Wednesday, September 4, 2013

Direct Primary Care: It's Not Just the Money

When we didn't receive Medicare payments for five of seven months between October 2012 and April, it hit my practice hard financially.  We were close to a disaster (like closing) until the OSMA (Ohio state Medical Association) helped us get connected with a human who could get our claims paid.

The non-payment was caused by new computer registrations we had to make for the Affordable Care Act (ObamaCare, aka, RomneyCare).  They made data entry errors in all three of the major changes, not easily detectable by the first four representatives we spoke with as the problem worsened from December through April.  After we had assurances in May that it would be fixed, we heard nothing at all for 30 days.

That experience was an eye opener.  Our survival as a practice is threatened by the massive system changes.We have no assurances that we'll have any patients after January 1, 2014.  We're small and vulnerable.  How do we continue?

I love being a Family Physician.  There is a sacred aspect to each of us that should be honored in our human endeavors.  As a Family Physician, I get to witness and experience that sacredness in my patients and myself.  The patient-physician relationship is the sacred core of the practice of medicine that I believe to still be worthy of honoring and protecting.  The relationship is a human connection that gives each patient and physician glimpses of the sacred nature of the other.  People are amazing and I'm blessed to get to help them with their health, illness and, eventually, their demise.  But, OUR demise as a practice is a surprising possibility.  How do we stabilize and increase our chance for survival?  We need to find an Island of Hope in the Heart of Darkness.

I'm starting to see that Direct Primary Care (DPC) might be that island.  It's a business model that gets us away from insurance companies, misaligned quality initiatives, and the quicksand of the Affordable Care Act.  (The ACA has some strengths and weaknesses, one of which is that we may disappear or drown in a sea of well-intended initiatives).

My practice has started Direct Family Medicine (DFM), the practice part of the DPC business model.  All new patients to the practice can only enter via DPC into our DFM.  I've posted about it before.  A good introduction to the concept can be found at  It's not just about the money.  It's also about serving others as a Family Physician as well as I am able.

I'm a member of the planning committee for the Direct Primary Care National Summit in St Louis October 11-12 at the Airport Marriott.  It will be an exciting opportunity to explore the "Island of Hope" and get some great information about how to proceed with Direct Primary Care.  Physicians and practices from pure DPC, hybrid (traditional/ DPC practices) and transitioning practices will all be represented as well as a few networks of DPC practices.  Click on the link below for more information.  More conferences of a similar nature will start to pop up as thousands of physicians seek to leave The Heart of Darkness and continue to practice.

Direct Primary Care National Summit


  1. Your third paragraph tells it all. Medical care is a human endeavor. It is about people. Primary care emphasizes that.

    ACA is about techno-centric care. IT as our savior. It is a tool, not the end. It is a means to the life we want to lead. The community hasn't realized that, but it will.

    It is interesting that I've now read about human-centered design from which the human centered health home derives. I've also read about patient centered care which is a misnomer. Recently I've been reading about citizen-centered democracy.

    These human-centered thrusts are not reactionary. They are progressive. They point out that we are in a transition through technocracy to a humanity we have yet to realize. It is a humanity and a quality of life that is enabled by technology, but it is centered on human values.

    Direct Family Medicine is a beacon on the horizon along the path we will all travel.

  2. Wow, Steve.
    A great message of human centered life. The ACA comments are extremely helpful as we seek to understand what's happening in healthcare.

    Human centered is progressive. Let's move it along via DPC/DFM and citizen centered democracy. apj