Protecting the Private Practice of Medicine
Direct Primary Care: Kicking Insurance Out of the Exam Room
Sabrina L. Noah
The evolution of our healthcare system has forced primary care physicians, like many other specialties, to operate an insurance-centric business rather than practic- ing medicine. In order to sustain a practice, physicians must see 20-30 patients per day, making the average office visit only 15 minutes. Physician and patient satisfaction are decreasing while reimbursements rates continue to decline. In response to these conditions a new practice model called direct primary care is gaining national attention. Direct primary care practices are designed to provide physicians with the freedom to practice medicine, instead of managing insurance claims. Recently our Vice President of Legal Affairs GregWad- dell traveled to Seattle, Washington, to interview the Co- Founder and Vice President of Medical Affairs of Qliance, Dr. Garrison Bliss. A primary care physician with more than 30 years of experience, Dr. Bliss founded his first direct primary care practice in 2007 after growing disillusioned with the current direction of healthcare. In addition to ad- vocating for the national expansion of the direct primary
a patient’s health. This is where patients go for check-ups, vaccinations, or sprained ankles. If a patient has a chronic illness, their primary care physician is a partner in their management every step of the way. Direct primary care practices are operated under the principle that the physician- patient relationship is the main focus. Bliss emphasized that “we want (the patients) to have trust in us; we want them to believe that we work for them and not for a bunch of other interests.” He believes direct primary care’s success is ultimately based on “a real doctor-patient relationship, reinforced by the economics, so that our customer is the patient. Our job is to get the care right, not the coding.” Direct primary care practices do not take insurance; therefore, there is no need for billing approval, deductibles, or co-payments. With lower overhead and dramatically less paperwork, direct primary care providers are no longer forced to squeeze in an unmanageable number of patients and can instead take the time necessary with each patient to deliver high-quality, personalized care. By eliminating insurance burdens from
care practice model, he has also served as the President of the Society for Innovative Medical Practice Design and the Direct Primary Care Coalition. Direct primary care practices offer a membership-based approach to routine and preventive care. Patients pay a low monthly fee, typically $49 to $100, to their physician for all of their everyday health needs. Like a health club membership, this fee gives patients unrestricted access to visits and care, allowing them use of the services as much or as little as they want. “What distinguishes us from other practices is that we have eliminated the fee-for-service model of care,” said Bliss. However, don’t confuse direct primary care with other pre-paid models. “This is not a concierge model; this model has been applied from the wealthiest patients to the indigent and uninsured,” he added. A direct primary care practice pro- vides routine healthcare, essential for the well-being and ongoing maintenance of
Dr. Garrison Bliss (left), co-founder and vice president of Medical Affairs of Qliance, a direct primary care practice in Seattle, talks with LSMS Vice President of Legal Affairs Greg Waddell (right).
J La State Med Soc VOL 166 March/April 2014 73
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