ER Costs vs. the new model of Direct Primary Care

February 25th, 2014 by Leave a Comment

The cost of the average ER visit is $969. Cost of primary care for a year under a new model: $600 to $720 a month for adults, with lower fees for children, according a New York Times report.

In this new model, called Direct Primary Care (DPC), “patients pay a monthly flat fee directly to a personal physician—cutting out the insurance companies—to cover primary care, is known as concierge care. Long existent as a niche market, it has been derided as an elitist model for the rich and never seriously considered as a health reform for the general population.”

In “Concierge Care for the Little Guy,” Jordon Bruneau, describes the practice of Dr. Lee Gross:

For $83 a month ($152 for a couple and $49 per additional dependent child), with no copays or deductibles, Gross’s Epiphany Health offers patients 25 office visits per year and covers all primary care needs, including annual physicals, pap tests, mammograms, prostate and colorectal screenings, routine labs, sutures, skin surgeries, and vaccines.

Annually, each member receives a comprehensive metabolic panel, complete blood count, lipid panel, and thyroid panel—tests that would otherwise cost an insured patient about $500, depending on his or her deductible—at no extra cost. There are no restrictions against preexisting conditions.

For specialist care and complicated medical services, which Gross emphasizes can often be taken care of at the primary level, Epiphany partners with physical therapists, ambulance services, and labs, and with cardiology, rheumatology, general surgery, imaging, and orthopedic centers to bring patients network prices close to the average insurance copay.

The DPC model could be paired with a low-premium/high-deductible catastrophic care plan running at about $100 a month to insure them in the event of major events or illnesses—such as heart attacks or cancer—that would entail potentially ruinous expenses.”

Dave Chase argues in Forbes magazine that DPC would be a much better way to provide access to primary care to Medicaid recipients.

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