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Direct primary care provides flat fees, more access

Published: Wednesday, Oct. 23, 2013 11:49 p.m. CDT • Updated: Wednesday, Oct. 23, 2013 11:57 p.m. CDT

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FOX RIVER GROVE – About a year ago, Dr. Bruce Bell added a new payment model to his practice.

Under this model – a more affordable offshoot of concierge medicine – called direct primary care, about 40 of his patients, about 2 percent of his practice, pay a flat rate to ensure they get quality time with him.

An estimated 5,000 to 5,500 doctors and clinics have adopted direct primary care or concierge medicine systems, according to the Concierge Medicine Research Collective. The most common specialties to use the model are primary care, family medicine, cardiology and pediatrics.

While a majority of doctors who enter concierge medicine or direct primary care would make the same decision again, Bell hasn’t seen it take off at his own Fox River Grove practice.

In fact, he has fewer patients going the direct primary care route – which at Bell’s practice is called concierge plus – than when he initially adopted it last August because they’re typically getting the same amount of time with him.

“It doesn’t make a difference because the doctor-patient relationship is important to me,” said Bell, adding that to make sure he gets the time with patients and can still make ends meet, he works longer hours.

Dr. Stewart Segal, the founder of the Lake Zurich Family Treatment Center, has had more success with the model.

About 10 percent of his patients pay $1,800 a year to be in his direct primary care program, which takes up about 20 percent of his time mostly before or after his office hours.

He expected his wealthier patients to sign up, but found it was his average, fairly healthy patients who took advantage of the program for its focus on preventative care.

He also was concerned his other patients would feel slighted, but he said that’s gone OK, too, because he still spends enough time with patients to develop good relationships.

In exchange for the flat payment, Segal’s direct access patients get to skip the front desk, dealing directly with one primary care nurse who will schedule their appointments and tests. They also have Segal’s cellphone number if they want to talk directly to him.

They’re also provided with a zip drive with all their medical records in case they need to see a doctor when they’re out of town.

The major benefit, though, is the physical, Segal said.

The nurse conducts an extensive physical with the patient, running an “extensive battery of tests,” which Segal then reviews in conjunction with the patient’s history to develop an action plan for improving the patient’s health.

Segal then refines that plan after meeting with the patient and conducting an examination. He’ll check in a month later, depending on the patient, to make sure progress is being made.

“My direct access patients are a lot of fun to take care of,” he said. “To take care of somebody who truly wants to be healthy and who is truly going to follow what you prescribe ... is a breath of fresh air.”

A physical like this would not be possible under an insurance plan, Segal said. Some insurers only cover one wellness visit a year, and some don’t cover any.

By taking the insurance company out of the equation, doctors can lower their overhead costs and therefore devote more time to fewer patients, advocates argue.

More than 40 percent of a primary care providers’ revenue goes to reimbursement costs, according to the advocacy group Direct Primary Care Coalition.

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