Doctors Offer Monthly Fee for Full Access
For a few years she just did volunteer and missionary work.
"I have fallen so many times, and if I died today, I want to be remembered for what I did, not what I lacked," the family physician said.
So last year, Aviles picked herself back up and opened one of the first direct primary care practices in
The idea is simple: pay the primary-care doctor a monthly fee for full access. Unlike some concierge practices, most direct-care providers don't work with insurance companies, and they tend to have lower membership rates.
Aviles' monthly fees range from
Advocates say this fee enables doctors to have fewer patients instead of balancing low insurance reimbursements with a higher number of patients. It also allows them to move away from a fee-for-service model of care to one that's more value-based.
"The idea of direct primary care was to create an environment in which we provided great care, with a smaller number of patients that are seen for longer periods of time and are seen in a relaxed atmosphere, in which people can actually talk," said Dr.
Bliss created one of the first direct primary care practices back in 1997 "for normal people," he said, and coined the term. He is the founder of
The model is slowly getting more attention partly because of the Affordable Care Act, where some consumers are gaining coverage but with high deductibles, and recent studies that have shown better outcomes for patients who go to direct-care practices.
"The first time I came here, she spent 45 minutes with me," said
There's no hard data on how many direct primary practices exist in
The most recent survey by the
But there are now enough doctors practicing both direct care and concierge medicine that they have their own professional society,
Dr.
Aviles, 50, started her new practice with a relatively small investment. "My husband is my venture capitalist," she joked.
She set up an office in a strip shopping center on
There's not a clear line separating direct-care and concierge practices, and depending on whom you ask, you get a different definition.
Dr.
Aviles had 200 member and nonmember patients in her first year. Her goal is 500, and eventually working with businesses. She does not take insurance for her services. Nonmember patients pay
Doshi says dealing with insurance takes more than half of her office manager's time. But insurance, she said, has its plus sides. For one, it's an additional source of income. It also makes tests and specialty care affordable for her patients.
"I would love to not deal with insurance, but I don't want to lose any patients right now. I feel like they would have to take more out of their pocket rather than less," she said.
Nearly 60 percent of Aviles' patients have no health insurance. Those who do can't use their insurance at her practice, Innova Medical Care, but can use it for their lab procedures or when they see other doctors.
Aviles works with several specialists in the region who are willing to treat uninsured patients at a discounted rate.
Stanford has catastrophic-insurance coverage and pays
But,
"She's in the loop about everything that's going on," said Maurer, who has to see several specialists for her psoriatic arthritis. She said she has seen Aviles about once a month this year.
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