What is Direct Primary Care? And What Are the Benefits?

I am Patrick Rohal, M.D., a family doctor and the founder of CovenantMD, Lancaster’s first Direct Primary Care practice, which will be opening in January, 2016.  I launched my website (www.covenantmd.net) on Tuesday, and posted announcements on Facebook and LinkedIn.  That made Tuesday a wonderful flurry of exchanging digital "high fives" with friends and collaborators, and answering questions with prospective patients.  As the first post on my News page on the website, I wanted to take a few minutes and explain Direct Primary Care. 

But first, you might be asking, "Why launch your website in August, when CovenantMD is not opening until January?"  The quick answer is that I wanted to get word out about CovenantMD and Direct Primary Care before Open Enrollment begins in October.  This is when individuals, families, and businesses choose their health insurance for 2016.  And since any discussion about Direct Primary Care must necessarily include a discussion about health insurance, there is not a better time than now.

So onto Direct Primary Care?  What is it?  What will set CovenantMD apart from other standard primary care practices?  I’ll offer a quick definition, and then talk about three distinctives that follow from this definition, three things that will set CovenantMD apart.  So here’s the definition:

Direct Primary Care:  A alternative primary care payment system in which patients contract directly with their doctor by paying low monthly fees.   That means that Direct Primary Care practices do not take insurance (though we think it remains important for every patient to continue to carry health insurance).  This arrangement eliminates third party influences from the patient-doctor relationship.  It also enables your doctor to keep his or her patient panel at low numbers (at CovenantMD, we’ll “cap” at 800 patients), whereas the typical primary care doctor has a panel of 1800-2500 patients.

Because CovenantMD is a Direct Primary Care practice, it will have three primary distinctives that will set it apart from standard insurance-taking practices:  time, access, and value.  To conclude this post, I'll talk about the first distinctive, time, and leave the other two, access and value, for future posts. 

This is the key ingredient in the doctor/patient relationship.  Not only should good medical care occur promptly when needed, but patients need time with their doctor.  Every illness, or any reason you might think to visit a doctor, has a backstory.  And it just takes time for you to tell your doctor this story.  But your doctor also needs time -- time to do all that is necessary to diagnose a problem, treat a chronic disease, or maybe guide you through home exercises for an injury.  It also takes time for your doctor to talk about and guide you into a healthy lifestyle.  (A little bit of biography here:  This is the primary reason why I regard Family Medicine a “calling” in my life – I love hearing each patient’s story, and I love tailoring treatment as the next logical step in that story.  Family Medicine is first and foremost about stories.)  

But time is what you don’t typically have in today’s healthcare environment.  In the standard insurance-taking practice, the fee-for-service payment arrangement is king.  In fee-for-service, the doctor gets paid every time you come to the office, and only when you come to the office.  Therefore, your doctor is incentivized to see as many patients in a day as he or she can.  (And by the same token, you, the patient, are dis-incentivized to see the doctor because you have to pay every time.  I’ll talk more about this problem in my VALUE post.)  This naturally leads to a time crunch -- ever diminishing payment to your doctor from health insurance leading to the necessity to cram as many patients into the schedule, leading to you, the patient, having inadequate time with your doctor.  And that crunch is just getting tighter in our modern healthcare environment. 

But Direct Primary Care offers a wonderful alternative.  At CovenantMD, you will enjoy 30-90 minute appointments – plenty of time to tell your story.  And plenty of time for me to do all that I need in order to reach an accurate diagnosis, optimize whatever chronic conditions you may have, and agree with you on a treatment plan.  You'll have plenty of time to get all your problems addressed, so that you might not need to visit the doctor as often (though we wouldn't mind if you did!)  And as a patient at CovenantMD, you'll enjoy same or next-day appointments, and after-hours access.  

For me, Direct Primary Care and CovenantMD is the culmination of a dream.  I look forward to having time with my patients.  I look forward to all the stories I’ll hear.

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