Moving past medical insurance to medical care

By Mike Turnlund
Reader Contributor

Sometimes we get the question wrong. In the arena of public discussion, where ideas are shared, debated, and often argued over, every topic under the sun has its day. But it is difficult if not impossible to effectively address a problem if the question is poorly stated. My point: Perhaps one of the problems facing us today is not access to affordable health insurance, but affordable health care. There is a difference.

Obamacare seems to have been a bust. Granted, some specific groups have benefited, especially those with pre-existing health conditions and limited budgets. But by and large, the Affordable Health Care Act has provided little that is affordable, especially with ever increasing monthly premiums, co-pays and limits on coverage. One would think that the health insurance industry wrote the legislation! Wait, um, maybe…

Some physicians in the field are fighting back. And in the thick of the fray is a local family-care practitioner. This physician actually decided to do something about unaffordable health care … by implementing a health care model that is affordable.

Dr. Frazier King meets with one of his patients. Photo by Mike Turnlund.

Oct. 1, 2016, was the one-year anniversary of Sandpoint Direct Primary Care, a new medical model in Bonner County. While to most of the world (or region, anyway) this second most northerly county in Idaho’s panhandle region is known for Lake Pend Oreille, Schweitzer Ski Resort, and one of most beautiful little towns in America, Sandpoint, it is also home to a radically different medical-care model. This new form of providing health care rejects the traditional insurance-centric model that prevails in the United States today. Here we find the slow-paced, relaxed and personal medical care of Dr. Frazier King at his practice, Sandpoint Direct Primary Care. For $50 a month! Or $60 a month if you’re older.

A Burley, Idaho, native, King had 24 years under his belt as a family-practice physician before he decided to locate to Sandpoint. He was first introduced to the community in 1993 when he visited his brother and sister in-law, who had taken residence here. As he puts it, “I was looking for a change … and I was smitten by the beauty of the area.” So, in 2001 he and his family moved to Sandpoint from Ogden, Utah.

But moving to the new community did not generate, at first, the change he was really seeking. While he and his family enjoyed the area, his medical practice was something different. He felt that his practice was ultimately structured not to serve the health-care needs of his patients, but for protecting the profits of insurance companies. This required him to see 20-25 patients a day, which is quite a feat for a seven-hour work day (if you subtract the one-hour lunch). You do the math. This also required having two employees on staff that were dedicated to dealing with the insurance companies, pharmacies, and, of course, client billing. “We were doing a lot of insurance work, resubmitting claims…filling out endless paperwork…we had limited amount of time with the patients,” King recalled.  “Thirty to 40 percent of our energy was really the two: insurance and billing. It seemed that insurance and pharmacies were becoming ever more intrusive in terms of trying to limit one’s practice,” he lamented.

This had to change. King had become increasingly frustrated with the current system and began a search for something different, a new way of delivering medical care to his patients. But he was unsure how to proceed. First and foremost, he didn’t want to abandon his true vocation: family medical care. He found this “something different” in the person of Josh Umbehr, a family-practice physician in Wichita, Kansas. Umbehr had developed a medical care model that was not dependent upon insurance companies.

King first learned about Umbehr while attending a physicians’ conference in Boise. King sat in on an hour-long presentation by Umbehr where he explained his new way of doing business—the “direct primary care model” of medical care. The direct primary care model, or DPC, completely removes insurance companies and pharmacies from participating in a patient’s medical care. Or, perhaps more accurately stated, from interfering in a patient’s medical care. The physician charges his or her patients what basically amounts to a monthly membership fee, and provides patients with the care they require, albeit limited to what can be provided in the doctor’s office. “This was an epiphanic moment!” said King. “I was astonished that he (Umbehr) had an alternate model that appeared to work quite well.”

Intrigued, and now thinking new thoughts about medical care, King returned to his existing traditional practice in Sandpoint. He now knew he could do better, for both himself and his patients. But before he converted his own practice to the new model, he wanted to see it in action, sort of as a proof of concept. This meant King had to personally visit Umbehr in Kansas. King recalled, “He was very generous with his time and energy to assist me.” King’s interest in Umbehr was not unique. In fact, because of an increasing number of inquiries Umbehr had even designed a “curriculum” to answer the questions of interested physicians and to help them establish their own DPC practices. King became convinced and decided to adopt the new model after attending a second conference in July 2015. “Thus, the rest is history. After returning from that conference in July I decided to proceed and on Oct. 1, 2015, [I] opened a direct primary care practice [in Sandpoint].”

Once patients sign on to this new type of medical care model and enroll in the DPC, what do they notice in comparison with the traditional model? “The differences are striking,” says King. This begins with his office. The first thing a patient would notice is that there is no waiting room, unless one considers a couple of chairs in a corner to be a waiting room. A waiting area is not needed because there is no need to wait; patients are served immediately. “Patients are scheduled to spend their time with the doctor and not in the waiting room,” King says, “[this is] more respectful of the patient’s time.”

The DPC is also very cost effective, passing on savings to both the physician and clients. By not having to work with insurance companies, the practice is now free of insurance claim processing. This equates to fewer employees. For example, there is no need for an insurance clerk, “making the efficiency of the office much better,” King says. And there is a litany of other savings, too: Membership fees in the DPC are handled by credit or debit card, eliminating the need for a billing clerk. Overhead costs are greatly reduced as supporting a large traditional office is eliminated. And, of course, no need for a waiting room. All of this makes the DPC an exemplary organizational model.

Still, the DPC is not about simply saving money, but improving medical care. “Instead of seeing 20-25 patients [a day as required by the traditional practice], now I see six to 10, sometimes less,” King pointed out. “New patients get a full hour for [their initial] examination. Follow-up visits are typically 30 minutes, but can be lengthened as needed.” King is also available to his patients 24 hours a day, having access by phone or computer, including what he calls “virtual visits.” His patients can text or email him images of a problem—say, a rash—allowing for diagnosis and treatment over the phone. “If its within my comfort level, I can diagnose and treat it that moment, without having [the patient] to show up at the office. Otherwise, an office visit is scheduled,” he says. And his office is fleet of foot, normally being able to provide same day or next day service.

There is also no limit on the number of times a client can see King, as every person’s needs are different. He often sees patients with significant problems every day, for a week at a time. “They have virtually unlimited access to me,” King says. “And there is no co-pay [cost] or other penalty for coming in more often.” This includes an annual wellness exam. And any treatment that can be done in a doctor’s office is covered by the DPC.

The DPC model lowers medicine costs too. “Prescription medications are available in a generic form at significantly discounted rates,” King says. Ironically, all medicines given out at his office are purchased from the same suppliers that pharmacies use. And because King’s patients do not need to go see a pharmacist to dispense those medicines, those savings are passed on. Medicine costs are significantly lower. Sandpoint Direct Primary Care has also worked out substantial discounts from referring laboratories. His patients get greatly reduced rates. And if patients do have traditional medical coverage, his office can still bill their insurance for labs without any problem, just as before.

Where does he think the DPC model is going to go? First and foremost, King thinks that the DPC is going to “keep the family practice a viable model.” Practitioners that operate family clinics, like himself, may all eventually need to adopt the model in order to keep this type of medical care available. “The DPC may be the salvation of primary care. It provides a less controlled, regulated, hassled type of practice that any family practitioner could move to. Working for patients instead of working for insurance companies, etc. So instead of quitting medicine altogether, a physician could move to this type of practice.”

King also notes that many fellow practitioners are greatly dissatisfied with the current insurance-dependent model of medical care, especially because of the growing influence of insurance companies in dictating patient care. King understands the frustration of family care doctors with insurance companies coopting their care, as evidenced by such requirements as pre-authorizations for physician-prescribed care or for “therapeutic substitutions” of doctor prescribed medicines.

King also does not believe that the DPC will replace traditional medical insurance. Instead, it will provide an opportunity for insurance companies “to return to their original model of being used for catastrophic-care needs.” He views the DPC model as being complementary to existing insurance. In fact, King estimates that 80 percent of his patients already have existing medical insurance, although it is typically the catastrophic-coverage type of insurance with large out-of-pocket co-pays. His affordable membership costs compliment this type of insurance coverage.

How have Frazier King’s patients responded to his DPC? “Many express disbelief that such a model exists and works,” he says. But he will be the first to admit that it is not for everyone. Younger, healthy patients who already have great insurance, with little or no co-pay, are not interested in maintaining a membership fee. But for many people, especially families with young children, it is an absolute bargain.

At a personal level, what has the DPC done for Dr. King’s own role as a family-medicine practitioner? “Overall, [the] stress level is definitely improved!” But more to the point, he says, “I provide medical care, not insurance. What they [my patients] get from me is medical care, irrespective of whether or not they have insurance.” And that is the bottom line.

Frazier King is not the first physician to offer the DPC model in north Idaho. A similar practice opened shortly before his own in nearby Hayden. And since King began Sandpoint Direct Primary Care, a two-physician DPC office has opened up in Post Falls.

As the old adage reminds us, “what goes around, comes around.” Perhaps King and others offering the DPC model are not so much at the head of a new medical-care model, as much as they are returning to a time when doctors knew their patients intimately and made themselves more directly and personally available to them. Sort of a twenty-first-century twist on the old country doctor model, black bag in hand, visiting a patient at home.

Need genuinely affordable health care? Go by and visit Dr. King’s office on the third floor of the Mountain West Bank building on the corner of Division and Pine Street in Sandpoint. Or visit his website at sandpointdpc.com.

The author can be reached for comment at [email protected].