Many doctors feel that health insurance has become a for-profit business, putting patient needs second to the almighty dollar. Some doctors are deciding to break up with traditional insurers and move towards direct primary care.
WATCH: Doctors are breaking up with 'traditional insurance'
What is Direct Primary Care? It is a healthcare model where patients can pay a monthly or annual fee to a physician or practice to avoid traditional insurance-based billing.
"We are a family medicine office, and so we offer all of the services that you would get from your family medicine physician," Dr. Christina Stamoolis told ABC Action News reporter Michael Paluska.
Dr. Stamoolis is the medical director at Craft Concierge in Tampa.
"In the insurance-based system, there's a real drive to see more patients in shorter appointment times. So you would get, sometimes, anywhere from, you know, 10 to 15 minutes with the patient," Dr. Stamoolis said. "And so a standard new patient visit is an hour long. Sometimes, we spend longer, and then follow-up visits, you know, anywhere from 45 minutes to an hour. One of the big reasons that I went into medicine, and particularly Family Medicine, was to be able to establish those relationships with patients, and I think this model allows me to do that better than I was able to previously."
The model is gaining traction among doctors nationwide. Paluska Zoomed with Dr. Lauren Hughes, a board-certified pediatrician. She never opted for the traditional route, instead opening Bloom Pediatrics in Kansas City as a Direct Primary Care provider.
"One of the biggest issues is that health insurance companies are for-profit companies; therein lies the problem," Dr. Hughes told Paluska. "There is this insanely difficult game of figuring out what code will get you reimbursed correctly."
"Insurance companies are now adding more rules for, like, in order to bill for a well child check, you have to have a 10-point review of system. So it's like, these charting requirements, these clicks, we had wellness groups about click fatigue because it is just so many things that you have to go through for every patient," Dr. Hughes said. "What direct primary care does is we cut all that out. We do not bill insurance. I do not work for any insurance companies. I do not make any reimbursement from any insurance companies, and instead, I work for who I should work for, which is my patient. And so my patients pay a monthly fee. Our patient average is about $120 a month, and that gets them everything that a primary care physician can provide. So that gets them all their well checks."
Dr. Steffie Woolhandler, a distinguished professor at City University of New York at Hunter College and a lecturer at Harvard Medical School, believes there should be Medicare for all.
"But if you had a Canadian-style system or Scottish-style system the day you were born, you would be eligible for medical care from any doctor or any hospital in the system. You would keep that insurance until the day you died. There would be no co-payments and no deductibles for covered services," Dr. Woolhandler said. "So I am a primary care doctor, and it's very, very frustrating. However, the solution is not saying that people who can pay an extra several hundred or several thousand dollars get to see me, and those who can't afford to pay that don't get to see me. You know, low-income people need healthcare, too. I do not agree with doctors saying, 'I'll only take care of you if you're going to pay me extra.'"
Some patients have opted to forgo traditional insurance and instead use a Direct Primary Care membership to see doctors. However, if you have a serious life event and need to be hospitalized or get sick or injured, you will have to go to a hospital without health insurance, something experts say is risky.
For Dr. Hughes and Dr. Stamoolis, the Direct Primary Care model enables them to be happier in their field, prioritizing the patient over profit.
