Why some Tarrant physicians are opting out of insurance to offer membership-based care

Melissa Hamiton, 44, never had a great experience with her primary care doctors.

The mother of four remembers taking her sick children to the doctor’s office and spending hours of the day in the waiting room. She spends only a few minutes in the exam room before the doctor is available and moves on to the next patient.

She said the children’s short time with their doctor was frustrating and she felt like the money her family had invested in insurance was being wasted.

“Insurance is expensive,” Hamiton said. “My husband is a veteran so he has insurance, but just me and our four kids who are still at home cost up to $1,400 a month, not including the primary care part. That’s just an astronomical number. ”

No matter how many years passed, nothing changed.

Hamilton’s family continued to use their insurance until new discoveries were made. direct primary care.

Through the Direct Primary Care model, practitioners opt out of accepting insurance plans and instead require patients to pay a monthly fee to receive primary care services. Instead of billing a third party, patients pay the doctor directly.

Although this model is relatively new, it has grown rapidly over the past six years, with more than 1,400 practices in the United States. According to a 2021 survey From the National Library of Medicine. Currently, Tarrant County has more than 20 direct primary care clinics. According to DPC Frontier.

More people, including those in Hamilton, are choosing not to pay into insurance plans and instead choosing clinics across Tarrant County that are taking advantage of the growing health model. For physicians, direct primary care offers a new dimension of clinic ownership never seen before.

“Needs are met”

Dr. Kara Farley has always been frustrated by the disconnect between patients and their doctors. When she decided it was time to start her own clinic, she wanted to offer something different.

“The reason I went into medicine was to build relationships with patients and provide quality care, and you can’t do that in a 15-minute model with patients,” she said. .

Through extensive research, Farley discovered direct primary care through the Facebook group “Real Physician Moms of DFW.” She was able to meet a doctor who was successfully running her own practice using her model of care.

When the model opened Farley’s eyes, she was the first to jump.

Farley is now open Mid City Direct Primary Care At Grapevine in January 2021. Monthly fees for this exercise range from $50 to $100 per person, depending on age, with a one-time participation fee of $150. According to Midcity’s website, the clinic is not currently accepting new patients.

As a member, patients have unlimited access to Farley and other physicians on her team. Farley said that during a visit, doctors can spend more time with each patient instead of rushing to see another patient because they don’t have a quota to meet.

“When patients started coming here, we noticed a difference in the quality of care they received,” Farley said. “We typically have an hour to hour and a half appointment. We go through their entire history. We cover everything we need to cover in one visit.”

Mid-City had 50 cases in the first six months. Since then, the practice has grown and he now serves more than 750 patients in North Texas.

In early 2021, Hamilton was referred to Mid-Cities Direct Primary Care by her husband. Although Hamilton was shocked to hear about her low membership fees, he was soon intrigued and joined her practice.

Ms. Hamilton enrolled and pays $400 a month for her entire family to receive primary treatment from Farley. Her clinic has changed her life, she said.

“All of our needs are met,” Hamilton said. “I can call (Farley) and I can text her. I texted her at 3 a.m. because my child had a fever and I was in a complete panic. …I’ve been a mother for 26 years. But I have never had such a great experience.”

The direct primary care model bridges the gap for people who can’t afford insurance but also don’t qualify for health assistance programs, said founder Dr. Alex Vilayson. enlightened health direct.

“Many patients don’t have health insurance, but because they earn too much, they receive too many benefits from JPS or Parkland,” he said. “We’re saying every dollar counts as a disqualification. …We wanted to cut out the middleman of health insurance.”

Like Mid Cities, Enlightened Health Direct also offers primary care services, but monthly fees range from $39 to $95, depending on the patient’s age. Since launching in 2022, Enlightened Health Direct has grown to serve more than 130 patients across North Texas.

“It’s hard to compete.”

As direct primary care clinics begin to grow in popularity, there are several challenges to overcome. Billiton said there is a lot of skepticism about commitment from patients, which could affect the success of the practice.

“When you come out of training, these big hospitals try to hire you, and they give you a good salary, but it’s hard to compete,” Billiton said. “It’s hard to turn that down and say, ‘No, I’m going to start my own practice on my own. I’m going to start with zero patients and hopefully at least one person will pay me.'” This is a really scary thing in direct primary care. ”

Although direct primary care helps keep children healthy, Hamilton worries about a major hospital emergency. Without insurance, medical costs can be high. Ms. Hamilton and her husband are considering insurance plans with high deductibles for emergencies, known as catastrophe coverage, she said.

However, Ms. Hamilton believes that keeping her children healthy reduces the chance of emergencies and that staying on a membership plan is more beneficial than quitting. She believes that direct primary care is revolutionizing healthcare.

“I told my husband that I would rather not have insurance than lose Carla,” Hamilton said. “She’s much more accessible. She’s a friend of mine now. I don’t just see her as my doctor. I feel like her practice really needs to move in this direction. ”

David Moreno is a health reporter for The Fort Worth Report. His position is supported by a grant from Texas Health Resources. Please contact [email protected] or @davidmreports X, formerly known as Twitter.

At The Fort Worth Report, news decisions are made independent of board members and financial supporters.Read more about our editorial independence policy here.

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