by Jared Rhoads, Student Leader (forming) Geisel School of Medicine at Dartmouth, who attended the conference on a BRI Scholarship.
Should we really be using health insurance to pay for primary care? Not if you ask Doug Nunamaker, Board Certified Family Physician with Atlas MD, a direct primary care practice based in Wichita, KS. Dr. Nunamaker recently spoke at the first annual conference of the Free Market Medical Association (FMMA) in Oklahoma City, OK. There he explained how his practice works and why third-party health insurance tends to hurt rather than help primary care.
Primary care, according to Nunamaker, does not need to be expensive. An ever-increasing range of services can be delivered in the primary care setting, and the supplies, tests, and equipment involved are by and large very affordable. Traditional arrangements involving private and public payers, he says, merely complicate and add overhead to what ought to be a straightforward and efficient patient-doctor relationship.
The Atlas MD model provides patients with an alternative. The practice does not accept insurance, but for a membership fee of $10 per month for children or between $50 and $100 per month for adults (depending on age), patients can get as many visits with their doctor as they like, for as long as they like, and with no co-pay and often no wait or scheduling delay. Every procedure that can be done in the office is included in the monthly fee, and most medications can be dispensed directly to patients at cost. If external laboratory tests or diagnostic imaging are needed, those can be shopped around arranged at steep discounts because the group is not locked into restrictive contractual agreements with insurers.
Direct primary care and its close relative concierge medicine are increasingly common in the U.S. as physicians look for ways to reconnect with their patients, set their own prices, and escape onerous regulations. Recent estimates put the number of American physicians practicing under this model around six percent, with an additional two to three percent reporting that they are considering a switch within the next few years.
Of course, not all physicians that go down the concierge path achieve success. According to Nunamaker, direct care practices that fail tend to do so either because they charge too high a membership fee to attract new patients or they do not offer a broad enough range of value to retain the patients they do attract. The majority of direct-pay and concierge physicians who do succeed, however, do so because they offer a superior value to their patients. To that end, these physicians are blazing a trail for American medicine that genuinely could improve access, control costs, and achieve other aims of health reform that are so commonly mis-portrayed as beyond the ability of the market.
(This is Part 4 of a seven part series of reports on the 1st annual meeting of the Free Market Medical Association held Sept. 26-27, 2014 in Oklahoma City. Seven BRI student leaders received BRI scholarships to attend. Previously posted reports can be found here: Part 1 Ralph Weber – Co-founder MediBid by Morgan Kohls; Part 2 Dr. Keith Smith’s keynote address by Kristy Hawley; Part 3 How the Free Market Works – Panel Discussion by John Grimsley. FMMA is in the process of posting full video recordings of the conference presentations here.)