Tuesday, June 26, 2012

Direct Family Medicine (DFM): More Details about DFM and Direct Primary Care

We've been reviewing information about Direct Primary Care and Direct Family Medicine for a couple months now.  Tonight on the Dr Synonymous Show, we'll review more numbers and information relative to DPC and DFM.  The charts and forms below are the work of Sonia Bennett, MPH a Wright State University second year medical student, with some input from Dr Jonas.  This is information for discussion and not perfectly organized or totally factual, but darn close.

Direct Family Medicine & WSU Sonia Bennett, MPH Interview 06/26 by Dr Synonymous | Blog Talk Radio  9PM ET

Family Health Connections, Inc in Beavercreek, OH intends to add Direct Family Medicine to their practice offerings in July, 2012.

v  What is Direct Family Medicine?
Direct Family Medicine (DFM), a Family Medicine version of Direct Primary Care (http://www.dpcare.org/difference) refers to care that is directly offered to patients without involvement of traditional insurance.  It is not health or medical insurance.  It allows people who do not have insurance to have access to medical care.  It is a way for patients to have a regular source of medical care, develop a relationship with their family physician, and work together to maintain their health and manage acute illness and chronic conditions.  The physician-patient relationship is the foundation of family medicine and DFM allows those without insurance to have access to such a relationship and medical care.

v  Who is Direct Family Medicine for and how does it work?
DFM is for people without insurance or people in career-transition who may temporarily be out of insurance to be able to receive medical care through monthly payments.  It is also for persons with a high deductable health savings account (HSA) in some states.  After enrolling in DFM, patients can have access to family medical care.  People with insurance or Medicare are not eligible for DFM.

Type of fees- Example
Infant (0 to 1yr)
Child (1yr to 17 yrs)
Adult (18 yrs and over)
Monthly fee
$60 ($720/yr)
Co-payment per visit

v  Do I need insurance to enroll in DFM?
No.  DFM is for uninsured patients or patients such as those with a high deductable health savings account (HSA) or who may be in between jobs.  Many who wish to cover their catastrophic medical costs with insurance, but keep their family medical care out of it will enjoy DFM
v  What services are included with Direct Family Medicine?
Preventive services, sick visits, chronic disease management (asthma, diabetes, high cholesterol, hypertension, hypothyroidism, depression, etc.), Saturday appointments, after-hours on-call physician access and other services listed in the Summary of Services are covered by the monthly fee.

Services that are covered by the monthly fee
Services not covered by the monthly fee
Visits for general wellness and preventive care from infancy to maturity
Infant, child, adolescent health (well-child checkups, school physicals, sports physicals)
Specialist care
Women’s health (annual checkups, pap smears, family planning discussion, menstrual issues, menopause, sports injuries )
Outside laboratory procedures such as pathologic exams, X-rays, heart monitors, etc.
Men’s health (sports injuries, prostate problems, erectile dysfunction)
Some immunizations and injections (vitamin B12 shot)
Acute sick care for all ages including routine office tests (urinalysis, strep test, pregnancy test)
Prescription medications. Blood tests
Chronic disease diagnoses and management (hypertension, diabetes, heart disease, high cholesterol, depression, thyroid diseases, asthma)
Surgeries and surgical procedures
Flu shot and injections for some infections
Obstetric procedures
Dermatological health (acne, rashes, skin cancer screenings)

Ear, nose, and throat health (ear irrigation, strep test)

Musculoskeletal problems (arthritis, joint pain/stiffness, back pain)

Gastrointestinal problems (GERD, diarrhea, vomiting, Irritable Bowel Syndrome)

Stress and psychological problems (anxiety, grief, situational reactions, depression)

Brain related problems (dizziness, headaches, numbness)

Weekdays and Saturday morning office hours

After-hours emergency telephone access

v  Is there a co-payment?
Yes.  Co-payment for every visit is $20.

v  Is there a registration fee?
Yes.  The registration fee is $80 for adults and $40 for children (0-17 yrs) and establishes care with a family physician.

v  What are the monthly fees?
Monthly fees are $60 for adults, $60 for infants (0-1yr), and $50 for children (1-17 yrs).

v  How do I pay the monthly fees?
You can pay by direct deduction from checking account, credit card, or debit card on the 25th day of the month
v  How do I cancel membership?
You can cancel anytime with, written notice, effective at the end of the month.
v  Can I re-enroll in the program at a later time if I cancel?
Yes.  You may re-enroll after a 6-month wait for up to 2 times but you will have to pay the registration fee each time you re-enroll.  Re-enrollment will also depend on whether we are accepting new DFM enrollees at the time.

v  Do I pay the monthly fees even if I don’t need to see the doctor every month?
Yes.  The monthly fee allows access to medical care and covers 24 hour on call physician coverage, preventive services and appointments for sick visits as well as chronic disease management.
v  What about the cost of prescription medications?
The cost of prescription medications is the patient’s responsibility.
v  What if I need to see a specialist? 
Referrals to specialists for further evaluation can be discussed with your physician and together you can decide the course of action.

v  What about other services such as specialist care, x-rays, and hospitalizations?
In-office lab work such as urinalysis, strep test, and pregnancy tests will not incur any charges, labs sent out of the office will incur a separate charge.  However, services such as x-rays and some vaccinations can be obtained from outside laboratories and will not be covered by the monthly fee.  Prescriptions, services provided by specialists, and hospitalization expenses will not be covered.
v  Will the physician see my family?
Yes.  At Family Health Connections, we believe in taking care of the family/ household and all members of the family are seen by our physicians and nurse practitioner.

Superficial Comparison of Direct Primary Care Sites

Health Access RI
Physician Care Direct
Family Health Connections, Inc. NEW
Level 1: $59-89/mo
Level 2: $ 54-129/mo
Level 3: $ 60-169/mo
Registration: $ 99
Copay: $0
Exam: $0-10
Sick: $0-10
Adult: $59/mo
Seniors: $39/mo
Child: $19/mo
Visit: $ 10
Copay: $20
Adults: $ 49/mo
Adult: $60/mo
Child: $50/mo
Infant: $60/mo
Enrollment: $40-80
Copay: $20
What/ outside services
On-site dispensary for prescription medication
Affiliation with labs, radiology, women’s care,  drug discount card
Partners with labs, imaging, and specialists
Partners with medical supply and labs.
Lab relationship
Massage therapy
Behavioral Therapy
Anyone with or without insurance, no Medicaid/ Medicare patients
Differs by practice, no Medicaid/ Medicare patients
Anyone with or without insurance, no Medicaid/ Medicare patients
Anyone with or without insurance, no Medicaid/ Medicare patients
People without insurance, no Medicaid/ Medicare patients
Seattle, WA
Various in CA, WA, FL, OR
Dayton, OH
Weekdays and weekends
Differs by practice
Depends on practice
Depends on practice
Weekdays and Saturdays
Shorter wait times, longer appointments, lower cost
Direct access to care
Because everyone deserves healthcare
Spend quality time with physician
Offer affordable medical care to the uninsured
Appointments, phone consultation, email
Contact participating practice for specifics
Contact participating practice for specifics
Access card plan, bundled services for primary care available through participating practices
Appointments, physician on-call 24/7 (as with other family medicine practices)

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