The Benefits of Seeing a Direct Care Physician

Hey, y'all. Dr. Dana Gibbs here. 

In this blog post I want to answer some questions I have been getting about direct care vs. insurance when it comes to getting health care. As you may know, my new thyroid and hormone speciality practice here in North Texas, Consultants in Metabolism, operates with this direct care model, so I want to go over what I, and so many others, have found to be the benefits of this model.

Let's get into it!

First, Let’s chat a bit about why I switched to a direct care model. There are several reasons why this is a better way to provide the kind of high level personal care I provide. 

With direct care, you get:

• Seen within a week or even days.
• Time efficiency - Choosing what care you need in collaboration with your doctor, and going ahead directly, instead of having to pick some alternative treatment because it’s all that is covered.
• Transparent, upfront pricing- agreed upon in-advance.
• Doc gets reimbursed for expertise and time spent, which results in no pushing for expensive, unnecessary procedures.
• Unlimited choice of other providers for procedures and other care, and frequently better prices! Example: MRI is $400 vs $1400 “copay”.
• Access to innovative options for holistic and integrative care, coaching, nutrition, acupuncture, and other less traditional modalities.
• Quick access to your physician to get questions answered. There's no need to “make an appointment,” because with this model, your doctor has choice in how she is reimbursed for time spent, regardless of whether it’s face to face or not.
• The doctor patient relationship is between you and your doctor only! And direct care doctors love their work! They see fewer patients, so may not mind filling out prior authorization forms for needed medications on your behalf, since it’s much less frequent.

To summarize, direct care allows for a more mutually beneficial physician-patient relationship due to increased transparency, fewer intermediaries, and more options for treatment that aren't under the gavel of insurance company approval.

Now let's take a look at the typical experience with working with insurance from both the patient and physician perspective. The experience is often:

• Waiting months for an appointment.

• Waiting for insurance approval before moving forward with your needed care. And from the physician's side, having to tell a patient to return a different day because insurance won’t cover two things on the same visit. Or, wasting months trying cheaper therapies before “qualifying” for higher quality or more innovative therapies.
• Never knowing in advance how much any particular care is going to cost you, or whether it will for sure even be covered.
• Because of reimbursement rules and declining reimbursement, doctors are forced to focus increasingly on those procedures that reimburse the most, and spend the least amount of time possible providing care.
• Limited network of choices for referrals to other specialists, or facilities, because with increasing frequency, the insurance companies or the hospitals “own” the doctors and the clinics in order to maximize their own profit.
• Limited choice of options for care, because insurance based healthcare is really sick care.
• Limited access to your doctor, which causes discontinuity of care when you have to go to urgent care because and can’t get timely attention, a needed prescription, or answers.
• Discontinuity and interference in the doctor patient relationship. If you even get to see a doctor and not a midlevel, doctors in insurance-based care are generally overworked, disillusioned, and restricted in what they can do and the time and care they can provide to each patient. 

So this begs the question. Why should you pay direct care doctors cash even when you have insurance? 

Here’s a reality about insured care. You actually get a ton more value for the dollars spent with direct care, in more ways than one, and here's why.

A physician who takes insurance has to spend a huge chunk of the dollars that are paid to them in order to hire a whole group of extra staff or even consultants. And to do what, you might ask? To deal with insurance companies.

Here's the start of a very long list of some of the tedious things that we have to make sure to do to appease insurance companies and abide by their systems:

• Pre-approval and insurance verification, because people’s insurance can get canceled without notice if they don’t pay premiums, or lose their job.
• Coding of the diagnoses and procedures
• Making sure the documentation matches what the doctor is asking to be paid for (and I’m not even going to talk about the time the doctor has to waste dealing with the EMR these days, since it is required by insurance).
• Billing the insurances, primary and secondary, and making sure the reimbursement matches the contract.
• "Working” denials and then dealing with badgering to collect money when insurance eventually doesn’t pay.

Like I said, that's just the start. But one of the most difficult requirements by the government and private insurance companies is EMR. It's a huge and mostly unnecessary expense, and it's also really expensive in terms of a physician’s efficiency and time that they have to spend face to face with you. EMR’s are designed primarily to make sure hospitals are getting paid for every vial of IV fluid, bandage, and second of nursing care that they provide, but that isn't exactly the case in smaller clinics, is it?

Also, insurance reimbursement has dropped phenomenally for face-to-face time over the years, far from keeping up with inflation. Insurance companies cut reimbursements, a little at a time, year after year, and in real inflation adjusted dollars, doctors today are paid about 30% of what they were paid 20 years ago for most things that they do. This is especially true in the small, independent physician offices and in primary care disciplines, like internal medicine and pediatrics, where there aren’t many procedures.

And how do the insurance companies work to make up for these losses? With increased efficiency and “productivity."

This translates to doctors having to see more and more patients each day just to keep the doors open. And in the end, they just don't have enough time to give each patient the personal attention they deserve. Hiring mid-level providers helps them do this, but these workers just don’t have the training, diagnostic acumen, or  medical decision making capacity of a well trained specialist.

So what happens when the efficiency in a clinic is all maxed out and the doctor still can’t make enough money to take care of their families?

Short answer, they sell out, frequently to the very insurance companies and hospitals that squeezed them in the first place. Or, if they’re in so deep that not even the hospital wants them, they shut their doors and quit medicine. This is happening at an accelerating pace all over the US, particularly since COVID.

And so, this has created a situation where there are too few doctors to see all the patients that need to be seen throughout the US, and smaller clinics that help people with more niche diseases and illnesses, such as thyroid disorders like Hashimoto's disease, are forced to shut down.

And of those thyroid and hormones specialists that manage to stay afloat, most just don't have the time to follow innovations and updates in hormone care and diagnosis, particularly for fringe-y but incredibly important topics like Hashimoto’s disease effects on the body or the interactions between stress, thyroid and the rest of the body hormones in the setting of menopause or low Testosterone in women. Or what about the updates in microbiome science, so you can know which supplements and other “new” interventions are worth your money?

The fact of the matter is that even many endocrinologists don’t have the full picture, or were taught methods and dogma that are outdated now. There's so much that us specialists need to stay on top of in order to provide the best care possible, but time is limited, especially when working with insurance companies. And within the current endocrinology landscape, only doctors who charge cash have the time and energy to stay up to date within their specialties.

I'm a hormone and thyroid specialist, and et’s face it - it’s a time consuming and complex process what I do:  figuring out what is going on with your hormones, working out the details of the individual plan that will work best for you while also minimizing your risks and side effects, and then educating you so you understand the “why” of the recommendations and the alternatives!

When you see a direct care specialist, you and the physician are the only ones in charge of that process. So it’s a much better way to pursue the regaining of health, rather than just taking a pill that will possibly alleviate the main symptom you have right now (and save your insurance company the most money). 

Of course it’s an investment to work with a direct care provider, in your time as well as your dollars. But what better way to invest in yourself than to achieve your best health?

I'll leave you with that. I am Dana Gibbs, MD, an integrative physician in North Texas and the founder of Consultants in Metabolism, where I help people address complex thyroid and other hormone imbalances.

To find out more, you can check out my website at www.danagibbsmd.com. I have discovery call openings to choose from. So let's find a time to talk about how you can ditch the exhaustion, weight gain, chronic pain, and other hormone imbalance symptoms.

See you soon!