Answers to the 70 Most Common Questions We’re Asked

Potential members always have lots of questions.

Although paying for health insurance takes up a huge chunk of money, at least it pays for a little peace of mind.

It seems like we hate the current system, but most of us are deathly afraid of trying something new for health care.

But you can have both peace of mind and a doctor who acts like a caring doctor should.

To lessen the fear of not having insurance, we’ve answered over 70 questions on this page. While much of this same material can be found on the various pages of our website, some want ‘just want the facts,’ so here they are.

The most-asked questions are organized into 5 categories. Scroll down to search for questions arranged by categories, or simply click on a category in the sidebar list and go directly to that topic.

Then when finished reading an answer, simply click on the arrow to close that answer and choose another question or category of questions if you wish.

Membership FAQs

  • Let’s chat. Every member has scheduled a relaxed Meet & Greet to have time to just chat, maybe drink some coffee or tea, and have a frank discussion about your health care concerns.
  • Here you will have the chance to find out what Direct Patient Care St. Louis is all about. You will have all the time necessary to ask all the questions you want to ask, so that you can figure out if a membership medicine doctor will work for you and your particular situation.
  • Plus, we get to figure out if you’d be a good fit for our practice.
  • It’s the only reasonable way to begin what, we hope, will be a long, productive, healthy relationship
  • Absolutely! We love to help kids grow up healthy and happy.
  • We happily accept the children of our enrolled members.
  • At this time, we are not able to provide routine vaccinations for young children, but we will happily
    work with you to arrange these. (Pediatric Vaccine supply explained completely under Immunizations
    page.)
  • The membership fee is a recurring, monthly charge – like a gym membership – that is billed to patients in exchange for comprehensive primary care services provided by the physicians and at DPC St. Louis, which is outlined in our Membership Benefits document.
  • The practice membership fee is most commonly based on the breadth of primary care specified in the Membership Benefits, which are generally related to the effects of aging.
  • The DPC model’s membership fee structure is designed to pay for the entire range of value-added services that physicians provide for their patients, including the critical, non–face-to-face services. The membership fee pays for all the comprehensive care provided before, during, and after the actual office visit.
  • Our transparent, straightforward and fixed monthly membership fee at Direct Patient Care St. covers all of your primary healthcare needs at our office. (There are nominal supply fees for certain supplemental services and procedures.)
  • No more worrying about whether you can afford a doctor’s visit or not, how much your co-pay costs, or when your deductible will kick into effect.
  • Here is an article explaining the benefits of membership-based healthcare (also known as Direct Primary Care or DPC).
  • Here is a recent news story on NBC Nightly News highlighting DPC from a patient’s viewpoint.
  • Membership at Direct Patient Care St. Louis works well in conjunction with certain insurance plans, specifically what are called ‘high deductible’ plans. We anticipate that almost all of our members will save money (compared to standard “co-pay” insurance plans) when combining Direct Patient Care St. Louis membership with a high-deductible health insurance plan.
  • Think of Direct Patient Care St. Louis membership program as an independent, supplemental and comprehensive way to obtain your primary healthcare
  • Direct Patient Care St. Louis presently allows you to choose a ondecide if you want to commit to a Standard Membership. Hpeople who come here will want to become members once savings and personal attention they receive.
  • This same one-time Trial Membership is a great way to provide qcare for family or friends who are visiting from out of town.
  • The primary commitment is made by us — we are committed to providing you with the best primary
    healthcare available. We want to give you quality care at an affordable cost in a compassionate
    manner. You simply agree to be honest, to be transparent about your health, and to reply to all emails and text messages we send you — all things that help us help you.
  • We don’t make you sign an annual contract like the cable company does.
  • You do sign a patient services agreement, of course, which outlines the services you can expect to be included in membership fee. 
  • You may decide to cancel your membership at any time. See the next FAQ for details on cancellation.
  • You may initiate the cancellation process at any time. When you tell us by text or email that you wish to end your membership, please be aware that means your membership will end on the final day of the following month. 
  • In other words, you cannot tell us you want to cancel and just walk away. There are requirements imposed on doctors by the state of Missouri; we each need to fulfill our respective responsibilities to end the patient-doctor relationship.
  • While Missouri state law requires I agree to see you for emergencies only for 30 days after giving notice, you actually get more than that. You will have full membership benefits right up until the last day of the subsequent month, which gives you time to find your new doctor and get your medication prescriptions from him/her. I can even order the labs your new doctor wants, for example, if that saves you money.
  • Your membership fee at Direct Patient Care St. Louis is not based upon any of your existing medical issues or conditions.
  • And, no, we do NOT have any income or health guidelines to prevent you from becoming a member.
  • Our fees are the same regardless of your income, insurance arrangement or level of health.
  • Because we are an insurance-free practice, we are in a delightfully unique situation — we can directly purchase medications at wholesale cost from the manufacturer. And then we pass these savings directly on to you by selling them to you at that same wholesale price.
  • In addition, we have contracts with Quest to purchase lab testing at wholesale prices with these savings passed directly on to you. Finally, we have a direct relationship for imaging studies, such as X-rays, ultrasound studies, CT’s, and MR’s, all at a substantial discount.
  • Much like a membership at Costco or Sam’s Club, membership in our practice gets you these cost- saving discounts on medications, lab tests, and imaging studies.
  • No, the practice is not yet full.
  • Yes, we are still accepting new patients.
    • No, in order to provide the highest possible level of personalized, quality care to patients who choose our practice, we must limit membership to 600 patients.
    • As a result, once our practice membership is full, a waiting list will be established. As openings become available, you will be contacted by a member of our team regarding membership.

    Fee FAQs

    • An annual membership fee, paid monthly, is all that is required. This will cover costs of providing care to you throughout the year. We will not charge or collect any copayments/coinsurance/deductibles for visits. When you come for a visit, it’s okay to leave your wallet at home. You’recovered!
    • Nope! We have tried to list every possible service you might need at our office so that you will have no surprises. Under the current insurance mess, procedures are billed twice — a professional component (the physician’s time and expertise in performing the procedure) AND a facility or supplies component (paying for everything needed by the doctor performing the procedure.
    • The easiest way to remember how our DPC practice handles it is this: There is no professional component you have to pay for – that would be redundant, since your membership fee covers all the time you spend with Dr. Hicks. So there is never a charge for Dr. Hicks’ time. Got it?
    • That leaves the facility/supplies component. Supplies: since we buy our supplies wholesale, Direct Patient Care St. Louis members will only be asked to pay for the specific supplies at our wholesale cost. The procedure is performed free, and the only charge is the wholesale cost of supplies needed. You will be told upfront what the supply charge would be, so that you can decide if it’s worth your money. Facility: office rent is shared by everyone’s membership fee, and we run it lean. The only charge resembling a facility charge would be the extra expenses involved in making certain housecalls, but again you will always be asked in advance if you are willing to pay for such associated charges.
    • We have arranged for discounted lab prices from LabCorp and Quest, whether we draw them in the office, or members prefer to go to the closest one of the many testing sites throughout the region. In the future, we may be able to increase transparency by having these prices posted online, but until then, just call and ask
    • NOTHING. You will already have paid your first membership fee, which pays for the doctor’s time spent during your first visit (and all other visits that month). If any non-covered lab or procedure/injection/immuniazation is required, you will be told the amount in advance, and the first visit might have a small cost associated with it. Trial members will typically pay $150 plus any supply or lab fees
    • In order to keep administrative costs down, we ask all regular Direct Patient Care St. Louis members to set up automatic withdrawals of the monthly membership fee from their bank account. Any charge for supplies, medicines, or other charges as mentioned above – once you approve of them – will be billed to the current’s month invoice and paid when you pay you next month’s membership fee.
    • The occasional Trial member is expected to pay their membership fee and supply costs in full at the time of service.
    • The occasional Trial member is expected to pay their membership fee and supply costs in full at the time of service
    • Yes, they are deductible for the purposes of Missouri state taxes. In 2015 Missouri passed H.B. 769 into law, stating medical retainer agreements like DPC are not insurance and that health savings accounts (HSAs) may be used to pay for retainer (membership) fees.
    • The problem is that DPC membership fees are not yet federally defined as a “medical expense.”
    • However, the Missouri State Medical Association (MSMA), the Missouri chapter of the Association of American Physicians and Surgeons (AAPS), and the Direct Primary Care Coalition (DPCC) are lobbying hard at the federal level to win rightful deductibility for these expenses. So we must advise you to discuss this further with your tax preparer or accountant.
    • Missouri says YES: As noted above, Missouri passed H.B. 769 into law in 2015, which states DPC membership fees may be paid from a patient’s health savings account (HSA) or reimbursed through their flexible spending account (FSA) or health reimbursement arrangement (HRA).
    • But federal law takes precedent, as noted in the statute, which states this 2015 Missouri law is “subject to any federal or state laws” regarding the use of HAS’s , FSA’s and HRA’s.
    • Again, you will want to check with your human resources department regarding possible payment options for your annual membership using Health Savings Accounts (HSA’s), Flexible Spending Accounts (FSA’s) and health reimbursement arrangement (HRA’s).
    • If you are unable to use these funds to pay for the annual membership fee directly, there is a good chance that you can still use your HSA/FSA/HRA as reimbursement for certain services provided through our office.
    • NO. Our membership fee is less than the cost of a buying a daily sandwich for lunch or a monthly cable contract. If more of the public were aware of how affordable this care can be, more people would be clamoring for it. Access 24/7, prompt appointments, same or next day sick visits, unhurried time with your doctor, health care coaching, continuity and advocacy. What is there not to recommend this model of care?
    • We love that question and we hear it often! Everyone benefits from medical care personalized directly for them. Our practice is committed to preventative health maintenance, which is a longterm investment in you! Physicals, e.g., preventative health visits, are not just routine; they are opportunities for early disease detection, much like a state inspection for your car.
    • Every visit, regardless of the reason, will give us the opportunity to get to know you better and to build a long-standing relationship over time. As a result, individual care plans can be developed that are tailored to the individual needs of each patient. Traditional medical practices, which are insurance-driven, find it difficult to forge this relationship like we are fortunate to be able to do.
    • We love that question and we hear it often! Everyone benefits from medical care personalized directly for them. Our practice is committed to preventative health maintenance, which is a long term investment in you! Physicals, e.g., preventative health visits, are not just routine; they are opportunities for early disease detection, much like a state inspection for your car.
    • Every visit, regardless of the reason, will give us the opportunity to get to know you better and to build a long-standing relationship over time. As a result, individual care plans can be developed that are tailored to the individual needs of each patient. Traditional medical practices, which are insurance-driven, find it difficult to forge this relationship like we are fortunate to be able to do.

    Visit FAQs

    • Until we have more patient members, there’s no need to just sit in the office wasting time. Instead, we are out in the community working to educate the public and local businesses about this new alternative to the healthcare crisis.
    • It confuses Google Maps and Google My Business if regular M-F hours aren’t posted online, but the reality is far better: you call or text Dr. Hicks with you special members-only cell phone number, and he will meet you at the office at a mutually convenient time.
    • For one ankle injury, that meant 8 in the evening, for another who couldn’t stop coughing, that meant Sunday after church. And those were for the few who actually need to be seen; others can be helped with just a text or phone call. So, who wants regular office hours that cover less than half of the hours you’re awake? You’ve got access whenever you need it – 24 / 7 / 365 by text or phone, with after-hours visits available whenever necessary.
    • Yes and no! Please contact us first to make an appointment. We want you to have an unhurried office visit that is scheduled as soon as possible. That usually means same day or next-day appointments, where you are given all the time and attention you need.
    • For however much time we need to take good care of you! Period.
    • OK, the technical (long) answer for a couple of readers, and you know who you are! The time may vary a little from situation to situation, depending on the number and complexity of your medical issues, as well as if we are in the sicker or busier seasons of the year.
    • Just as any insurance-based, family doctor does, we can suggest and arrange referrals for diagnostic testing or visits to specialists. Fortunately, Direct Patient Care St. Louis provides many urgent care and minor emergency services that can help you avoid an expensive trip to the emergency room. However, as noted above, we always recommend having a HDHP or a healthcare sharing ministry plan in case you experience an unexpected, catastrophic or expensive event that needs surgery or hospitalization.
    • If you do need hospitalization, we can facilitate the process by talking to the hospitalist, providing recent EKGs or lab results, for example, giving them a ‘live update,’ and answering any questions that may arise during your stay.
    • Our commitment is to help you avoid hospitalization by early detection and treatment of disease. Having a physician that is free of insurance mandates and time constraints is the key to staying out of the hospital, because he or she is available to notice the subtle signs that signal an existing disease state is worsening.
    • Yes. It always depends a little on your location and physician availability, of course. But if you’re too sick to get to the office, we’d rather you call and ask us to make a house call today, instead of waiting, getting worse, and calling the ambulance to go to the hospital tomorrow.
    • By all means, yes! “Because illness and injury do not respect regular office hours, you may call me any day, any time. I try to make it fit into your lifestyle instead of disrupt it. You call my cellphone, you text me, you email me and we set something up. It’s how I do custom health care.
    • Addendum – “After having received a phone call and a text from one patient after 2 am, and then a different patient’s call and text before 6 am the same night, I need to make you aware of how my circadian rhythm performs. If you text or call between 1 am – 9 am, there’s a 99% chance the beeping or ringing telephone won’t wake me up. Although the phone sits less than 12 inches from my ear, I will most likely sleep right through the noise. Alarm clocks don’t work for me either, but that’s another story. Feel free to call and leave a message, and I’ll return your call first thing, usually by 10am. Please just be aware of my limitation so you won’t get frustrated, thinking I don’t want to take your call or try to help you.”
    • Naturally we provide such care! This is another freedom we enjoy together as a result of our independence from the restrictions of third-party payment. Because we know you well, we can streamline your care when you’re sick while away from home. Many illnesses, suffered by a patient whose physician know them well, can be diagnosed and treated with a conversation by phone, email, text or webcam. We’ll locate the nearest pharmacy and order the medications most appropriate for your circumstances. Bam!
    • Every visit is on time; you are not waiting. If you call or text in the morning you are ill, you are able to be seen the same day. And I don’t mean ‘squeezed in.’ I mean seen in a relaxing, comfortable visit. You are not seen for five minutes with a ‘practitioner’ asking you about your problem, but is too rushed to listen to your answer because five more people are waiting.
    • When patients call at 10 o’clock on a Saturday night, they get their doctor on his cell phone — not an answering service, not a doctor who is covering for the weekend. It is their own doctor. He knows them. He doesn’t have to go back to a computer and say, ‘I see here that three years ago, you had pneumonia and we prescribed Cipro.’ Because when you have a small number of patients, you know them.
    • Thomas Bodenheimer, M.D., writing in the New England Journal of Medicine, says, “The majority of patients with diabetes, hypertension, and other chronic conditions do not receive adequate clinical care, partly because half of all patients leave their office visits without having understood what the physician said.” In other words, they didn’t spend enough time with their doctor.
    • Patients with chronic diseases benefit from direct primary care. The Centers for Disease Control and Prevention (CDC) recognizes that “Chronic diseases and conditions … are among the most common, costly, and preventable of all health problems.” The CDC adds, “Diabetes is a widespread, chronic disease and is projected to become more prevalent as the baby-boomer generation ages.
    • Diabetes can be managed more effectively through better coordinated, longitudinal, preventive primary care such as that provided by direct primary care practices.”

    Insurance, Health Plans, Medicare, and Medicaid FAQs

    • Absolutely not! However, membership can give you a similar peace of mind, because you know that you have a doctor who is available when you need him.
    • Once again, no. Membership in DPC St. Louis is a great way to receive high-quality, primary health care, but insurance is helpful for unexpected emergencies and expensive events. See this link for an explanation of how membership (Direct Primary Care) and insurance can work together.
    • NO. The most pivotal and difficult decision that we have made is to cut all ties with insurance companies. And this is the most critical distinction of our membership model of health care — it centers on a direct, personal relationship between you and your doctor.
    • That directness carries over to our business model as well. While the tender mercies of an insurance company might be appropriate for fixing a damaged fender on the family car, we see no reason for any insurer to have a voice about the quality, amount, or the cost of your family’s health care.
    • By refusing insurance reimbursement, we secure the freedom to see patients on our terms — without being tied to the rhetoric and rules of insurance companies whose business model has no room for your well- being.
    • Similarly, our direct membership fee-for-services arrangement frees us from the typical contractual agreements that prevent physicians from offering wholesale prices on laboratory tests, imaging, and medications. To summarize, then, our philosophy of health care is diametrically opposed to the insurance industry’s philosophy of health care profit.
    • We are committed to the health and well-being of our patients; insurance is committed to cutting costs and spending related to medical expenses.
    • We are committed to forging a direct personal relationship between you and your doctor, insurance is appropriately committed to their stockholders, defined as making as much money from each ‘covered life’ as possible.
    • Profit is not a bad thing for investors, of course, but patients should not be forced to get their family’s health care within that framework.
    • No. DPC St. Louis does not contract with any private or public insurance plans. However, Trial Members may submit our receipt to their private insurance plan for their initial office visit, if they choose. See next question…
    • If your health insurance plan allows for out-of-network coverage and reimbursement, then quite likely you can. Direct Patient Care St. Louis can provide a receipt of your payment so that you can process it with your insurance plan. However, even if your insurance plan will not reimburse you for these services, you will most likely find our prices still save you money.
    • Your insurance plans will continue to operate “as usual” at other doctors’ offices, hospitals and pharmacies. Some plans do not require a designated “gatekeeper” doctor for referrals, medications, tests, and the like, so DPC St. Louis can order those services as needed just as any other doctor would do. Some HMO-style plans do require an “in-network” primary care doctor for access to other services, so these plans do not pair as well with membership in DPC St. Louis. Please check with your insurance company.
    • The rules continue to evolve on both state and national levels, often in a very favorable way concerning DPC. Because of this rapid change, however, we strongly encourage you to verify this with your accountant or financial advisor.
    • But as far as we understand it, yes, you can use your FSA (flexible spending account) or HSA (health savings account) to pay for membership in DPC St. Louis and for service fees (specialized visits, labs, etc.)
    • Yes, you do. Patients in a DPC practice need to understand that the membership fee is not the same as health care insurance.
    • Although health insurance is NOT necessary for membership, it is advised We do encourage patients to maintain some level of health insurance to help cover the costs of hospitalization or specialist referral, should either become necessary.
    • Although Direct Patient Care St. Louis is not a financial or health-insurance advisor, we expect that members with high-deductible (catastrophic) type health insurance plans will be very pleased with their arrangements, when combined with our services. Also, members of healthcare cost sharing ministries like Christian Healthcare, Liberty, Medi-Share, and Samaritan find that those programs complement membership in DPC St. Louis quite nicely.
    • Direct Patient Care St. Louis can provide day-to-day services while a high deductible or a healthcare costsharing plan can help limit the enormous expenses of a major event. High deductible health insurance plans usually have 20-50% lower premiums than low-deductible (“co-pay”) type plans. Christian healthcare cost sharing plans, while not insurance, have even lower monthly out-of-pocket costs. And they are compared on the ‘Healthcare Sharing Ministries’ page of our website, with active links to the four sharing ministries mentioned above.
    • Probably not, but who knows what the Senate and House are going to do, so this is a great question that’s become even more complicated since President Obama left office. Although Direct Primary Care (DPC) is mentioned briefly in the Affordable Care Act as “participating in insurance exchanges with a wrap-around insurance plan,” the details of this are still very unclear.
    • Like other Direct Primary Care offices we know about, we are not going to wait around for Washington, D. C. to provide our community with high quality, affordable, compassionate primary healthcare.
    • We asked this exact question of Missouri Medicaid, and received a generous response from Mr. Dale Carr, the MMAC Provider Enrollment Manager. Here in part is his answer. “Missouri State regulation 13 CSR 70- 4.030(1) contains language which indicates Dr. Hicks can provide services to MO HealthNet patients who self-pay, as long as (there is) ‘an agreement between the provider and the participant indicating that MO HealthNet is not the intended payor for a specific item or service, but rather that the participant accepts the status and liabilities of a private pay patient.’ “
    • Mr. Carr then added this warning, “My prior experiences with Medicaid participants indicate it doesn’t make sense for them to self-pay with Physician A, when they can see Physician B and MO HealthNet will pay for the services. Self-paying for covered services might cause the participant eligibility units to take a closer look at a Medicaid participant to see if they really need Medicaid coverage.”
    • Yes. Medicaid recipients are welcome to join Direct Patient Care St. Louis, although we do not bill Medicaid for our services, as described in the regulation cited above.
    • We have opted out of Medicare — we cut the red tape – we removed the restraints of both government and insurance controlling your health care choices and decisions.
    • So, yes, we gladly see patients with Medicare. We do not bill Medicare for those services, however. Medicare regulations require you sign a one-time waiver declaring that neither you nor your doctor will directly bill Medicare for our services. Medicare will still cover any laboratory testing, imaging, medications, or hospitalizations prescribed by our office.
    • Even though Medicare will not pay us for any services you receive in our practice, your Medicare benefits will remain otherwise unchanged and can continue to be used for all other medical care received outside of our practice.
    • A Direct Patient Care St. Louis membership can save you money even if you already have Medicare – you can read more about it here.
    • NO — absolutely not! Being insurance-free means that we can never be obligated to provide any third party with a copy of your records, unless you specifically ask that we do so. (legal disclaimer: or if our attorney says we must do so in response to a legitimate, duly-authorized court order.)

    Miscellaneous FAQs

    • Direct Primary Care is a nationwide movement of Primary Care doctors who have divested themselves from insurance companies and their assembly-line model of medicine, in favor of reestablishing the direct doctor-patient relationship. It is like concierge medicine, but without valet parking, and is designed to be affordable for the masses.
    • Direct primary care practices offer a membership-based approach to routine and preventive care that can dramatically reduce health care costs for individuals, families and businesses.
    • At the core of a direct primary care facility is a medical practice dedicated to providing routine, everyday care, essential for the well-being and ongoing maintenance of a patient’s health. This is where patients go for check-ups, vaccinations, sprained ankles, or frequent headaches.
    • Direct primary care providers know their patients. They have talked with their patients in detail, gotten to know them, treated past conditions and know what recurring problems are experienced. If a patient has a chronic illness, like arthritis or diabetes, their primary care provider is already a partner in management every step of the way. And, in the unlikely event of a life-threatening accident or disease, the provider serves as the patient’s advocate, coordinating care across multiple providers, facilities, and prescriptions.
    • Consider that our current health care crisis is a byproduct of an overloaded third-party payment system that often expects a doctor to care for nearly 3,000 patients, even though he or she is not reimbursed appropriately for doing so. This process undermines sound medical practice and compromises the quality of patient care.
    • Before the rapid growth of employer-based health insurance coverage in the 1940s, Americans paid directly with cash for virtually all of their health care. With the rise of third-party health insurance after World War II, cash payment for medical services declined sharply. Doctors, hospitals, and other medical professionals increasingly were reimbursed through third-party insurance, which often provided “first dollar” coverage. On the surface, this appeared to be efficient, quick, and easy, but it had the unintended consequence of making health care financing largely opaque. This hid the true cost of services, leaving patients with the false impression that their employers paid for their medical expenses, except for the occasional co-pay, deductible, or coinsurance.
    • This major transition in American health care financing during the 1940s left physicians to seek reimbursement from patients’ insurance companies. Over time, the third-party payment systems in both private health insurance and public programs, such as Medicare and Medicaid, have become increasingly complex and costly, less transparent, and more economically inefficient.
    • In light of these mounting complexities and inefficiencies, increasingly dissatisfied doctors and patients are looking for innovative ways to deliver and receive primary care. Direct primary care has become a viable solution for many Americans.
    • NO. We offer a simple membership fee for primary care, with no copays and no insurance. This is quite different than concierge medicine practices like MDVIP. Other terms used for concierge medicine include boutique medicine, retainer-based medicine, and innovative medical practice design.
    • MDVIP and other concierge doctors still contract with insurance companies, and as a result are required to collect a copayment, coinsurance, deductibles, and any non-covered service amounts as required by the health insurance contract, plus the retainer fee, and this is exactly why we chose not to go that route.
    • MDVIP doctors also have a much higher retainer fee, $1650 per individual or more AND MDVIP also requires an up-front payment in order to join their practices. We are happy to offer the option of a monthly payment plan, and have even waived the $99 enrollment fee for the first 150 patients who join.
    • Lastly, MDVIP offices are unable to sell wholesale medications and lab services. We are able to do all of this because we don’t take insurance.
    • In summary, the significant difference of membership medicine DPC practices, then, is that we don’t bill for medical visits, we don’t require patients to have the usual, expensive insurance like concierge medicine does, and we provide medications and immunizations at wholesale prices.
    • NO. Although it may seem strange, this is actually old-fashioned medicine brought back to life. Author Catherine Sykes calls it “the oldest, new form of medicine.” Doctors carrying a medical bag and coming into a patient’s home was standard into the late 1960s. Watch the reruns of the Marcus Welby. MD TV show. That’s what our grandparents enjoyed. There was a time when patients valued their family doctor, trusted their opinion and called their doctors after-hours to help decide if symptoms needed urgent attention or could wait till the next morning.
    • But, medicine became government regulated, and that started the death spiral we’re in. It came in for a reason — there did need to be some amount of administration — but now regulation and administrative tasks have overburdened and frustrated doctors. I’ve accepted the piece of advice from a DPC doc who said, “Be intentional with your excellence, don’t be normal.”
    • When you think of medicine as it was portrayed on the Andy Griffith show, the doctor had a clinic in the local town. It’d be strange for him to ask, “What kind of insurance does Opie have?”
    • YES. Tiffany Sizemore-Ruiz, D.O., of Choice Physicians of South Florida says, ”Being a good physician is not just about knowing how to diagnose and treat disease. Honestly…that’s what books and studying are for. Being a good doctor entails earning the trust of your patients by being honest and forthcoming. It means knowing how to communicate effectively while still remaining sympathetic. It requires you, first and foremost, to be a human being.” She continues by saying, “It honestly bothers me that young doctors feel like they have to ‘know everything’ to be a great physician. Put down the damn book and go talk to your patient. It’s really that simple.”
    • We agree with what she says, specifically that there is no substitute for a doctor whom a patient knows and trusts, and who acts exclusively on behalf of that patient’s own needs and interests. Fortunately, anyone in St. Louis can now have this type of care.
    • In their February/March 2018 issue, AARP magazine published an article highlighting telemedicine in St. Louis, in which they turned a spotlight on Mercy’s telemedicine center in Chesterfield. This form of electronic office visits has always been available to all member patients of Direct Primary Care St. Louis.
    • YES. According to Daniel McCorry at The Heritage Foundation, an independent think tank, who says, “Preliminary data show excellent outcomes for patients enrolled in direct primary care and a reduction in health care costs.”
    • YES. We love that question and we hear it often! Everyone benefits from medical care personalized directly for them. Our practice is committed to preventative health maintenance which is a longterm investment in you! Physicals, i.e., preventative health visits, are not just routine; they are opportunities for early disease detection, much like a state inspection for your car.
    • Every visit, regardless of the reason, will give us the opportunity to get to know you better and to build a long-standing relationship over time. As a result, individual care plans can be developed that are tailored to the individual needs of each patient. Traditional medical practices, which are insurance-driven, find it difficult to forge this relationship effectively like we are fortunate to do.
    • As you may know from personal experience, many patients will only be able to afford a high deductible plan in the future, in which the insurance won’t cover the first $2,000-$6,000 ‘deductible’ that they spend anyway.
    • But with our new membership model of health care, people can maximize the amount of healthcare they get and minimize their cost. Direct Patient Care St. Louis works with our patients directly, who pay a monthly membership fee and get practically unlimited office visits, as well as technology visits using their computer or smart device.
    • They never have co-pays for anything in our office, so any procedures we perform in our office are done by the doctor without charge: EKG, PFT’s, biopsies, sutures, splinting, cryosurgery, joint injections, etc.
    • Since your membership fee pays for all the doctor’s time spent with you, whether performing procedures or chatting on the phone, you’ll only need to buy the medicine we inject or pay for the pathology report from the lesion we biopsied at no charge. Whenever there is a small supply charge, you will be told in advance how much and what it’s for. Then you can decide in advance if it’s worth it to you — you are always in control of choosing how to spend your own money.
    • In addition, we run our own pharmacy out of the office, so we can get medications at wholesale pricing. We can also get labs at wholesale pricing as well, which will be a substantial savings for our patients.
    • So in the long run, we actually end up saving many of our patients more than their membership costs.
    • NO. And here’s the logical reason why. Young doctors today are refusing to go into primary care medicine, due to the fact that working as a PCP in our broken system demands they see 30 patients per day for 25-35% less than what a specialist earns. On top of that, the average medical school debt of a new graduate doctor is close to $250,000.
    • The above factors have understandably contributed to making a shortage of doctors willing to practice primary care medicine. Now let’s add in the fact that physician suicide is higher than it’s ever been, and more and more doctors with 10 or 20 good years left are leaving medicine entirely.
    • DPC can’t cause a shortage – the shortage of primary care doctors already exists. “Over the long run, the only way to increase the number of qualified primary care doctors is to make the profession more attractive, both from a professional and financial perspective. It is our current broken system that has caused a shortage of primary care doctors; and if we stay on the old path, it will only get worse.” ~ Dr. Steven Knope, Tucson, Arizona in The Myths of Concierge Medicine
    • YES, but slowly. Again, according to The Heritage Foundation, “Policymakers should create a legal and regulatory environment that is less restrictive toward direct primary care. If policymakers will encourage change, innovation, and competition instead of just reacting to the increasingly dysfunctional status quo, the possibilities are endless.“
    • Endless possibilities – Wow, think about that for a moment.
    • Realistic health insurance carriers can see the writing on the wall. Their current business model become irrelevant once patients understand the facts behind our failing health care system. Some health plans are still trying to insert themselves into this new movement by actively evaluating DPCstyle patient engagement, as plans shift reimbursement away from “fee-for-service” and toward care coordinating value and outcome compensation.
    • The only way for players in the health insurance industry to survive is to realize that insurance in every other sector is intended to be used for just one thing: a means of protection from financial loss. More technically known as a transfer of risk, buying insurance transfers your personal risk to an insurance company. So insurance is a form of risk management that is primarily used to hedge against the risk of a uncertain loss, such as cancer, major surgery or even hospitalization. Wikipedia definition of insurance, accessed 02/18/18
    • Yet the fact remains – the health insurance industry helped create our current fiasco. They must face the music, realize they are unnecessary for obtaining the routine health care most of us need, and learn to operate like any other kind of insurance people buy in the US.
    • You might think so, but that’s not correct. Preventative medicine is now our top priority in medicine. The upfront costs associated with genetic testing, inflammatory testing, etc. pales in comparison to the cost of treating chronic disease.
    • Stakeholders are realizing that it is more important to invest in technologies that detect disease at an earlier stage when it is less challenging to treat effectively. So, spending capital now on tailored treatment plans for individuals will save billions in the future.

    NO. Let’s look at the facts together:

    • For a typical physician, “half of each day is consumed with clerical and administrative tasks, such as completing insurance claims forms, navigating complex coding requirements, and negotiating with insurance companies over prior approvals and payment rates.” The Benefits of DPC, published by Private Practice Direct
    • The Direct Primary Care Coalition estimates that 40 percent of all primary care revenue goes to claims processing and profit for insurance companies. Article published in Medical Economics, April 24, 2014
    • A typical physician would need 7.4 hours per day to provide all of the preventive care as determined by the U.S. Preventive Services Task Force. Such time commitment is unfeasible when physicians must spend several hours per day on the clerical work described above. Article published in American Journal of Public Health
    • YES. Health care has been cutting reimbursement to doctors for years, which has forced doctors to see more patients in an attempt to maintain a stable income. Consequently, the time doctors can spend with their patients has declined so much that today the average time spent with patients for most doctors is less than 10 minutes. This means that each visit is only long enough to address the bare essentials, seldom more
    • NO. Most doctors are not ok with that. Let’s consider the facts. A 2016 survey of more than 17,000 U.S. physicians by The Physicians Foundation found that 48% plan to reduce hours, retire, take a nonclinical job, switch to concierge medicine or take other steps to cut back on the number of patients they see.
    • We can’t speak for all docs, but most of us miss sitting and listening to our patients – when the doctor can’t spend time with a patient, she can’t get to know them well enough to truly make a difference in their health. So this lack of meaningful interaction and insufficient time for primary care is eroding the doctor–patient relationship. Practiced this way, medicine is not meaningful or enjoyable anymore.

    Glossary of Common Terms Used in DPC

    • Direct Primary Care is a nationwide movement of Primary Care doctors who have divested themselves from insurance companies and their assembly-line model of medicine, in favor of reestablishing the direct doctor-patient relationship. It is like concierge medicine, but without valet parking, and is designed to be affordable for the masses.
    • Direct primary care practices offer a membership-based approach to routine and preventive care that can dramatically reduce health care costs for individuals, families and businesses.
    • At the core of a direct primary care facility is a medical practice dedicated to providing routine, everyday care, essential for the well-being and ongoing maintenance of a patient’s health. This is where patients go for check-ups, vaccinations, sprained ankles, or frequent headaches.
    • Direct primary care providers know their patients. They have talked with their patients in detail, gotten to know them, treated past conditions and know what recurring problems are experienced. If a patient has a chronic illness, like arthritis or diabetes, their primary care provider is already a partner in management every step of the way. And, in the unlikely event of a life-threatening accident or disease, the provider serves as the patient’s advocate, coordinating care across multiple providers, facilities, and prescriptions.
    • Direct Primary Care is a nationwide movement of Primary Care doctors who have divested themselves from insurance companies and their assembly-line model of medicine, in favor of reestablishing the direct doctor-patient relationship. It is like concierge medicine, but without valet parking, and is designed to be affordable for the masses.
    • Direct primary care practices offer a membership-based approach to routine and preventive care that can dramatically reduce health care costs for individuals, families and businesses.
    • At the core of a direct primary care facility is a medical practice dedicated to providing routine, everyday care, essential for the well-being and ongoing maintenance of a patient’s health. This is where patients go for check-ups, vaccinations, sprained ankles, or frequent headaches.
    • Direct primary care providers know their patients. They have talked with their patients in detail, gotten to know them, treated past conditions and know what recurring problems are experienced. If a patient has a chronic illness, like arthritis or diabetes, their primary care provider is already a partner in management every step of the way. And, in the unlikely event of a life-threatening accident or disease, the provider serves as the patient’s advocate, coordinating care across multiple providers, facilities, and prescriptions.
    • Direct Primary Care is a nationwide movement of Primary Care doctors who have divested themselves from insurance companies and their assembly-line model of medicine, in favor of reestablishing the direct doctor-patient relationship. It is like concierge medicine, but without valet parking, and is designed to be affordable for the masses.
    • Direct primary care practices offer a membership-based approach to routine and preventive care that can dramatically reduce health care costs for individuals, families and businesses.
    • At the core of a direct primary care facility is a medical practice dedicated to providing routine, everyday care, essential for the well-being and ongoing maintenance of a patient’s health. This is where patients go for check-ups, vaccinations, sprained ankles, or frequent headaches.
    • Direct primary care providers know their patients. They have talked with their patients in detail, gotten to know them, treated past conditions and know what recurring problems are experienced. If a patient has a chronic illness, like arthritis or diabetes, their primary care provider is already a partner in management every step of the way. And, in the unlikely event of a life-threatening accident or disease, the provider serves as the patient’s advocate, coordinating care across multiple providers, facilities, and prescriptions.
    • Direct Primary Care is a nationwide movement of Primary Care doctors who have divested themselves from insurance companies and their assembly-line model of medicine, in favor of reestablishing the direct doctor-patient relationship. It is like concierge medicine, but without valet parking, and is designed to be affordable for the masses.
    • Direct primary care practices offer a membership-based approach to routine and preventive care that can dramatically reduce health care costs for individuals, families and businesses.
    • At the core of a direct primary care facility is a medical practice dedicated to providing routine, everyday care, essential for the well-being and ongoing maintenance of a patient’s health. This is where patients go for check-ups, vaccinations, sprained ankles, or frequent headaches.
    • Direct primary care providers know their patients. They have talked with their patients in detail, gotten to know them, treated past conditions and know what recurring problems are experienced. If a patient has a chronic illness, like arthritis or diabetes, their primary care provider is already a partner in management every step of the way. And, in the unlikely event of a life-threatening accident or disease, the provider serves as the patient’s advocate, coordinating care across multiple providers, facilities, and prescriptions.
    • Direct Primary Care is a nationwide movement of Primary Care doctors who have divested themselves from insurance companies and their assembly-line model of medicine, in favor of reestablishing the direct doctor-patient relationship. It is like concierge medicine, but without valet parking, and is designed to be affordable for the masses.
    • Direct primary care practices offer a membership-based approach to routine and preventive care that can dramatically reduce health care costs for individuals, families and businesses.
    • At the core of a direct primary care facility is a medical practice dedicated to providing routine, everyday care, essential for the well-being and ongoing maintenance of a patient’s health. This is where patients go for check-ups, vaccinations, sprained ankles, or frequent headaches.
    • Direct primary care providers know their patients. They have talked with their patients in detail, gotten to know them, treated past conditions and know what recurring problems are experienced. If a patient has a chronic illness, like arthritis or diabetes, their primary care provider is already a partner in management every step of the way. And, in the unlikely event of a life-threatening accident or disease, the provider serves as the patient’s advocate, coordinating care across multiple providers, facilities, and prescriptions.
    • Direct Primary Care is a nationwide movement of Primary Care doctors who have divested themselves from insurance companies and their assembly-line model of medicine, in favor of reestablishing the direct doctor-patient relationship. It is like concierge medicine, but without valet parking, and is designed to be affordable for the masses.
    • Direct primary care practices offer a membership-based approach to routine and preventive care that can dramatically reduce health care costs for individuals, families and businesses.
    • At the core of a direct primary care facility is a medical practice dedicated to providing routine, everyday care, essential for the well-being and ongoing maintenance of a patient’s health. This is where patients go for check-ups, vaccinations, sprained ankles, or frequent headaches.
    • Direct primary care providers know their patients. They have talked with their patients in detail, gotten to know them, treated past conditions and know what recurring problems are experienced. If a patient has a chronic illness, like arthritis or diabetes, their primary care provider is already a partner in management every step of the way. And, in the unlikely event of a life-threatening accident or disease, the provider serves as the patient’s advocate, coordinating care across multiple providers, facilities, and prescriptions.
    • Direct Primary Care is a nationwide movement of Primary Care doctors who have divested themselves from insurance companies and their assembly-line model of medicine, in favor of reestablishing the direct doctor-patient relationship. It is like concierge medicine, but without valet parking, and is designed to be affordable for the masses.
    • Direct primary care practices offer a membership-based approach to routine and preventive care that can dramatically reduce health care costs for individuals, families and businesses.
    • At the core of a direct primary care facility is a medical practice dedicated to providing routine, everyday care, essential for the well-being and ongoing maintenance of a patient’s health. This is where patients go for check-ups, vaccinations, sprained ankles, or frequent headaches.
    • Direct primary care providers know their patients. They have talked with their patients in detail, gotten to know them, treated past conditions and know what recurring problems are experienced. If a patient has a chronic illness, like arthritis or diabetes, their primary care provider is already a partner in management every step of the way. And, in the unlikely event of a life-threatening accident or disease, the provider serves as the patient’s advocate, coordinating care across multiple providers, facilities, and prescriptions.
    • Direct Primary Care is a nationwide movement of Primary Care doctors who have divested themselves from insurance companies and their assembly-line model of medicine, in favor of reestablishing the direct doctor-patient relationship. It is like concierge medicine, but without valet parking, and is designed to be affordable for the masses.
    • Direct primary care practices offer a membership-based approach to routine and preventive care that can dramatically reduce health care costs for individuals, families and businesses.
    • At the core of a direct primary care facility is a medical practice dedicated to providing routine, everyday care, essential for the well-being and ongoing maintenance of a patient’s health. This is where patients go for check-ups, vaccinations, sprained ankles, or frequent headaches.
    • Direct primary care providers know their patients. They have talked with their patients in detail, gotten to know them, treated past conditions and know what recurring problems are experienced. If a patient has a chronic illness, like arthritis or diabetes, their primary care provider is already a partner in management every step of the way. And, in the unlikely event of a life-threatening accident or disease, the provider serves as the patient’s advocate, coordinating care across multiple providers, facilities, and prescriptions.
    • Direct Primary Care is a nationwide movement of Primary Care doctors who have divested themselves from insurance companies and their assembly-line model of medicine, in favor of reestablishing the direct doctor-patient relationship. It is like concierge medicine, but without valet parking, and is designed to be affordable for the masses.
    • Direct primary care practices offer a membership-based approach to routine and preventive care that can dramatically reduce health care costs for individuals, families and businesses.
    • At the core of a direct primary care facility is a medical practice dedicated to providing routine, everyday care, essential for the well-being and ongoing maintenance of a patient’s health. This is where patients go for check-ups, vaccinations, sprained ankles, or frequent headaches.
    • Direct primary care providers know their patients. They have talked with their patients in detail, gotten to know them, treated past conditions and know what recurring problems are experienced. If a patient has a chronic illness, like arthritis or diabetes, their primary care provider is already a partner in management every step of the way. And, in the unlikely event of a life-threatening accident or disease, the provider serves as the patient’s advocate, coordinating care across multiple providers, facilities, and prescriptions.
    • Direct Primary Care is a nationwide movement of Primary Care doctors who have divested themselves from insurance companies and their assembly-line model of medicine, in favor of reestablishing the direct doctor-patient relationship. It is like concierge medicine, but without valet parking, and is designed to be affordable for the masses.
    • Direct primary care practices offer a membership-based approach to routine and preventive care that can dramatically reduce health care costs for individuals, families and businesses.
    • At the core of a direct primary care facility is a medical practice dedicated to providing routine, everyday care, essential for the well-being and ongoing maintenance of a patient’s health. This is where patients go for check-ups, vaccinations, sprained ankles, or frequent headaches.
    • Direct primary care providers know their patients. They have talked with their patients in detail, gotten to know them, treated past conditions and know what recurring problems are experienced. If a patient has a chronic illness, like arthritis or diabetes, their primary care provider is already a partner in management every step of the way. And, in the unlikely event of a life-threatening accident or disease, the provider serves as the patient’s advocate, coordinating care across multiple providers, facilities, and prescriptions.
    • Direct Primary Care is a nationwide movement of Primary Care doctors who have divested themselves from insurance companies and their assembly-line model of medicine, in favor of reestablishing the direct doctor-patient relationship. It is like concierge medicine, but without valet parking, and is designed to be affordable for the masses.
    • Direct primary care practices offer a membership-based approach to routine and preventive care that can dramatically reduce health care costs for individuals, families and businesses.
    • At the core of a direct primary care facility is a medical practice dedicated to providing routine, everyday care, essential for the well-being and ongoing maintenance of a patient’s health. This is where patients go for check-ups, vaccinations, sprained ankles, or frequent headaches.
    • Direct primary care providers know their patients. They have talked with their patients in detail, gotten to know them, treated past conditions and know what recurring problems are experienced. If a patient has a chronic illness, like arthritis or diabetes, their primary care provider is already a partner in management every step of the way. And, in the unlikely event of a life-threatening accident or disease, the provider serves as the patient’s advocate, coordinating care across multiple providers, facilities, and prescriptions.

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