Model allows for easier access, more time with physician

Direct primary care is an arrangement in which doctors and patients contract for services for a monthly payment. The system is designed to cut out third parties in the medical industry. The model reduces expenses and allows doctors to spend more of their time on patient care rather than filling out forms and rushing patients through their office in order to receive payment, said Dr. Michael Garrett, owner of Direct MD Austin, on Bee Caves Road in Austin.

"It is a new take on a similar model—concierge medicine," he said. "I think it will explode in the next two to five years."

Garrett said the biggest difference between the DPC model and concierge medicine is the price and contract structure. DPC uses monthly contracts instead with patients as opposed to yearly contracts through the concierge model, which makes DPC available to everyone, he said.

"I think this model will really take off—in a way concierge medicine never did—because of the frustration with the [current health care] system," Garrett said. "I'm not saying this [model] has all the answers, but it is part of the solution. It doesn't solve all of the problems [with the current health care model], but it solves a lot of them. This is one way people can take control of their health care and save some money."

Dr. Chris Larson, who runs Austin Osteopathic Family Medicine on 38th Street in Austin, said he thinks DPC is the beginning of a trend.

"[DPC] is old but also new," he said. "Doctors haven't always used health insurance [as a way to be compensated]. Patients used to save money or barter for services. We're getting to a point where that is being done again."

Garrett said a monthly plan with his practice can range from $50–$100 for adults, dependent on age, and $20 for minors, which covers all office visits and any test that can be completed in-house. Non-covered expenses such as ultrasounds and X-rays must be paid for out of pocket, he said.

"Expensive tests may still be run through insurance," he said. "We also negotiate the very best cash price for tests and services. Something that may cost thousands of dollars with insurance—which may not meet your deductible—could cost a few hundred dollars with no involvement from the insurance companies."

Larson said there are larger DPC groups in the Pacific Northwest that have combined health insurance plans with a DPC model, something that he would like to eventually bring to the Austin area.

"There are a lot of unexpected things when you are the first [to do something]," Larson said. "But as people hear and read more about [DPC] they will get excited because it offers things other clinics can't."

Additionally Garrett said he is much more satisfied as a doctor in the DPC model than as an emergency room doctor. A number of other U.S. doctors are also considering a change in the way they practice, according to a September 2012 survey by The Physicians Foundation.

More than 50 percent of the 13,575 U.S. physicians surveyed will cut back on patients seen, switch to a cash- or concierge-based practice, retire or take other steps to reduce patients within three years. Nearly 7 percent of the doctors surveyed plan to switch to a cash- or concierge-based practice and part of the switch is because of morale issues, Garrett said.

"You will see a substantial increase in the number of direct primary care doctors in the next year, and that is because they tend to be happier in this type of model," he said. "There is far less time spent on paperwork geared to getting paid [with this model], and that results in a lot less stress for doctors."

In the 2012 survey nearly 70 percent of physicians described their feelings as "somewhat negative" or "very negative" in relation to the current state of the medical profession. Close to 85 percent of physicians surveyed agreed that the medical profession is in decline.

"Most physicians want to help people," Larson said. "Unfortunately the current model doesn't allow them to do that. [DPC] allows for a nicer way of life, not having to see 30–35 patients a day. I think, in the next 10 years, you will see 25 percent to 40 percent of family practices switch to this model."