The COVID-19 pandemic has proven to be one of the most chaotic and destructive global events in history.
Beyond the obvious direct human toll of illness and death, COVID-19 has led to massive upheaval in nearly all sectors of the economy.
Yet, one sector proved to be surprisingly resilient; namely, direct primary care.
These low-cost membership-model primary care practices ($49 to $89/month) generally provide copayment-free primary care with extended medical visits and same- or next-day availability.
By deriving their revenue from fixed payments from their patients, they reduce the massive overhead and restrictions that limit traditional medical practices dependent on insurance payment.
With the compulsory coronavirus shutdowns, many insurance-based, fee-for-service practices were devastated by the precipitous drop in office visits. As they largely were only compensated for in-office visits, many were forced to furlough staff or even close as they were unable to adjust.
Others found themselves scrambling to adapt to a world that had gone remote. Designed around centrally controlled billing and coding rules that were dependent on face-to-face visits, these insurance-based practices desperately awaited emergency rules that sought to acknowledge the advent of the telephone.
Even in a “national emergency,” practices suffocated as bureaucracy in public and private insurers struggled to create the relevant codes and rules for billing remote visits.
The process took months during a pandemic that was changing daily. That resulted in many patients nearly losing access to care entirely, and only able to obtain care at already overwhelmed emergency rooms.
During this time, direct primary care patients continued to access care largely uninterrupted. Those practices were able to continue functioning as their revenue stream remained intact, coming from predictable, low-cost membership dues. If patients lost their employment, they did not lose their doctor.
Additionally, direct primary care practices seamlessly transitioned to remote care as they had already been practicing telemedicine for years.
They provided several months’ worth of unlimited primary care, including telemedicine visits, for the cost of a single insurance-based telemedicine visit. That was possible as the physician’s time had already been compensated within the membership dues. Thus, the physician was eager to assist the patient in whichever format (in-person or virtual) that best addressed that patient’s needs.
Unlike their insurance-reliant colleagues, direct primary care practices were freed from awaiting the coding rules from a repeatedly unreliable bureaucratic machine. Instead, they were able to adapt in real time to the needs of their patients, collaborating online, innovating new ways to address the complexities of the pandemic.
In addition to telemedicine, many direct primary care practices shifted to parking lot and drive-up visits, dispensed medications directly to their patients, made house calls, and performed point-of-care testing at patients’ homes or even their places of work.
Some arranged for home oxygen and IV fluids, allowing coronavirus patients to remain home, freeing hospitals to care for the sickest patients. They also continued to treat non-coronavirus illnesses, keeping those patients out of overtaxed emergency rooms.
The direct primary care model has not just survived, but thrived, during the worst health care crisis the world has seen in more than a century.
Direct primary care’s nimble practice model allowed “mass customization” of health care, where the rest of the system was stuck in a mass-production mode. That flexibility proved critical for success in a very dynamic world.
Removing physicians’ heavy regulatory burden proved to be a key feature for their success. Yet, there are still strong headwinds to the more widespread adoption of this practice model.
In a recent paper for The Heritage Foundation, we laid out a detailed road map for adoption of direct primary care patient-centered reforms through regulatory and legislative changes at all levels of government.
If implemented, these recommendations could help to transform American health care from an impersonal assembly line of costly medical care to a more cost-efficient, responsive, and personalized form of care proving to be the silver lining of an otherwise horrible pandemic.
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