Dr. Rebecca Berens is like any other primary care physician. She takes the temperatures of toddlers, jots down prescriptions for antibiotics and recommends lab work to diagnose what’s wrong with a patient.
But unlike most doctors, she doesn’t take health insurance, and she doesn’t pack her schedule to see as many patients as possible.
Berens, who runs her practice out of a converted Heights home, is a direct primary care doctor, charging patients a flat monthly fee for unlimited visits, telemedicine access and minor procedures such as sutures. As millions of Americans lose jobs and employer-sponsored health care, many are flocking to medical practices such as Berens’ Vida Family Medicine as an affordable, stop-gap alternative to costly insurance available on the exchanges of the Affordable Care Act.
“Almost every day,” Berens said, “ I’m seeing someone saying ‘I’m losing insurance, I can’t afford (Affordable Care Act Exchange) marketplace plans, what are my other options?’”
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At Vida Family Medicine, inquiries about becoming a member have doubled from about two to four a week, primarily from people who say they lost employer-sponsored insurance or can’t afford health insurance premiums. While there are no statistics on the numbers of patients turning to direct primary care during the pandemic, practices nationwide are reporting an increase in patients, said Tom Banning, CEO of the Texas Academy of Family Physicians and a board member for the Direct Primary Care Coalition, a professional association that represents about 1,200 direct primary care doctors across the country, including Berens.
“It’s sad that it took a pandemic,” Banning said, “but it forced individuals to think more about the care they’re buying.”
The draws
Membership fees are relatively inexpensive for what’s basically having a doctor on-call 24/7. Vida Family Practice, for instance, offers three levels of membership based on age, with the highest costing $100 per month for a patient 50 and older. Prices for a family are capped at $250 per month. Patients pay an additional one-time enrollment fee of $99.
Most services such as physicals, stitches and telemedicine are included in the cost of the membership. More costly procedures and tests generate additional fees tacked on to the bill. At Foundation Primary Care in Katy, for instance, Dr. Thanh Ho Taylor charges $11 for a diabetes monitoring test which would not usually be included in the price of membership.
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Here’s the rub: direct primary care is best suited for healthy patients. The membership fees don’t cover emergency room visits, hospital stays and other services that can result in hundreds or thousands of dollars in charges.
Doctors usually recommend that their patients supplement direct primary care with a catastrophic coverage or health insurance plan with a high deductible, which have lower premiums than traditional plans. Both hold financial risks since patients typically must cover thousands of dollars in medical costs before the coverage kicks in.
But, they said, the combination of direct primary care with catastrophic or high deductible coverage can still be cheaper than traditional health insurance with low deductibles because the model capitalizes on the idea that close relationships with primary care doctors keeps patients healthier and reduces the chances of hospitalization and other expensive care.
A recent report from the Direct Primary Care Coalition and Society of Actuaries found that patients using direct primary care visited the emergency department 40 percent less over a year compared to their peers on who see a traditional primary care physician.
Patients also are looking for telemedicine options. Both Berens and Taylor were offering telemedicine services before the pandemic as a convenience for patients who couldn’t always stop in for in-person exams.
Taylor estimates that in the three years before the pandemic, about 50 percent of her visits were telemedicine, either over the phone or video calls. That skyrocketed to 90 percent in March.
Mitchel Balladares, a 39-year-old Houston resident, lost his health insurance when he was laid off from his oil and gas job in June. By the first week of August, he was looking for an option that would cost him less than an Affordable Care Act plan, which starts at $253 monthly for a man his age and includes an $8,000 deductible.
Balladares is healthy and only sees a doctor for check-ups and the occasional illness. With a couple Google searches using the keywords affordable health care options, he discovered direct primary care and booked an appointment on Aug. 13 with Taylor at Foundation Primary Care.
At $45 per month, which includes physicals, telemedicine and discounted rates on vaccines and lab tests, it seemed reasonable given his limited income right now, which consists of unemployment benefits, that make up about two-thirds of what he was earning.
“For what I'm looking to get done,” Balladares said. “I think it’s adequate.”
A little personal space, please
The bottom line for many people is that health insurance has become increasingly unaffordable, especially for those out of work or on reduced salaries due to COVID-19. An estimated 659,000 adult Texans lost health insurance during the pandemic, according to Families USA, a consumer healthcare advocacy nonprofit.
Those who are still able to afford a doctor’s visit have seen things change — doctors suit up in head-to-toe protection, from face shields to plastic bags over their shoes. But the small patient bases of direct primary care doctors mean limited numbers of people in waiting rooms, adding an extra layer of protection that patients might not get at a large practice.
Dr. Kathrym España, a physician who runs Concierge Pediatrics in the Rice Military neighborhood, attributes the increase in her patient volumes to parents worried about taking their kids waiting in a crowded lobby.
Recently, she’s had a fuller schedule, fitting in 10 patients on the busiest days — which is still only about one per hour, compared to doctors at major medical systems who schedule three or four — and seeing up to 60 patients monthly. That’s a 50 percent increase from her schedule in January and February, when she’d see roughly 40 patients per month.
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“It’s more attractive to come to an office where there’s going to be nobody in the waiting room,” España said.
The downside
On the surface, getting a direct primary care doctor is cheaper than many people’s health insurance premiums. But if a patient needs to go to the emergency room, they’re stuck paying out of pocket for at least a large share of costs, even if they have catastrophic health insurance and similar lower cost plans.
But focusing on preventive care and regular check-ups reduces the chance that patients will need to go to emergency rooms or hospitals for conditions such as strokes, direct primary care doctors say.
Taylor, on her first visit with Balladares, the out-of-work patient, recommended he supplement his membership with catastrophic coverage, but he hasn’t bit the bullet and bought such insurance yet. His plan for now is to avoid getting seriously ill, which is easier said than done when a global pandemic is raging.
“It’s not a one stop shop to fix everything,” Balladares said, “but for the relatively healthy person, I think it works.”
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