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Direct Care Offers Option for People Without Medical Insurance

The Congressional Budget Office has estimated more than 20 million people could eventually lose their health insurance if either the proposed House or Senate health care bills become law.

One option for those who can’t afford insurance is to pay their doctors directly when they have an appointment. Another option is available in some states but not others. It’s called ‘direct medical care’ and it’s offered at a handful of clinics in Spokane.

“We charge a $110 initial setup fee and then it’s $65 a month.”

Michelle Spivey is the president and CEO of True North Health Clinic, near Holy Family Hospital.

“And included in that is your initial labs, which is just a basic panel to show us how you’re doing, and then you can come in as often as you need to for $65 a month.”

Spivey’s clinic specializes in care for veterans, especially those who can’t get care at the VA facilities. They also care for people with traumatic brain injury. She says True North got into the direct care business last December. It’s a small part of the clinic’s clientele, but growing.

“Direct primary care offers a lot of freedom for both patients and practitioners and that freedom allows for a much healthier relationship with your health care provider,” Spivey said.

Washington and Idaho are two out of not-that-many states in the nation that allow direct care. There’s no insurance involved. The states don’t allow coverage for hospital stays or prescription drugs or dental visits. Many direct care providers advise their patients to also carry some sort of catastrophic care policy to cover them in case something serious occurs.

At Dr. Donald Condon’s office in Spokane’s Northpointe district, the monthly fee is $75.

“You get in the same day. It’s more relaxed. The whole idea of payment is not on the issue. They come, they get cared for and they walk out. No dollars exchanged, nothing to fill out. All done,” Condon said.

Condon says direct care goes back to some of the best parts of the American medical system. Doctors have ongoing relationships with their patients. Patients get more face time with their doctors. And he says care, not money, becomes the focus of the relationship. He says one of the best things is the third party is removed.

“Insurance companies are dictating what doctors get paid and what doctors can do and what medicines they can use. And the consequence is that the cost has gone way up,” he said.

Direct care, he says, with its fixed monthly costs, gives patients an incentive to go in and see their doctor when something’s wrong, instead of waiting until their situation gets worse.

“If they end up in the emergency room, the average cost of an emergency visit room visit in this state is two thousand dollars. I can take care of you for more than a year for that,” Condon said.

Condon is one of the pioneers in direct medical care in Spokane and yet, he says, only 10% to 20% of his patients take that route. He recently ran a TV ad to drum up business.

“‘I want better health care.’ ‘That’s an advantage of direct care.’ ‘But I also want to save money.’ ‘That’s another advantage of direct care.’ ‘I want my kids seen right away if they’re sick.’ ‘Another advantage of direct care.’” (fade under)   

Condon and Spivey say direct care is not for everyone. But Spivey says, for some, it’s a good alternative to traditional medical insurance.

“I make too much money to qualify for any of the exchange programs, but I don’t need to go to the doctor enough to make it worth spending $400 a month for health insurance. So, at $65-a-month, I can go see my primary care provider whenever I want and need and I get all of my prescriptions and many of the basic labs are included with that,” Spivey said.

Another name for direct care is concierge care. Dr. Jeff O’Connor says one caters more to folks with higher incomes.

“Concierge practices offer more," O'Connor said. "They offer more access for more things that may be done in the office, but it’s an annual payment. Direct care is more like renting something month-by-month. All of the benefits might not be there, but everything you need is there. And it’s every month and if you can’t do it that month, then you move on and that’s more aligned toward middle class people.”

Which is perhaps why direct care has a foothold in Spokane that concierge care doesn’t appear to have. But O’Connor says even direct care is only a niche business right now.

“In Spokane, it’s really not taken root. There’s some reasons for that. One, it’s unfamiliar to people. Two, even when they hear about it, they go ‘huh, I’m not sure how that’s going to work for me.’ And third, there are some tax disincentives right now. The IRS code doesn’t look at the monthly pay as a deductible medical expense.”

O’Connor says there have been attempts at the federal level to change that. He says the benefits of direct care are not only realized by the patients. He says any reduction of contact with insurance companies leads to less stress on his staff and the need for fewer employees to deal with insurance-related issues. If he could lure enough direct care patients…

“We’d flip in a minute and it would be very good because I would have a set income every month. I wouldn’t have to worry about whether the insurance company thinks that digit’s wrong on that billing code. Therefore we’re not going to pay you for the work you’ve done. That’s a weird concept," he said. "And not have to do any of the billing, not have to do with all of that headache and heartache, truly, that comes with that. It’s just you and me.”

Dr. Donald Condon says, just as there’s uncertainty with patients considering a flip, the same goes for physicians.

“To be blunt, because it takes guts to get out there and pioneer a new way of thinking, a new way of approaching care. A lot of them aren’t willing to give up their insurance-based practice,” Condon said.

So that would seem to point to little to no growth in the direct care industry. But all three of our guests seem to think it’s the wave of the future as health care costs continue to grow. Michelle Spivey, whose clinic has a nurse practitioner as its only provider, believes the move away from physician care toward midlevel provider care, will have an effect.

“Direct primary care and nurse practitioners, I think you’ll see, will go hand in hand, as far as nurse practitioner-owned clinics becoming more direct primary care clinics," Spivey said.