Category: Direct Primary Care

Keeping Laboratory Costs Low

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10 May 2019

Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; where I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is a new approach to family medicine and addiction medicine that creates the time and space your healthcare deserves. Beyond Primary Care is a Direct Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County.

The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being. 

In this post I am answering a common question that I receive, and that is how does Beyond Primary Care (DPC) keep laboratory costs low for it’s members? Offering low bill rates for labs is a key feature of virtually all Direct Primary Care (DPC) practices, and is something that is done to increase the value of a membership. Just how low? Many DPC practices do in-clinic phlebotomy and can provide numerous laboratory studies to their patients at a tenth of the costs that many hospitals and fee-for-service providers can provide.

How DPC Practices Keep Laboratory Costs Low

To start DPC practices typically do their own phlebotomy (that is the collection of blood from your veins) and rarely bill for these services. This starts the savings before a single drop of blood is collected. DPC practices then contract with laboratory diagnostic companies, many times the same companies that service smaller hospitals or fee-for-service clinics. My clinic, Beyond Primary Care, uses a few laboratory diagnostic companies, Quest Diagnostics, True Health, and Aurora Diagnostics

Prior to drawing any labs for our patients, DPC practices negotiate what we call ‘client bill rates’ with these diagnostic companies. A client bill rates is basically saying, what is the lowest cash price for a particular laboratory study you can offer to my clinic’s patients? Compare this to smaller hospitals or fee-for-service providers. They bill for phlebotomy (U of M states they charge $9 for this service alone) and then these providers bill the labs through your insurance. Often times the laboratory costs often never negotiated down on behalf of the patient because there is no incentive from the practice to do this. 

DPC gets these low laboratory fees for their members in this innovative manner because our primary business is taking care of you and NOT being just a blood-draw center. Your membership for care to a DPC practice allows for this innovation.

Savings from Laboratory Costs

I have a colleague who recently had a pap smear completed, which is a diagnostic test used in females to detect cervical cancer.  She claimed she had ‘Cadillac Health Insurance’ through her employer, meaning basically she thought she had really great insurance that would cover the costs of her healthcare. Look at her bill below and what she was left to pay out of pocket. At my clinic, Beyond Primary Care, the procedure of completing the pap smear if part of the membership. No extra charges. The fee for the pathologist (that I have negotiated) is $44. The difference in costs in this ONE laboratory study alone would pay for months of healthcare at any DPC clinic.

DPC Members can obtain Labs other Doctors Order

DPC providers understand you may need to see another specialist from time to time, and these providers may want their own labs completed. A common question I receive is if the other specialist request labs, can I get them done through your clinic? 

Yes, absolutely this is another great way to minimize your financial impact. No doctor or hospital can force any patient to have routine laboratory studies done only at their location or where they tell a patient to complete them at. That is against the law. They may use convincing language saying ‘the results integrate into our electronic system faster,’ or ‘those other providers may not know exactly what I want.’ Stay firm and request a written and signed order for your labs. Your DPC clinic will complete the exact same labs, bill you at the much lower rates (compared had you used your insurance), and will promptly fax the results over to the requesting specialists that meet their needs. As noted by this Wall Street Journal article analysis of medical services, prices tend to be higher when services are performed in hospital outpatient facilitates instead of at doctors’ offices.

Improve Your Financial Health

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20 April 2019

Dr. Jeff O’Boyle with Beyond Primary Care teams up with Dennis LaVoy CFP® CLU® with Telos Financial to discuss ways individuals, businesses, and families can free up cash flow.

Free Up Cashflow In Your Budget

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4 April 2019

What are some ways to help free up cashflow in your budget? How about healthcare through Direct Primary Care?

Hi, thank you for coming back for the latest edition of Beyond Primary Care’s blog; where I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is a new approach to family medicine and addiction medicine that creates the time and space your healthcare deserves. Beyond Primary Care serves patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County.

The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being. 

Today, I’m glad to welcome guest blogger, my friend Dennis LaVoy. Dennis and I co-authored this piece about freeing up cashflow through Direct Primary Care (DPC).

Who is Dennis LaVoy?

Dennis LaVoy is the owner of Telos Financial, a fee based, holistic financial planning firm located in Plymouth, Michigan specializing in serving young professionals and families. Dennis is a Certified Financial Planner (CFP®) professional and a Chartered Life Underwriter (CLU®) founded Telos to provide financial advice and uses his experience, knowledge, and expertise to help families and individuals in Ann Arbor, Detroit, and across the country achieve their financial objectives.

He went to school at Eastern Michigan University where he graduated Magna Cum Laude while receiving his degree in Finance. He has worked 10+ years as a financial advisor and opened his own firm, Telos Financial in February 2018. 

We’re going to discuss some of the financial incentives for using a DPC model.

What could using a DPC practice mean for my budget? 

Health insurance coverage is a very personal decision each family must make on their own, considering their personal values, tolerances, geographic location, and needs. Direct primary care is a membership model of health care that works well in conjunction with a High Deductible Health Plan (HDHP), commonly referred to as ‘catastrophic insurance.’ Combining a DPC membership with a HDHP addresses the main drivers of increasing cost in healthcare, such as the patient being seen in a timely manner, being proactive about your health, and ancillary medical costs (medications, labs, imaging). This allows individuals and families to have extra money on-hand every month, often saving thousands of dollars per year. So, if this type of insurance aligns with your values and tolerances, it can mean big monthly savings for your family versus a higher premium insurance arrangement.

How would it work?

Hospital systems and insurance-based clinics have higher costs for many medical services and their prices do not reflect the true cost of services even after insurance negotiations. When eliminating the costs of using health insurance, many patients can find equally effective and far more affordable options for their healthcare needs.

For example, let’s say your family is pretty healthy overall and have a high premium/low deductible health insurance policy that you pay a lot of money towards every month, where your monthly premium is $1,600, or $19,200 per year.* You believe you are not extracting enough value from your insurance, but still want coverage for those ‘what if’ scenarios. 

Switching to a HDHP insurance plan combined with a DPC membership still means you have that insurance for those ‘what if’ scenarios, but now also you have virtually unlimited access to your doctor where they can focus directly on you and not the middleman (insurance companies). Your new monthly insurance premium is $718*, and by enrolling in a DPC practice for as low as $130** a month you will have $750 in savings every month, or $9,000 per year.

*These figures were obtained by providing realistic information to ehealthinsurance.com to compare health insurance rates for 2 adult non-smokers along with 2 children for comparable health insurance plans that are compliant with the Affordable Care Act (ACA), commonly referred to as Obamacare. 

**This figure was obtained by combining the rates for adults and children at Beyond Primary Care, Ann Arbors only direct primary care practice.

Financial Savings and Opportunities

Combining a DPC membership with a HDHP can save families and individuals thousands of dollars per year where this arrangement is appropriate. Because Direct Primary Care provides so much in a membership, it is gaining national attention for the associated cost savings. A testimonial to this national attention is Consumer Reports listing Direct Primary Care as a top five smart money move in 2019 saying “joining a DPC medical practice will give you around-the-clock access to your doctor and could save you money on primary care.” 

With a couple hundred saved each month, that is money you can have working for you- not the health insurance companies. An extra $9,000 may allow you to create an ‘emergency fund,’ pay off loans, or even invest for the future. 

A $750 savings per month could build a substantial investment portfolio over time. I always recommend working with a financial planner to decide how best to invest for your family, but depending on your income, goals, and life situation, you could also save to a Roth IRA, Traditional IRA, or to a non retirement investment account. 

The Power of Compound Interest

$750 per month is a lot of money for many families. Over time, it can be hugely impactful for long term financial. Let’s further play out the scenario in this example and you have a family of 4 and that you were able to invest $750 per month at 7% growth. 7% is an assumption based on a balanced portfolio, as a point of reference, the S&P 500 from 1937-2017 (90 years) averaged 10.4%. Further, let’s assume in this example the family of 4 is two adults aged 30 and they’ll save for 12 years (Let’s say until the kids move on). 

In this example, at the end of 12 years or age 42 for the adults, you would have saved a total of $108,000 and the account would be worth over $175,400! If they didn’t save another dime after that, the account would be worth over $1,000,000 around their age 65 and 3 months. If they were able to continue the $750 per month savings, when they reached age 65, the account would be worth $1,532,591 on a total investment of $315,000. The numbers really speak for themselves and really demonstrate the power of compound interest. 

Why wouldn’t I do this?

DPC is not available locally in all communities. If you do not utilize healthcare services on a regular basis or when you do, you are just looking for one-off visits or one-time services, DPC probably is not the right fit. As always, it is something you have to consider personally.

If your employer provides a ‘comprehensive’ high premium/low deductible policy, DPC may not initially be advantageous. Still, consider bringing up DPC to your human resources leaders and incorporating into your benefits package. A partial, or fully self-insured model in conjunction with DPC has been show to result in a 30-60% reduction healthcare expenditures. 

The views expressed are my own opinions and do not apply to every situation. Your situation may vary so make sure to consult a professional for advice prior to making any decisions.

Conclusion

Financial planning should take into consideration all your needs and wants, review costs and tolerances, and educate yourself about the options. To learn more about financial planning, Dennis LaVoy, CFP®, CLU®, or Telos Financial please check out his website at https://telosfp.com/. If you believe Dennis may be a good fit for your family and you live in the southeast Michigan (or really anywhere), call him today at 734-468-3050.

These examples are for illustrative purposes only, not indicative of any specific investment product. Material discussed herewith is meant for general illustration and/or informational purposes only, please note that individual situations can vary. Therefore, the information should be relied upon when coordinated with individual professional advice.

Dr. Jeff O’Boyle of Beyond Primary Care is not affiliated with FSC Securities Corporation.

Direct Primary Care keeps Medication Costs Low

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19 March 2019

Hi, thank you for reading! My name is Dr. Jeff O’Boyle. I am a board certified family medicine physician. My clinic, Beyond Primary Care is located in Ann Arbor, Michigan. In this post I am answering a common question that I receive, and that is how does Direct Primary Care (DPC) keep medications costs low for it’s members? Offering low priced medications is a key feature of virtually all DPC practices, and is something that is done to increase the value of a membership. Just how low? Many DPC practices do in-clinic dispensing and can provide hundreds of medications to their patients at a tenth of the costs that many national retailers can provide.

How DPC Practices Keep Medication Costs Low

DPC practices, like pharmacy retailers have applied for and obtained their medication dispensing license from their respective states. This allows a DPC provider to contract with pharmaceutical wholesalers of medications, the same wholesalers who retail pharmacies such as RiteAid, Walgreens, or CVS may use.  My clinic, Beyond Primary Care, uses two wholesalers of medications, AndaMeds and Bonita Pharmaceuticals. 

These wholesale companies sell the medications, often in large quantities to the DPC practice. However, unlike hospitals and retail pharmacies where selling medications IS their business – resulting in the expected mark-ups (250%!) and high-prices as noted by the American Journal of Pharmacy Benefits– DPC practices turn around and sell the exact same mediations to their patients at those near-wholesale prices. As noted, DPC sell the medications to their members in this innovative manner because our primary business is taking care of you and NOT being just a pharmacy. Your membership for care to a DPC practice allows for this innovation. 

Savings from Medication Costs

You may be or may know some people who take multiple medications. Medications for blood pressure, diabetes, urinary incontinence, anxiety, heart conditions, COPD, or erectile dysfunction may add up to hundreds of dollars a month you are paying out of your pocket. Compare this to the costs I charge my members for the exact same medications. Often times the money saved in medication costs alone pay for a DPC membership! Don’t see your medication on my sample list? Don’t worry, I may still stock it or I can order it too!

* Prices are subject to change without notice, one month supply listed unless noted

Did I Mention In-Clinic Dispensing?

Many DPC practices do in-clinic dispensing of medications. Once the doctor evaluates you and discusses the best course of treatment, that provider can have the necessary medications dispensed to you before you leave the office. In urgent situations, this saves you time, energy, and of course MONEY, something that rarely happens in fee-for-service medical offices. 

Obtaining Specialty or Brand Name Medications

As I mentioned in my earlier post, there are times a member needs or would benefit from a certain medication that is brand name only (very expensive) and would be best obtained through insurance that requires a prior-authorization (what is prior authorization) from the insurance company.

In this scenario, we will work to fill out the necessary paperwork to get your needed medications at reduced costs or even reach out to the pharmaceutical companies seeking a reimbursement or free supplies on your behalf. A great example is we got one of our members Vivitrol, a vital medication for Medication Assisted Therapy in Addiction Medicine. This medication costs over $1,000 on the market, but we worked to get our member the medication FREE of charge with their insurance. Did I mention the office visit and the injection itself were included with the membership? So the patient literally paid $0. Saving money for our patients gets me so excited! 

Direct Primary Care Works With Your Insurance

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5 February 2019

Hi, thank you for reading! My name is Dr. Jeff O’Boyle. I am a board certified family medicine physician. My clinic, Beyond Primary Care is located in Ann Arbor, Michigan. In this post I am answering a common question that I receive, and that is does Direct Primary Care (DPC) work with your insurance? The answer for a vast majority of DPC clinics is yes, DPC works with your insurance, but not for your insurance. This is an important distinction.

DPC does not work FOR your insurance

This is the essence of DPC, that it works directly for you- the patient! We forgo insurance payments in order to save our patients from the arbitrary, intrusive decisions that inevitably follow with third-party payers (health insurance). Furthermore, since DPC practices are independent, we are free from hospital contractual agreements and can offer reduced prices on laboratory tests, imaging, and medications. As noted by this Wall Street Journal article, hospital systems are ignorant of their actual costs. Instead, they often increase prices to meet profit margins.

DPC works WITH your insurance

While DPC’s goal is to cover the vast majority of healthcare needed for all individuals, there are many instances in which a patient may need to utilize their insurance to see providers or utilize services outside the membership.

Specialist Referrals

This would be when a member needs to see a specialist for a condition that requires care past what could be offered in a family medicine clinic. Examples include physician specialist, psychiatrists, counselors, and physical therapists.

Say a member needs a referral to an oncologist- which is a doctor that specializes in the diagnosis and treatment of cancers. No one ever anticipates needing a such a doctor. But when called upon, a DPC doctor will work to find a doctor that accepts your insurance, help coordinate your care, while minimizing your financial impact. How do we minimize your financial impact? If that specialist requires imaging, medications, or blood work, DPC practices will work with you to find the lowest costs– often through our DPC clinics- that meet the needs of the health provider. 

Hospitalization Coordination

From time to time, accidents or serious medical conditions do occur and an elevated level of care is required where a member needs to be monitored 24/7 by a team of doctors and providers.

An example could be a member suffers a broken arm from falling and needs to be hospitalized for a major surgery. DPC will help communicate with your inpatient hospital team of providers making sure they know your current health status and working towards understanding your options for care upon discharge. While we may not be able to care for you in the hospital, we can certainly use virtual medicine (also known as telemedicine) to discuss your needs and questions. We can also give you helpful advice to make sure you won’t receive any unexpected bills from the hospital upon your discharge.

The following picture is a hospital bill from a patient who posted her hospital bill online. The patient was contemplating hurting themselves and walked into an Emergency Room seeking help. The patient states the “physician charges” are NOT shown that bring the grand total to over $18,000!

Here is some FREE Doctor Advice from Beyond Primary Care: In the hospital, ask to know the identity of every unfamiliar person who appears at your bedside. If you’re too ill, ask a companion to serve as gatekeeper. Write it down. What seems like a pleasantry may constitute a $700 consultation

Special Medications

One of the coolest features about DPC is many practices offer in-clinic dispensing of hundreds of generic medications, often at substantial price differences compared to retail pharmacies. Still, there are times a member needs or would benefit from a certain medication that is brand name only (very expensive) and would be best obtained through insurance that requires a prior-authorization from the insurance company.

In this scenario, we will work to fill out the necessary paperwork to get your needed medications at reduced costs or even reach out to the pharmaceutical companies seeking a reimbursement or free supplies on your behalf. A great example is we got one of our members Vivitrol, a vital medication for Medication Assisted Therapy in Addiction Medicine. This medication costs over $1,000 on the market, but we worked to get our member the medication FREE of charge with their insurance. Did I mention the office visit and the injection itself were included with the membership? So the patient literally paid $0. Saving money for our patients gets me so excited!

Virtual Home Medicine in Direct Primary Care

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3 January 2019

Hi, thank you for reading! My name is Dr. Jeff O’Boyle. I am a board certified family medicine physician. My clinic, Beyond Primary Care is located in Ann Arbor, Michigan. In this post I am answering a common question that I receive, and that is how does Direct Primary Care (DPC) take care of it’s members with virtual home medicine? Virtual home medicine, also referred to as telemedicine, is a where you connect with your doctor via phone or computer’s webcam without physically being in the doctor’s office.

The Exception rather than the Rule

Why is it nearly impossible to get a doctor to talk with you over the phone in a timely fashion? Because because certain services like virtual home medicine are typically not be reimbursed by private insurance carriers and government payers. Nearly 40% of what we do in medical offices the patient doesn’t actually have to be there. But why are you there? That is the only way for doctors in a fee-for-service system to get reimbursed for your care, is to actually make the patient physically come in to the brick-and-mortar office to be seen- no matter how routine (eg- common cold, urinary tract infection) or obscure (filling-out paperwork for FMLA or work) the visit seems.  

Standard of Care with DPC

Under the DPC model of care, we naturally provide such care – yet another freedom we enjoy together as a result of our independence from the restrictions of third-party payment. As noted by this Forbes article, telemedicine pairs well with DPC. Since DPC has opted out of insurance contracts altogether, and we contract directly with you, the patient. DPC offers our patients around-the-clock access to primary care medical needs in exchange for an average fee of $50-75 per month. Phone calls, emails, texts, FaceTime- are included in a patient’s membership. Patient are routinely connected with their doctors within minutes to hours when reaching out, versus days to weeks with fee-for-service doctors.

Benefits of Virtual Home Medicine

One of the defining characteristics of DPC is that we keep our practices small so we can spend more time with our patients. Because we have the increased time in our visits to know you well, we can streamline your care when you’re sick away from home or even at home. Many illnesses can be diagnosed and treated with a simple conversation by phone or computer webcam.

Say you are traveling out of state and feel sick. You have access to a conversation with your DPC doctor from your pocket. We will discuss your symptoms, discuss management, then we’ll locate the nearest pharmacy and order the medications most appropriate for your present circumstances.

As a doctor, there have been times where I have seen patients- with just the act of walking from the waiting room to the examination room- get winded or experience excruciating pain. Why would doctor offices allow this? Where is the concept ‘first, do no harm?’ If you are local, often times the DPC doctor may deliver the medications right to your address, saving you the hassle of a trip that may potentially worsen the condition.

Curbside Referral Consult

Adding more value the DPC membership at no additional cost to our patients is many DPC practices participate with electronic consults, or online consultations for speciality care. Primary care can handle nearly 80-90% of all medical conditions, but there are times when a condition may be past our scope of practice. Instead of rushing the patient to the nearest specialist, which will result in a bill likely through the patient’s insurance, many DPC practices seek medical advice on behalf of our patients through an online service call RubiconMD. Through this online service, many DPC practices pay a monthly fee where we can get medical advice on behalf of our patients from more than 100 medical specialities. The company guarantees a response time within twelve hours. The DPC physician fills out the necessary forms, get’s the response through the RubiconMD service, then will pass this medical information onto the patient- at no cost!