office without considerable difficulty. Yet with the recent surge in home visits, seeing the doctor becomes feasible and for many, enjoyable.  In Episode 21, Dr Roussel interviews with house call doctors Dr Marguerite Duane and Dr Matthew Haden about their experience doing house calls for patients in the Washington DC area. In the interview they discuss how being house call doctors has added convenience to their patients, how its helped them avoid much of the overhead associated with running a clinic and how this arrangement has been possible only via DPC.

Time Stamped
[2:45] When did Modern Mobile Medicine start and what were the circumstances around its genesis?
[4:22] What was the inspiration to be house call doctors?
[9:20] Do you still do hotel calls?
[9:36] Where did you get your referrals when you were getting hotel guests?
[10:05] What does a typical day of house calls look like for you?
[15:01] How has your practice been able to fill a need for the community you’re working in?
[19:47] How does the environment or flow of house call visits differs from the usual clinic routine?
[23:03] How has Modern Mobile Medicine allowed you to meet your own personal needs in terms of time and scheduling. And how has the house call aspect has helped with the business side of things?

Dr Marguerite Duane
Dr Matthew Haden

Guest

Dr. Marguerite Duane: Dr. Duane is a part of Modern Mobile Medicine in Washington D.C. She is a family physician who does housecall only direct primary care. She has served on the faculty of Georgetown University and as the medical director for two community health centers in the D.C. area.

Dr. Matthew Haden: Dr. Haden is a part of Modern Mobile Medicine in Washington D.C. He is a family physician who does housecall only direct primary care. He did his residency at Georgetown University.

Related Episodes

Episode 22

Episode 23

Episode 20: Physician Burnout & Suicide: Stemming the Tide via DPC–with Dr Pam Wible

Quote

“People who do primary care should be free range, and they should not be factory farmed, and they should be in their own offices, and they should be able to do things the way that makes sense for them and their patience.”

~Dr. Pam Wible

Resources

Ideal Medical Care (Dr Wible’s Blog)

“Why Doctor’s Kill Themselves” (Dr Wible’s Ted Talk )

Physician Suicide Letters (Dr Wible’s Book)

Do No Harm: Exposing the Hippocratic Hoax

Summary

Most people think of doctors as living a charmed life full of grateful patients, high income, ideal health, and perfect families, but the reality, says Dr. Pam Wible, is very different. Many physicians commit suicide because they feel trapped into providing medicine in what feels like an assembly line, and many more are distressed or–as phrased by pop-psych terms– “burnt out.” Direct primary care, she notes, provides a path for doctors to get out of factory-based care and to do what they went to medical school for. In Episode 20, physician suicide expert and DPC doctor Pam Wible argues that our present-day healthcare payment model is largely to blame for this. In the interview they discuss why physician suicide and ‘burnout’ are on the rise, how to stem the tide of these unfortunate trends and how DPC can help to provide joy and purpose to many doctors who have been hurt by an unfriendly system.

Time Stamped

[1:51] How did you get involved in speaking about physician suicide and burnout?

[4:24] How did that translate into you speaking on suicide amongst physicians and ultimately having these retreats to help physicians who are having trouble shall we say?

[8:46] Was your first practice, the ideal clinic you designed with your community, direct primary care practice?

[11:40] How do you see DPC in helping stem the tide of suicide or distress amongst physicians?

[13:12] Do you think that the sort of continuous insertion of third-parties into insurance based care effects physicians likelihood or predisposition to depression and anxiety?

[13:38] What advice would you give to physicians who are in the system and feel like they can’t escape?

[15:42] Would you offer your encouragement the physician who’s mired in a hospital based practice or a multi-practice group to jump out on their own if that what they’d like to?

[16:54] Why is it so important to you to help other physicians realize their dreams?

[18:15] How can our listeners find your blog and your retreats?

Dr Pam Wible

Guest

Dr. Pam Wible: Dr. Wible is a direct primary care doctor from Oregon and an internationally known speaker, blogger, and author. She has appeared on CNN, NPR, and in a TED Talk. She is the author of “Physician Suicide Letters Answered” and has devoted her career to help prevent physician burnout and suicide.

Related Episodes

Episode 1

Episode 19: Medicare and DPC: To opt out or not?–with Jim Eischen

Quote

“There is no interest in over policing direct care. You simply have to play by the rules. And the rules are pretty easy to follow.”

~Jim Eischen

Resources

Jim Eischen’s Legal Practice

Addressing Direct Primary Care’s Medicare Issues (Physician’s Practice)

Opting Out of Medicare (DPC Frontier)

Summary

How does Medicare affect DPC? Should DPC doctors opt-out of Medicare to avoid legal problems? Can a DPC physician charge for services not covered by Medicare? Has the Office of the Inspector General ever gone after a DPC practice or clinic? In the interview, DPC compliance expert Jim Eischen discusses important factors to consider with DPC and Medicare. For DPC doctors who accept Medicare assignment, Eischen argues, they must be careful to not bill for services covered by Medicare. That said with appropriate legal homework they can safely bill ‘fee for non-covered services’ and still accept Medicare assignment. In the interview Eischen discusses how this can be done and what factors to consider for a DPC practice considering whether or not to accept Medicare assignment.

Time Stamped

[1:49] How did you get involved in doing legal work for direct primary care doctors?

[6:20] What have you seen in your work with who do both DPC and Medicare assignment?

[10:19] If a doctor has opted in to Medicare is there a way for a DPC physician to charge a membership fee?

[15:58] Can you charge a patient for fees that are not covered in Medicare and do that on a monthly basis as a membership fee and how would you do that?

[18:43] What services are not covered by Medicare that a DPC doctor can charge a membership fee for?

[20:38] Isn’t the Annual Wellness Visit (AWV), the Initial Preventive Physical Examination (IPPE), and the G0439, covered by Medicare?

[24:44] Has the federal government taken action against a membership based physician?

Jim Eischen

Guest

Jim is a licensed attorney who works with McGlinchey Stafford in Irvine, CA. He has several decades of experience as a lawyer and is an expert in the area of direct primary care. He has spoken around the country on DPC and Medicare.

Related Episodes

Episode 18

Episode 4

Episode 18: Drafting DPC Patient Contracts Right The First Time–with Luanne Leeds


Quote
“DPC docs are a really great self-selected group of physicians who are willing to take a risk and who refuse to just roll-over for insurance companies or for Medicare.”
~[Luanne Leeds]
Resources
Luanne Leed’s LinkedIn Profile
Leeds Law in Topeka Kansas
Sample DPC Patient Agreement 1 (Whole Family Direct Care)
Sample DPC Patient Agreement 2 (Evermed DPC)
Sample DPC Patient Agreement 3 (Coastal DPC)
Summary
DPC doctors know all too well that a pound of prevention is worth more than an ounce of cure. That saying is just as true when it comes to the legal aspects of setting up and growing a DPC practice. The doctor/patient relationship is all about trust, and that’s especially true for DPC physicians.  In Episode 18, Attorney Luanne Leeds provides guidance for doctors thinking about starting a DPC practice. In particular she elaborates on three legal issues they need to address right from the start. (1) Will they accept Medicare? (2) What about previous contracts? (3) How can doctors create a good dpc patient agreement?

Time Stamped
[1:54] How did you get into doing legal work for direct primary care?
[4:45] What would you rate as the top three legal issues that a direct primary care doctor needs to address when they’re starting a direct primary care practice?
[8:37] What are some of the typical areas where  misunderstanding in a direct primary care agreement show up?
[15:42] Can doctors draft their DPC patient agreement themselves or should they seek legal help?
[18:26] What can a doctor reasonable expect to pay to have a patient contract drafted?
[21:47] How can a doctor go about finding a lawyer who has experience helping DPC practices?

Luanne Leeds

Guest

Luanne Leeds: Luanne Leeds is one of the most experienced attorneys when it comes to direct primary care. She works with Leeds Law out of Topeka Kansas and has been retained by many DPC doctors to help them manage the legal issues involved in starting and maintaining a healthy DPC practice.

 

Related Episodes

Episode 19

Episode 4

Episode 17: Breaking Even with DPC– with Dr Joseph Sheppard

 

Quote

“If you maintain your expenses low, and if you provide quality service, if you have the right staff, if you treat people right, and you’re just not stupid with your money, I think it most cases it’s eventually going to work out.”

~Dr. Joseph Sheppard

Resources

DPC powerpoint 2016 (complete)

Dr. Joseph Sheppard’s LinkedIn Profile

Direct Primary Care (DPC) Summit Draws Hundreds of Enthusiastic Family Physicians

Free Market Physician in Neosho Missouri

Wall Street Journal Article on Financial Realities of DPC

AAFP Article: ‘Practice Transformation: Taking the DPC Route’

Summary

Starting a direct primary care clinic is hard. Making a direct primary care salary is even harder, but there are things doctors can do to predict revenue, cut expenses, and get their clinic past the break-even point. In Episode 17, Dr Roussel interviews Dr Joseph Sheppard about how to get to the break-even point with a DPC practice. While economic conditions vary from one community to the next, Dr Sheppard notes, sound business practices stay the same. While DPC physicians may need to bridge the gap via moonlighting between opening their clinic and reaching the point of taking home a direct primary care salary, DPC can be financially sustainable in many places with the right business plan. 

 

Time Stamped

[2:07] How long have you been in direct primary care?

[2:51] How can a doctor go about predicting a revenue stream for their direct primary care practice?

[4:08] How can a doctor predict first-year growth when they’re opening the first direct primary care clinic in their community?

[6:24]  How can a doctor increase revenue outside of DPC membership fees?

[10:21] What’s a good starting point for what a doctor should budget for? What are the essentials and what can wait?

[12:00] What about advertising? How should a doctor budget for that?

[13:49] What are some things we absolutely should not cut from our budgets (location, rent, staff)?

[15:37] What should doctors starting a DPC practice expect their minimum overhead to be?

[16:50] What’s a reasonable expectation of when to start making a salary for direct primary care practice?

Guest

Dr. Joseph Sheppard: Dr. Shepherd works with the Free Market Physician in Neosho Missouri. He has spoken at the Direct Primary Care Summit in Kansas City on the financial realities of DPC. He graduated his residency in 2014 and opened his clinic right after he graduated.

Dr Joseph Sheppard

Guest

Dr. Joseph Sheppard: Dr. Shepherd works with the Free Market Physician in Neosho Missouri. He has spoken at the Direct Primary Care Summit in Kansas City on the financial realities of DPC. He graduated his residency in 2014 and opened his clinic right after he graduated.

Episode 16: Short Term Medical Plans that Pair with DPC–with Kurt Wagner and Mandy Jacobson


Quote
“The price of a [Blue Cross] plan back seven or eight years ago was one-third or less than it is now for the same person, same coverage.”
~Kurt Wagner
Resources
Affordacare MEC Insurance Plans
Health Insurance Innovations Short Term Medical Plans
CBS Article on What you Need to Know About Short Term Medical
Summary
Historically, short term medical insurance plans were used as a bridge for clients changing jobs, but with the recent rise in insurance premiums, short term medical plans have become an attractive option for many to obtain some sort of health insurance coverage at an affordable price. In Episode 16, Dr Roussel talks with Kurt Wagner, a seasoned health insurance agent out of Baton Rouge, LA, and Mandy Jacobson, a seasoned financial advisor out of Baton Rouge, LA, about the benefits of short term medical and how they can be combined with DPC membership to provide healthcare coverage that would otherwise not be affordable.
Time stamped
[2:30] How do short term medical plans cover a patient’s medical needs but don’t have a major medical plan?
[2:54] What are the typical policy periods you see in short-term medical plans?
[3:08] Have you come across situations where patients have been denied coverage because of a pre-existing condition?
[5:26] What’s the distinction between a short-term plan and a major medical plan you may get from your employer or on HealthCare.gov?
[7:28] How big of a difference is the cost between short-term and long-term coverage? And how does that price difference effect the level of coverage?
[10:05] Which carriers offer short-term medical plans and what are the coverage length of those plans and the renewal periods?
[14:01] Are these plans available everywhere? Or does it depend on where I live?
[14:30] What changes have you seen to the health insurance marketplace over the last few years?
[18:33] Why do insurance agents and companies seem to be averse to working with primary care doctors and primary care clinics?
Guest(s)

National General Insurance Company
New York Life Insurance Company

Kurt Wagner

Kurt works is an insurance agent in Baton Rouge, LA with National General Insurance Company. He’s worked in the health insurance market for more than ten years. He has spoken on Louisiana Public Broadcasting (LPB) about direct primary care.

 

 

Mandy Jacobson

Mandy is an insurance agent with with New York Life Insurance Company. She has served as a financial advisor out of Baton Rouge for many years and has extensive experience with short-term medical options.

 

Related Episodes

Episode 13

Episode 14

Episode 15

Episode 15: Self-funded Insurance Options that Pair with DPC–with Dan Meylan



Quote
“The direct primary care physician and their compelling story is, ‘we reduce cost, we improve access, and we improve quality.'”
~Dan Meylan
Resources

  1. Allied National Insurance Company
  2. The Freedom Plan from Allied National
  3. Dan Meylan’s Presentation at the 2017 DPC Summit
  4. Dan Meylan’s LinkedIn Profile

Summary
Small businesses can often save substantial sums by providing employees with Direct Primary Care along with self funded insurance plans, which provides more access to healthcare for the employee via DPC along with substantial reductions in premiums via the self funded insurance plan. In Episode 32, Dr Roussel interviews Dan Meylan, a seasoned insurance agent with decades of experience in third-party administration, who discusses how combining self funded insurance plans with DPC works and how it can substantially improve care and reduce costs. As well, they talk about how many insurance agents aren’t offering them because they’re used to plans that offer a fixed commission over serving as advisors who negotiate a price for serving as a consultant rather than a broker. Finally, Dan gives his thoughts on why insurance companies have unwilling to give up the networks, even though their network-free (reference based pricing) insurance plans save money.
Time Stamped
[2:37] What is Allied’s history with self funded insurance plans and how Alliend has come in contact with direct primary care?
[5:39] How many plans do you have for patient who see direct primary care doctors?
[6:49] What’s the average employer size for your self funded insurance plans?
[9:36] What would your recommendation be for employers that go through medical underwriting where it would be more costly because of the health state of the employees to get underwritten?
[11:14] What is the Freedom First Plan and what pricing model does it use?
[15:47] Many insurance companies are very reluctant to let their health care networks go. Why is that?
[18:51] Why are so many insurance companies unwilling to work or adapt to direct primary care?
[25:37] What is the impact on direct primary care physician’s actions are on the overall cost of care?
[26:44] Why aren’t insurance agents “getting it” when it comes to direct primary care?
[28:52] What should a PCD do to get more information on working with Allied?

Dan Meylan

Guest

Dan Meylan VP of sales with Allied National Insurance in Kansas. Dan has spoken around the country about self-funded insurance plans. Dan is an excellent resource for direct primary care related insurance questions. Dan trains insurance agents around the country on how to integrate direct primary care options into their consultation process with employers. Having spent six years Allied National and many more in the insurance market Dan speaks from his deep experience.

 

Related Episodes

Episode 13

Episode 14

Episode 36

Episode 37

Episode 38

Episode 45

Episode 14: Health Sharing Ministries and DPC (Part 2: CMF CURO/Samaritan)–with Mr Michael Vacca

Resources

  1. CMF Curo
  2. Samaritan Ministries
  3. Health Sharing Video

Summary

Health sharing ministries work by pooling funds from members of a group, joined by a common belief system, to pay for medical expenses of its members. CMF CURO is a Catholic health sharing ministry whose members receive coverage of medical expenses through Samaritan Ministries International. Health sharing plans can often provide coverage of medical expenses at a fraction of the cost of insurance and without the hassle of insurance contracts and premiums. In the interview Mr Michael Vacca, Director of Ministry and Policy, discusses how the health sharing process works, how it is similar to and different from health insurance and how membership can be paired with DPC membership to provide full spectrum medical care.

Key Questions

  1. So to start out, can you each tell me about the history of your programs?
  2. Can you tell me about how the sharing process works?
  3. How are insurance and health sharing different?
  4. If the programs are not insurance, can they still pay? What about large bills?
  5. Both programs have some basic requirements to join including a statement of belief and a commitment to certain lifestyle requirements. Can you give us an overview of each?
  6. How do each of your programs treat DPC?
  7. How would you recommend a DPC doc who has interested patients get more info?

 

Michael Vacca

Bio

Michael Vacca is a licensed attorney in Michigan and prior to working with CMF Curo he worked with the Pontifical Council on the Family in Rome. He is now at CMF Curo where he provides a helpful voice for the program. He serves as Assistant Direct of Ministry and Policy Development. He is a strong supporter of DPC and has helped many health sharing members find DPC doctors as a way to receive medical care.

Related Episodes

Episode 13

Episode 15

Episode 13 DPC and Health Sharing Ministries Part 1: Liberty Healthshare–with Mr Dale Bellis

Quote

“We believe as health sharing members…that we have to break the [sick care] model.”

–Dale Bellis

Resources

  1. Liberty Healthshare

Summary

In Episode 13, Dr Roussel interviews Mr Dale Bellis, Executive Director of Liberty Healthshare. As one of the oldest health sharing ministries, Liberty has extensive experience coordinating healthcare sharing with DPC. Founded as an organization devoted to paying for healthcare expenses in a radically different way, Liberty’s health sharing process allows each member to share their healthcare expenses without the cumbersome requirements of an insurance plan. Liberty, notes Mr Bellis, is a strong supporter of DPC because it promotes the doctor patient relationship, lowers healthcare cost and allows for a more personalized approach to healthcare. In fact, Liberty has gone so far as to reimburse members of their plan for a portion of their membership expenses when they join a DPC Practice. In the interview, Mr Bellis discusses the health sharing process. In particular he discusses how the health sharing process works, how it is similar to/different from insurance. He also discusses what needs are or are not eligible for coverage. Finally, he elaborates on how Liberty membership pairs with DPC.

Time Stamped

[02:02] Mr Bellis on how the health sharing process works

[02:41] How healthcare sharing is different from health insurance

[03:42] Can Liberty still pay every time even if it isn’t insurance?

[05:00] Has Liberty ever not been able to meet a need?

[05:20] How Liberty views DPC

[07:53] Does Liberty pay for DPC?

[09:57] Where to find more about Liberty

Mr Dale Bellis

Guest

Mr Dale Bellis is the Executive Director of Liberty Healthshare. Prior to joining Liberty in 2012, he worked for decades in third-party administration of healthcare plans for employer groups. He is a strong believer in Direct Primary Care as a way for member’s to access healthcare. At Liberty he has made it a priority to encourage members to join DPC practices and is a firm supporter of the DPC movement.

Related Episodes

Episode 14

Episode 15