Direct primary care: Health care via monthly membership

Feb. 20--BATTLE GROUND -- When people walk into Dr. Dino Ramzi's office for the first time, they often have a common reaction: "Am I in the right place?"

Like at many medical offices, the lobby has chairs lining the walls and a receptionist sitting behind a desk. But that's about where the similarities between Ramzi's office and most other medical offices end.

It's not unusual for Ramzi to poke his head out of his office, right inside the main entrance, and greet patients when they walk in. If he's not there, his physician assistant, Ila Champine, will come say hello.

Inside Ramzi's office is a desk, a couple of chairs and a sofa. He has a small table that looks as if it's constructed from wood pallets; the floors are like distressed wood floors in historic homes.

His office also serves as his exam room.

A small room divider separates Ramzi's desk from the exam table. A nearby tray holds medical supplies. A blood pressure cuff, digital thermometer and other tools hang on the wall.

"It's a throwback," Ramzi said. "This is how offices were in the '40s."

The office arrangement isn't the only thing "old fashioned" -- the way in which Ramzi and Champine provide medical care is, too.

Ramzi's practice, Patient Direct Care, uses a model called direct primary care, in which people pay a monthly fee for access to primary care services. The Direct Primary Care Coalition estimates such practices exist in at least 42 states. The model is supported by the American Academy of Family Physicians, which in a statement said it supports any ethical delivery system that allows the physician and patient to, respectively, provide and receive health care.

"This is not insurance," Ramzi said. "This is direct patient care, where patients purchase their care directly from the provider."

Ramzi opened his practice in a tiny home in May until his permanent office space, 209 E. Main St. in Battle Ground, was ready in July. He currently has 800 patients. Some of the patients are individuals, some are families. Some purchase the membership themselves, others have the fee paid -- partially or entirely -- by an employer.

The membership fee is $75 per month for individuals, $140 per couple and $200 for a family of up to four people. Membership is month-to-month; there's no required commitment length.

The clinic provides primary, preventive and urgent care services, as well as sports physicals and annual wellness exams. In addition, the membership fee covers the cost of many other services and tests, such as urinalysis, blood glucose, rapid strep, immunizations, alcohol and substance abuse screening. EKG and a number of X-rays. The clinic also provides immunizations at no cost for nonmembers younger than 19.

If a patient needs services that cannot be done in-house -- such as some lab tests -- Ramzi said he is transparent about the additional costs.

Wendi Deans has been a patient of Ramzi's since he opened the clinic in July. She has health insurance and a physician at another medical clinic, but she prefers to use Ramzi's office for its convenience. Deans owns a tea house a few blocks from Ramzi's office and can pop in for a visit when she has a break.

"I'm really busy, and sometimes appointments don't work," she said. "But here, I can have an immediate issue and get an immediate response."

Many patients at Patient Direct Care are insured, but that doesn't mean they have the access they want or that they can afford the care.

A Patient Direct Care membership guarantees access, Ramzi said, because if he and Champine get to a point where they cannot accommodate patients the day they call or the following day, he will stop accepting patients or hire another provider.

"This is a product designed around service levels," Ramzi said.

When it comes to affordability, the monthly membership fee may be less than an insured person's copays and other out-of-pocket costs, Champine said.

"This is ideal for someone who has a high deductible," she said. "This way you can feel more comfortable coming in for every sore throat."

Jen Tumlinson of Battle Ground has been seeing Champine weekly. If she used her insurance plan -- her employer provides both insurance coverage and a membership at Patient Direct Care -- Tumlinson would be paying a $30 copay at each visit.

"Not having a copay is very nice," she said.

Affordability was one of two things -- the other was quality care -- that Debra McClure looked for when trying to find health care.

McClure doesn't have health insurance -- she couldn't find a health plan she could afford -- so she was happy to learn about Patient Direct Care on Facebook. She researched the clinic, went in for a visit to meet the staff and signed up. It was the first time she had seen a doctor in eight years.

"I was shocked when he called me one day to just see how I was doing," McClure said of Ramzi. "I can't remember the last time a doctor called a patient just to see how they were doing and if the treatment was working."

Ramzi sees it as providing more effective primary care. If he can keep people healthy and ensure they have access to him, then use of urgent care centers and hospital emergency rooms, which are more costly places to receive care, will go down.

"I really believe in this," Ramzi said. "This can change the health system, one patient at a time."

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