Monday, July 9, 2012

Direct Family Medicine: Our Membership-Based Care is Open for Business

July 1st was our kick off day at Family Health Connections, Inc. in Beavercreek, OH for Membership-Based Direct Family Medicine- our variation on the Direct Primary Care model of care. THIS IS NOT INSURANCE!!! It was on a Sunday when we were closed, but we had already closed the practice to new patients June 30th.  After that date, all new patients (families actually, since we only take families) would have to want a Direct Family Medicine membership and have no health insurance for outpatient care. Currently we have capacity for 65 new families who want membership-based care.  A representative of the family or multiple representatives is asked to attend a brief meeting explaining the business model and our style of practicing Family Medicine before we allow them to sign up- as an entire family unit (defined as a household of related or committed people).

At the meeting with family representatives (or the entire family, if they wish), we will review aspects of our practice that may be helpful to know, such as our Philosophy of Care, Family Medicine as we practice it, definitions of membership-based Direct Primary Care and Direct Family Medicine and the fees for membership-based care and a list of other prices for services not included in Direct Family Medicine.

Since it was the July 4th holiday week and the temperatures soared into Ohio record levels above 100 degrees F and major power failures persisted from a huge storm, no one enrolled as a new family.  We haven't advertised yet, but will test those calling this week who are looking for a new Family Physician with their affinity for Direct Family Medicine.  Based on their responses, we'll learn how best to present the opportunity to them.

It's definitely not for everyone, but it's been known to significantly reduce hospital admissions, emergency room visits and use of advanced technology considerably in the Seattle area.  You're right when you note that the Dayton, Ohio area isn't Seattle and each Direct Primary Care membership practice is different.  The Qliance practices in Seattle are mature in using the membership-based model and have several extra services for a higher membership fee than ours.  As they say on TV, your results may differ from theirs.

So here's part of the deal: (Modified from Dr Synonymous June 26th post which was written mostly by  Sonia Bennett, MPH)

hWhat is Membership-based Direct Family Medicine?
Direct Family Medicine (DFM), a Family Medicine version of membership-based Direct Primary Care ( 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 through a membership.  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 membership-based 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
Infant (0 to 1yr)
Child (1yr to 17 yrs)
Adult (18 yrs and ove
Monthly Membership
$60 ($720/yr)
Co-payment per visit

v  Do I need insurance to enroll in DFM?
No.  DFM in our practice is for uninsured patients initially and, later, for 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 this Summary of Services are covered by the monthly fee.

Services that are covered by the monthly membership fee:
Services not covered by the monthly fee:
Visits for general wellness and preventive care from infancy to maturity
Hospitalizations.  We admit our patients to a KHN hospitalist group in the Kettering Health Network 
Infant, child, adolescent health (well-child checkups, school physicals, sports physicals)
Other Specialist care.  We want patients who are willing to relate to the KHN medical staff.
Women’s health (annual checkups, pap smears, family planning discussion, menstrual issues, menopause, sports injuries )
Outside laboratory procedures such as pathologic exams of removed tissue, 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
Skin health (acne, rashes, skin cancer screenings)
Newborn Nursery Care
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, pain, fibromyalgia, numbness)

Weekdays and Saturday morning office hours

After-hours emergency telephone access

v  Is there a co-payment?
Yes.  Co-payment for every membership-based 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.

This type of program, when combined with government approved hospitalization insurance, so far is included in the "insurance exchanges" of the Affordable Care Act, just reaffirmed by the Supreme Court Decision.  As the insurance offerings are developed for the exchanges in each state, we'll know better what will actually be available to Ohioans.  We are hoping that a state as large as Ohio will easily have a wide variety of insurance offerings through the exchange that will fit with Membership-Based Direct Family Medicine.

More later.

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