A different way to see a doctor

A different way to see a doctor

CHAMPAIGN — One thing Kim Kellenberger didn't like about the old way she and her family used to get medical care was how rarely her five kids ever saw their own doctor.

When they got sick, their pediatrician was booked for the day, so they'd be scheduled with someone else, she said.

Those days are over for the St. Joseph family.

Mom and all five kids are now patients of a doctor who has time for them when they're sick, who knows them all by name, who communicates personally with Kim Kellenberger on the phone and even found them an out-of-state surgery center that would do a needed ear procedure for one of the Kellenberger kids at less than one-sixth the price a local hospital is charging.

Their doctor, LeRoy family medicine physician Dr. Deborah Chisholm, has time for such personalized care because late last year she decided to spurn today's typical way of running a medical practice, based on billing and collecting health insurance payments, and became a direct primary care practitioner.

In a direct primary care practice, doctors such as Chisholm manage a much smaller group of patients and they get paid by the month directly by the patients, bypassing the insurance middleman. There are no added co-pays, and their monthly fees sometimes cover unlimited care.

At least two other health care providers in the area are operating this way: Dr. Susan Mantell just converted her Philo clinic to direct primary care, and physician assistant James Chandler recently hung out a direct primary care shingle under the name Square 1 Healthcare in downtown Champaign.

Kellenberger said she pays Chisholm $50 a month for unlimited primary care for herself and $10 a month for each of her kids, and she considers the drive she makes from St. Joseph to LeRoy a fair trade-off for the time they used to spend sitting around waiting rooms elsewhere.

Chisholm also communicates with her via phone calls, text, email and Skype when needed, and can sometimes even save her a trip, she said.

Kellenberger and her family are also covered under her husband's insurance plan through his employer, she said, but she believes the uncovered primary care she and the kids are receiving through Chisholm is keeping her family much healthier these days.

"I've never experienced having such personal medical care in my life, and I'm 34 years old," she said.

What they stand to save on one surgery alone more than covers the cost of paying Chisholm for a year. Kellenberger said she and her husband recently learned they were facing a $12,000 ear surgery for one of their kids, for which their share of the cost through their health plan would be $5,000. Chisholm recommended them to a surgery center in Oklahoma that will do the same procedure for $1,700, she said.

"It's kind of been mind-blowing for us," she added.

About the care

Direct primary care is a term sometimes used interchangeably with concierge medicine, though it's often considered to be a newer, more affordable version with some differences.

It isn't health insurance, but it may hold some surprising cost savings for the insured facing growing out-of-pocket costs under their health plans. Direct primary care providers, including all three in the local area, often negotiate attractive price breaks for their patients on other medical services such as labs and x-rays that make these services more affordable than what patients would pay to meet their insurance deductible, co-pay and co-insurance obligations.

"A complete blood count is usually billed by insurance at $75 to $150, and my patients pay $1.65," Chisholm said.

Chandler makes similar lab prices available for his clients, some for $5 or less, along with an MRI for $450. Medicare prices the average MRI, a diagnostic that sometimes involves high out-of-pocket costs for people with insurance, at $2,600.

While these savings can help make direct primary care more affordable, Chandler, Mantell and Chisholm all say they're largely in this for the quality time they're able to give their patient clients.

Chisholm, a mother of four with a waiting list for her practice, said she made a few house calls in the last week, and being able to offer that service to a parent with a vomiting child or an adult too dizzy to drive, for example, "it's an absolute delight for me."

Chandler removed the clock from his office wall when he moved in. He has a comfy recliner chair instead of a table for exams, and deliberately didn't include a waiting room.

"My goal will be to have no patient pass another one coming in and out," he said.

His monthly fees of $27-$57 for adults and $10 for kids cover unlimited care plus such services as weight management, repair of cuts, virtual visits if you're out of town, urinalysis and strep tests, sports physicals and urgent care, and he's also accepting appointments for one-time visits.

Chandler said he's out to address the three biggest complaints he's heard during his years of working in health care: People are tired of insurance coding errors, they're tired of their long waits and they're tired of never knowing how much things are going to cost. His rates and Chisholm's are posted on their websites and Mantell said she has an updated website coming soon that will include that information.

"There are people out there that are super-happy with their insurance and their health care. We don't want them," Chandler said. "I don't feel most people are happy."

Busy docs

Do you ever wonder why your doctor so often makes you wait?

Your doctor's time is increasingly taken up by dealings with insurance companies, sometimes challenging decisions being made about your care by people who aren't equipped to make those decisions, according to Dr. Scott Cooper, president of the Illinois State Medical Society.

Doctors need more support staff to help handle all the paperwork and they need more patients to cover the overhead. Direct primary care providers manage 600-800 patients, and locally 600 is the high end. But in conventional primary care practices, each full-time doctor has 2,505 patients and needs nearly five support staff people, according to a report last year by the Medical Group Management Association.

Electronic medical records, intended to be a tool for quick data retrieval, are also eating up chunks of doctor time because the federal government requires so much information to be charted that isn't necessarily relevant to the patient, Cooper said. He refers to these electronic records as the "narcissist in the room," he said.

"It demands all the attention. It needs all the things to be in there, so the federal government is happy, so billing is happy," he said.

One doctor he knows is required to see a patient every 10 minutes, said Cooper, an emergency physician in Waukegan, but not all patients will fit into 10-minute slots.

Mantell said a doctor accepting insurance has to take in 25 patients a day to pay all the bills and do OK financially.

"When you take in that many patients a day, it puts a lot of burden on the staff, and I feel you don't get to take care of the patients the way you should," she said.

Her plans are for her and two other providers at her Philo clinic to each care for 500 patients, at monthly rates ranging from $30-$70 for adults and $10-$20 for kids. For now, she is also still accepting insurance for the patients who have been part of her established practice as she makes the transition to direct primary care, she said.

"I went to medical school because I wanted to communicate with my patients. I wanted to care for them," Mantell said. "But you don't have time if you only have 10 or 15 minutes per patients. Time is what really helps you manage patients."

Chisholm said she loves helping patients see that health care can be different, and "it doesn't have to be this revolving door medicine."

Her average office visit lasts 45 minutes, she said.

"My favorite part is I really get to know my patient. They relax and tell me things they'd have trouble telling a physician in a 10-minute visit, but will come out in a 45-minute visit," she said. "It's good health care."

And she's not getting burned out, either, she said. Chisholm said she was going to grow her direct primary care practice to about 600 patients, but she's considering capping it off at her current number, just over 300.

"I don't know about you," she said, "but I don't want a burned-out physician."

Working it out

If you're going to try to make seeing a direct primary care provider affordable with your insurance, be prepared to figure out all your costs and do some things out of the ordinary, like drive to a surgery center outside Champaign, Kellenberger advised.

"When you go this route, you kind of have to go all in," she said. "You're kind of doing it or not. You're making your investment outside of meeting your deductible."

She and her husband have come to view their health insurance like car insurance: They use it only for the big expenses, she said.

Direct primary care may be a workable option paired with a high-deductible health plan. In a high-deductible plan, you're already paying out-of-pocket for doctor visits and smaller expenses, anyway, Mantell said.

What she hopes to see soon are insurers stepping up with wrap-around coverage plans that will work with direct primary care, she said.

As it stands now, paying both insurance premiums and a direct primary care doctor can be unaffordable for some, Cooper said. But for those willing and able to pay, he said, he believes the primary motivation isn't potential cost savings.

"I think it's the service, it's the trust," he said. "They feel there's better care."

Helpful hints

For Medicare and Medicaid patients: Be aware your coverage won't be accepted by a direct primary care provider. Medicare beneficiaries can go to a direct primary care practice as long as the retainer fee doesn't cover services already covered under Medicare, according to the American Academy of Family Physicians.

If you have a high deductible health plan paired with a health savings account, current tax law doesn't allow using your HSA to make payments to direct primary care providers.

Learn more: Direct Primary Care Coalition at dpcare.org, Square 1 Healthcare at square1healthcare.com, Dr. Susan Mantell Center for Your Health at centerforyourhealth.com and Chisholm Center for Health at chisholmcenterforhealth.com.

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Global Citizen wrote on November 18, 2015 at 9:11 am
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After reading the News Gazette article I decided to give Square 1 a call as I'm currently out of network with my insurance and needed to be seen following an ER visit. I was pleasantly surprised that I was scheduled for an appointment the next morning with James Chandler.

When I arrived at his office there was zero wait time, in fact he greeted me at the door and politely introduced himself. His office was very welcoming with a nice recliner chair (that extends all the way back for the exam) which somehow made me feel more relaxed and less anxious about what was possibly wrong with me. He was thorough and knowledgeable and most importantly he listened to my concerns and spent about 25 minutes with me which is almost unheard of. He referred me for imaging and I paid a fraction of the price for their services thanks to special rates extended to Square 1- lab work and other tests are very reasonable as well. I called him following the imaging appointment and he reassured me that he would be in touch as soon as the results were in so I could change my int'll travel plans if necessary. 

I paid $35 for the visit. That's $35 total for the visit- not a co-pay or initial billing. Just $35. That's what I would have paid for a co-pay had I been in network so I happily paid it and called my husband in shock that I had such a pleasant experience.  

Best of all, I didn't have to sit in a waiting room full of other sick people and there were no surprises about how much it would cost. 

 

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