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Episode 25: DPC and the Hispanic Community–with Dr Kissi Rosabel Blackwell & Dr Dalian Caraballo



Resources

  1. Clarity Direct Care
  2. Your Family MD

Summary

Traditionally the Hispanic community in the US has been considered underserved when it comes to healthcare. There are many diseases for which hispanic health disparities is a reality. With DPC however, many in the hispanic community have been able to get medical care due to its affordable pricing and added ability to foster doctor-patient trust, which has been a huge barrier in the community. In Episode 25, Dr Roussel interviews Dr Kissi Rosabel Blackwell of Wichita Falls, TX and Dr Dalian Caraballo of Miami, FL about their experience providing healthcare to hispanic patients via DPC. As Dr’s Kissi and Dalian note, many hispanic patients avoid going to the doctor due to requirements or insurance, high cost and mistrust of the system. With DPC however, these barriers are leveled, reducing many of the hispanic health disparities that have adversely affected the community. In the interview they discuss how they’ve been able to deliver high-quality yet affordable care to the hispanic community via DPC.

Time Stamped
[02:05] So to start out, can you tell me about your DPC practice(s)? Wheere are they and when did you start?

[02:40] Tell me about the Hispanic community in our practice area.

[03:24] How have you reached out to the Hispanic community?

[04:44] In many areas of the US, the Hispanic community struggles to get access to care as a result of hispanic health disparities. in large part because of affordability but also because of language. How have your practices been able to address those issues?

[10:16] Based on your experience, can you give me your thoughts on ways DPC doctors can reach out to the Hispanic community?

 

Dr Kissi Blackwell
Dr Dalian Caraballo

Bio

Dr Kissi Rosabel Blackwell is a family medicine doctor and founder of Clarity Direct Care in Wichita Falls, TX. Originally from Nicaragua, she attended medical school in Texas at UT Southwestern prior to settling in Wichita Falls to where she has now started her DPC practice.

Dr Dalian Caraballo is a direct primary care doctor and founder of YourFamilyMD in Miami, FL. Originally from Puerto Rico, she completed her medical training in Ohio prior to moving to Florida where she now runs her DPC practice.

 

Related Episodes

Episode 26

Episode 3

Episode 24 Q&A: Best DPC Resources

 

Resources

Summary

 

Because DPC is a new concept for many doctors, we get questions about what resources are the best to learn more about DPC. While there are relatively few resources for direct primary care doctors to start a practice compared to resources for the traditional fee-for-service model, the resources available to DPC doctors are growing. In this episode I discuss some of the best direct primary care resources giving you my recommendations about books, blogs, websites, conferences, and podcasts that I’ve found helpful. This is a developing field so new resources are always popping up. Keep a look out and let me know if you find a gem you think I might not know about.

Time Stamped

[1:35] Do you have any guidance about books, blogs, or other resources that might guide me towards an even more serious consideration of establishing my own direct primary care practice?

Best Direct Primary Care Resources Reviewed

[1:55] Books that have been helpful for starting a direct primary care practice.

[3:38] Best direct primary care blogs.

[4:30] Best direct primary care support groups.

[05:19] Conferences that have been helpful in my direct primary care training, including the DPC Summit, Hint Summit, and the DPC Nuts and Bolts Conference.

 

Related Episodes

Episode 1

Episode 10

Episode 12

Episode 41

Episode 42

Episode 23: DPC and Maternity Care–with Dr Vance Lassey


Quote
“Who on God’s green earth is better at taking care of that patient than you? Nobody. That’s who. You are the best because you know them.”
~Dr. Vance Lassey

Resources
Holton Direct Care
“What About OB” (DPC Frontier)
The System Had Robbed Me of My Autonomy

Summary
There aren’t many a family doctor who delivers babies, however Dr Vance Lassey is one of them. And he does it purely via direct primary care. For a low-cost flat fee, Dr Vance provided full spectrum maternity care to his direct primary care patients from conception to birth to postpartum care.  What’s more is that he did it without any involvement of health insurance for–what most would consider–affordable prices. In Episode 23, Dr Vance discusses how he’s handled being a DPC doctor who delivers babies, including payment, call and management of complications. He further discusses how DPC provides a level of continuity simply not afforded elsewhere under our current healthcare system.

Time Stamped
[2:07] What motivated you to start a direct primary care practice in Holton Kansas?

[3:42] Did you have a patient base that followed you did you have to start on your own?

[5:47] Do you practice in an underserved area?

[6:35] Do you do home visits for your direct primary care patients?

[7:37] How have your patients responded to your willingness to do house calls and the relationship it allows?

[9:40] How did you get into being a DPC doctor who delivers babies?

[13:05] How did that work in terms of being on call and your availability for a birth if you were out of town?

[15:55] Would you advise other direct primary care doctors to offer maternity care?

[23:29] Are you still doing maternity care? Why or why not?

Dr Vance Lassey

Guest

Dr. Vance Lassey: Dr. Lassey work with Holton Direct Care in Holton Kansas. He’s a family doctor who founded Holton Direct Care after eight years as a family doctor at a community hospital. Dr. Vance provides a wide spectrum of family care from birth to death.

 

Related Episodes
Episode 21
Episode 22

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