Direct primary care appears to be catching on

Sept. 04--BREMERTON -- It's been a year since Tanya Spoon stepped off the health care treadmill.

Tired of the hectic pace at a conventional family practice in Silverdale, the nurse practitioner opened a clinic near her home in Bremerton that operates under a direct primary care model. Spoon's patients pay a flat monthly membership to cover their basic care and their insurance isn't billed.

The idea clicked. After 12 months, Spoon has nearly 700 patients and is hiring a second nurse practitioner this month to continue growing the business. She said Manette Clinic broke even after six months.

Spoon doesn't make as much money as she did at her former practice, but she measures her success in the time she's able to devote to patients, and her own quality of life.

"My life/work balance is amazingly better," she said. "I get to go home ever day for lunch."

Similar direct primary care practices are gradually catching on across Kitsap. In Poulsbo, family physician Peter Lehmann left The Doctors Clinic at the start of 2016 to open Vintage Direct Primary Care. He signed up nearly 550 members in eight months and, like Spoon, considering bringing on a second provider.

Two other former Doctors Clinic doctors in Poulsbo, Andrea Chymiy and Marie Matty, created Pacifica Medicine and Wellness, which offers both direct primary care memberships and what the duo calls "affordable concierge medicine." The concierge option allows patients to pay a monthly fee to ensure easy access to care, while still using insurance to pay for services. Pacifica Medicine had more than 1,000 patients in June, according to a Kitsap Peninsula Business Journal story.

Only a tiny fraction of the county's providers and patients are involved in direct primary care, but many are eager to extol its benefits.

For providers, its an opportunity to spend more time practicing medicine. Spoon cared for about 4,000 people at the conventional primary care practice in Silverdale, carving out a few minutes for each visit. At Manette Clinic, she guarantees patients at least 30 minutes each time they see her, and she makes frequent house calls and visits to assisted living facilities.

Lehmann said he can devote 90 percent of his time to patients, "not on billing, medical coding, compliance with insurance regulations, etc."

Most patients still carry an insurance plan to cover specialty care and emergencies. The direct primary care memberships, which range from about $25 to $100 depending on the practice, give them virtually unlimited access to their primary care provider.

Manette Clinic patient Janet Gibson said she spends less on her monthly membership than she typically would on insurance co-pays. The Port Orchard resident said she hasn't had to take her children to urgent care since signing up for the service, and she appreciates the extra attention Spoon gives her family.

"It's been amazing," Gibson said. "You have plenty of time for your appointments."

The direct primary care model isn't a fit for everyone. The monthly membership tends to make the most sense for families that see their doctor frequently. Spoon said she's had a number of people sign up for memberships and later drop out.

Still, buzz around Spoon's clinic is growing. August was her busiest month to date, with 36 patients signing up, all from word-of-mouth referrals.

As for herself, Spoon said she has no interest in returning to a conventional practice.

"I'll do this for as long as I can," she said. "It's given me a lot of peace and freedom."

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