Saturday, June 9, 2012

Direct Family Medicine: Basic Package and Fees

 Considerations in establishing Direct Family Medicine charges pile up as one considers the business model versus patient need.  We reflect on, "What is Family Medicine?"  What is a basic package of FM services in the context of the patient-physician relationship?  What  is beyond the basic package but within the purview of generalist physician training that would be included in a list of services for separate payment?  What complementary and/or alternative practices might be included in the fee list for non-FM services on site?

First, the enrollment fee: These vary from $25 to greater than $100 per person.  Family rates seem to expect the full enrollment fee from the adults and a lower fee (like half the adult fee), such as $75 for each adult and $40 for each child.

Monthly membership charges vary depending on the scope of services in the basic package.  $50-60 is a common range for adults, while children may be charged (at the end of the month is when this happens to avoid being considered to be an insurance plan) $30-60 monthly depending on the inclusion or exclusion of immunizations in the basic package.  Imaging with X-Rays in the office usually is not include except for Qliance.  Hospital rounds and admissions are included in the more expensive Qliance package.

Administrative, scheduling or co-pay fees per visit are widely variable with a few plans having no per visit fee and many having a $10 to $20 fee.  For "complete" details about several Direct Primary Care programs click on these links:
Qliance      Health Access Rhode Island     Medlion    Forrest Direct Pay     Physician Care Direct

What aspects of each plan appeal to you?  Which elements don't seem to apply to you and your family?

A Family Physician planning to start Direct Family Medicine must carefully consider the above variables and make a decision.  What will be my basic services and non-basic services?

What basic fees will I start with and what variables will I monitor to know how we're doing for our patients and ourselves?

What do you think?



  1. I don't like the monthly payment model because most patients have insurance. Even if the doc doesn't take insurance, patients can file a claim for out-of-network benefits. A monthly membership fee messes that up, imo. Also, I tend to only see my doc 3 or 4 times a year, so I know I won't be in every month.

    The Integrative MD I see, handles it like so: You pay $200 for the first appt and $75 per office visit thereafter, plus fees for things like shots and IVs etc... The different with them, is they don't provide any phone coverage. If I need to go the ER, I don't call them although they ask to be kept updated. They don't prescribe abx or any 'primary care' meds. So it's a smaller work load outside formal appts from what I've seen.

    The last indep. family practice doc I saw, was a flat fee and they gave me a form for my insurance to file the out-of-network claim to get whatever refund I could. I liked them very much--they had TIME to see me and they were much more involved in my health.

    All of these docs are busy--no shortage of patients. I think if you build it, they will come. People are desperate for good medical care. But then you might also end up with a bunch of patients like me, which may be no fun for you!

  2. Thanks, MM for your input. The insured may have no need for Direct Pay such as Direct Family Medicine (DFM)or Direct Primary Care (DPC)unless they have a high deductible health savings account (HSA). In those cases, the DFM or DPC doctor may be able to serve them unless the physician is in a contractual relationship with the insurance company that offers the HSA, forcing the doctor to only deliver services as contracted with the insurance co. With the uninsured, especially millions who have a job, the DFM doc can fully relate to the patient per the DFM agreement and the patient directly pays the practice the enrollment and on-going membership fees and per visit fees as applicable.
    I agree with you that people are desperate for good medical care and they will appreciate the benefits of DFM/DPC.
    Also, unique patients like you are a reminder about the "Oneness" of each patient we relate to. The DFM model allows time to identify, appreciate and respond to that oneness. Thanks again for your comment.

  3. Thank you, Dr. Jonas, for bringing DPC to the forefront. At MedLion, we believe that insurance was never designed for primary care - it was created for high medical cost scenarios. Unfortunately, due to time, inflation, the business of health insurance, and consumer expectations, primary care is also relatively expensive, hence the need for insurance in primary care.
    But, what if primary care were to be made affordable? After all, most medical visits are to primary care doctors. Why would someone need insurance coverage for something extremely affordable? At MedLion, where our children dependent fees are as low as $19 per month and doctor visit fees of just $10, we have done just that. Insurance is reserved for catastrophes, expensive specialist visits, etc., as it was originally intended.
    Patients, we have found, receive better care in DPC practices. This is because doctors have fewer patients in their panel, and thus, can spend more time with them as well as providing greater access when actually ill. Another great advantage is that our doctors do not have to rely on per-visit-reimbursement due to revenue streams being generated via monthly membership. Our doctors, therefore, do not hesitate to practice telemedicine when there isn't a need for the patient to come into the clinic. Simple bronchitis, UTIs, and seasonal allergies are treated remotely, reducing unnecessary testing, visits, and wasted patient time. In contrast, traditional, insurance-dependent doctors have to rely on face-to-face visits, otherwise they don't get reimbursed. A third advantage our doctors have is that they are able to counsel patients on preventive medicine subjects more effectively. The overweight patient doesn't mind coming in for a $10 visit to receive guidance on nutrition and exercise. Most such patients would refuse to come in if the costs were considerably higher for simple counseling.
    Our doctors are happier because their revenues are substantially higher, they get to practice medicine without the intrusions of an actuary, and they get to spend quality time with patients who don't feel robbed during quick visits.
    At MedLion, we don't believe DPC is just a temporary trend or a "symptom" of the current, sick health care system. We believe it is the way primary care should be practiced - happier doctors and happier patients. We believe DPC is here to stay. At MedLion, our doctors are also contracted with insurance companies, but they also care for employers and individuals when they choose to contract with primary care doctors directly, instead of through insurance companies. And America is about choice. After all, when ill, who wants to see their insurance agent? Society needs their doctors, and MedLion aims to supply them.

  4. Dr. Qamar,
    Thank you for your important comments. Readers wanting more information about MedLion, please click on the link in my post. This is an exciting model for medical care and medical practice. apj