New clinic promotes direct-service model of health care

Oct. 06--Related Information

Cost of membership

Individuals

-- Ages 0-18: $35 per month

-- Ages 19-64: $95 per month

-- Ages 65 and older: $125 per month

Families

-- 2 adults, up to 5 children: $200 per month

-- 1 adult, up to 5 children: $150 per month

Employers

-- 0-9 employees: $95 per person

-- 10+ employees: $85 per person

-- 30+ employees: $75 per person

-- 100+ employees: $65 per person

YAKIMA, Wash. -- When Dr. Richard Edgerly shows up for work at Assurance Healthcare and Counseling Center, he's not worried about racing through 30 or 40 patients in a day to break even.

He's also not overly concerned with immediately labeling patients with a certain diagnosis, just so he can be reimbursed for his services.

Nor does he care about how much an insurance company will pay him for certain procedures.

Instead, he gets to focus on spending time with his patients and keeping them healthy.

"That's kind of what it's all about," Edgerly said last week at his office on 40th Avenue and Nob Hill Boulevard. "Patients, I think, want different care than what they're now getting, and I wanted to give different patient care than I was being allowed to give."

The idea for Assurance Healthcare came about a year and a half ago, Edgerly said, when he was working at Ahtanum Ridge Family Medicine, a practice owned by Yakima Regional Medical and Cardiac Center.

The myriad requirements within the health care and health insurance system have taken patient care away from the physician and the patient, he said. It was too much about the money and the paperwork, not enough about patient care.

So he and Holly Porter, a licensed mental health counselor, are now running what's called a direct-service practice, sometimes known as "concierge medicine." For a set monthly membership fee, patients get unlimited office visits, medications and lab work at cost, and easy access to their providers. Appointments last as long as they need to, and insurance does not enter the picture.

"For a basic membership, they come in and get a complete physical, the labs that go with that annually and as many office visits as it takes to take care of their health care," Edgerly said. "It includes all procedures; anything we can do in our office is included in that membership."

The office contracts out with a mobile service vendor for X-rays, whom they call when a patient needs an X-ray and who shows up within 30 minutes. For the X-ray and a read of the image by a radiologist, the total cost to the patient is $75.

For a glycohemoglobin test, a common procedure for diabetic patients, he charges patients $3. Normally, patients are charged about $58, he said.

Edgerly is also able to limit the number of his patients, so he'll only have 600 to 800 patients to keep track of, rather than 2,500, as is the norm at traditional doctor's offices.

Including mental health services in the same building was important, he said, because often the hassle of calling around to find a counselor can be a very high barrier to people who truly need mental health services. At Assurance, he can just walk them down the hall to meet Porter.

Both providers are constantly on call, although once more physicians join the practice, they'll be able to rotate. But they say patients have respected their time and only call when they truly need it.

"Part of wanting our patients to have access to us is we really do care about them; we really want to be their doctor and their counselor," Porter said. "I think it gets to the heart of why we're doing this model. It does limit how many patients we can see a day, so we can take care of our patients when they need us, which might be outside the regular 8-to-5 workweek."

So far, Assurance has nearly 600 patients, Edgerly said. They're talking with several businesses that might want to use the clinic for their employees' primary health care needs, and to four or five other physicians waiting to join the practice once the patient load increases. But their patient panel will be dictated by their physicians' capacity, not by reaching a certain number in order to make enough money.

"We're in the black," said Edgerly, who used his own savings to help start the practice. "I'm not making as much money as I did last year yet, but everything's paid for."

This kind of direct-service practice was codified in Washington state law in 2007. As of December, there were 28 such practices statewide, according to a report by the state Office of the Insurance Commissioner.

There will probably be continued interest in the idea from physicians as the model gains more recognition, along with other alternative pathways to providing medical services, said Bob Perna, director of health care economics and practice support at the Washington State Medical Association.

"The driver behind this ... is the very high cost of operating a medical practice," he said. "It used to be much simpler: You could just open an office and invite your colleagues to send patients to you. But the cost of running medical practices has become so prohibitively expensive that people look for economies of scale," like mergers and acquisitions and affiliating with larger organizations to spread the cost around.

For patients, he said, the benefits of direct-service doctors seem clear: Reliable access to a primary care provider, longer appointment slots and a strong personal relationship with their physician.

Direct-service providers are not meant to replace health insurance, he said, as they only provide primary care services, not procedures for major accidents or treatment for serious illnesses like cancer. But Washington's state's insurance exchange will increasingly offer catastrophic policies, he said, which patients might choose to pair with the primary care offerings of a direct-service provider in an attempt to get the best bang for their buck: Pay $95 a month for unlimited primary care, and keep the high-deductible catastrophic plan in case of a real emergency.

"Patients will need to have both," he said. "They're not intended to be mutually exclusive models."

For now, Edgerly and the team know that others are watching them closely, waiting to see how it works. "It's something that physicians love, and other places have talked about," said Jason Larsen, CEO and co-founder of the practice. "Could this be the revitalization of primary care?"

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