A new “direct primary care” clinic recently opened in Durango, a model of health care that seeks to keep costs as well as wait times low by bucking the bureaucracy of the health insurance system.
Dr. Dan Schaefer and physician’s assistant Karassa Yeomans Schaefer, who are husband and wife, opened the Whole Health Family Medicine Clinic in April at 555 Rivergate Lane.
“The U.S. health system is broken, despite the efforts of many well-intentioned medical professionals,” said Dan Schaefer. “So our motto is: Our focus is on you, not the insurance company.”
Direct primary care providers offer basic or preventive services – much like a traditional family medicine doctor – at relatively affordable rates that don’t require the high processing fees of an insurance company.
The other direct primary care provider in Durango – Mountain View TLC – did not respond to requests for comment on this story.
At Whole Health Family Medicine Clinic, patients pay a fixed monthly fee (with no commitments) of $10 per child (0 to 19 years old); $55 for 20- to 44-year-olds; $79 for 45- to 64-year-olds; and $99 for 65 years or older.
Patients are allowed unlimited visits, and Medicaid patients are also allowed to sign up.
Schaefer said direct primary care providers fill a necessary gap in the health care continuum as traditional primary care providers in the U.S. face increasingly heavy demands on wait times, actual time spent with a doctor and cost.
A 2016 Physician Compensation Report, which surveyed 19,200 doctors in 26 specialties, found that doctors spent about 13 to 16 minutes with each patient, similar results to a study conducted in 2011.
And in 2014, the health care consulting firm Merritt Hawkins determined the average wait time for an appointment with a doctor was 18 days.
In La Plata County, a shortage of primary care physicians can exacerbate the problem.
“Physicians in primary care face significant burn out,” said Ryan Biehle, director of policy and government relations for the Colorado Academy of Family Physicians. “In fact, 1 in 2 (physicians) face burnout, which leads to early retirements or folks deciding not to chose primary care.”
Biehle said direct primary care has become increasingly attractive for doctors, who can perform the “person-oriented medicine they always envisioned themselves doing.”
Whereas a primary care physicians see about 25 to 30 patients a day, direct primary care providers usually visit with far fewer patients, allowing for up to an hour of patient-physician time.
Direct primary care doctors, including Whole Family, also offer 24-hour access to physicians, encouraging patients to call, text or email at all hours in times of need.
“From a family physician perspective, the doctor-patient relationship is one of the pillars of good health care,” Biehle said. “And direct primary care really enables them to get back to those basics.”
Yet, Adam Fox, director of strategic engagement for Colorado Health Initiative, was quick to point out many patients still would need to buy insurance for the more “catastrophic” health care needs – such as a car crash, hospitalization or serious illness – that direct primary care can’t provide.
“For those who are buying health insurance, it would be much more of a luxury (to have direct primary care),” Fox said. “We would certainly have concerns if we see consumers forgoing health insurance, thinking direct pay services are a substitute for coverage.”
However, Biehle said for patients who tend to use their health insurance more frequently, direct primary care might actually turn out to be cheaper, especially with the high deductibles of many insurance plans.
And the style of care’s popularity has certainly grown, with 4,400 direct primary care providers across the country as of 2013, up from just 150 in 2005, according to the American Academy of Private Physicians.
Biehle said a provision included in the Affordable Care Act, if enacted, proposes to pair a direct primary care provider with insurance plans that have high deductibles.
“In long term, it would be great (to enact this provision),” Biehle said. “For folks with high-deductible plans, they’re not necessarily getting the care that keeps you healthy to begin with.”
The Schaefers and their three-person staff have about 250 patients since the practice opened eight months ago. Dan Schaefer said they’ll likely cap that number at around 1,200 patients, as long as the two doctors are still able to provide the time and attention they want to give.
“What we really offer is the deeper level of why we did this model,” he said. “And that’s the core – is relationship between the doctor and patient, and we prioritize that by creating more time.”
Durango residents Danny and Cara Flynt signed up with Whole Family four months ago when the couple had a baby, and decided they wanted to re-evaluate their health care coverage.
“I feel like this is what traditional family medicine is supposed to be like as opposed to what it’s transformed into,” said Danny Flynt. “Which is: The provider at the mercy of health insurance companies, and as a result, the patients at the mercy of that relationship.”
For the Schaefers, with a combined 25 years of experience in family medicine, and having spent the last eight years at Farmington Family Practice, that’s exactly what they want to hear.
“It’s a system where the wheels have come off in a direction no one seems to be able to stop,” Dan Schaefer said. “So we got out.”
jromeo@durangoherald.com
