Most Americans have been to a doctor’s office at least once in the past year. The process is usually the same: book an appointment, visit the office, make your out-of-pocket and/or insurance payments, and leave quickly.
These visits are brief for a reason. A typical physician’s income largely depends on the number of patients they see daily. The more patients that come through, the more money the physician makes. Consequently, doctors are financially incentivized to make each visit as quick and efficient as possible.
Some people enjoy the convenience of fast and easy medical care. Regardless, many of today’s typical medical practices can lower the quality of that care.
Enter Uncommon Healthcare, a Direct Primary Care (DPC) clinic in Waco. By emphasizing the doctor-patient relationship, Uncommon Healthcare provides a unique model of healthcare service.
“I think patients choose Uncommon Healthcare because it is about the relationship,” said Dr. Felicia Macik, the founder and sole doctor at the clinic. “It’s about great patient care, but the relationship helps me provide really personalized care for the patient. I take the time to get to know them, their family history, their personal history…You just can’t do that in a 15-minute visit,” she said.
Many doctors do care about their patients, and most people still receive high-quality healthcare in the U.S. Health insurance also provides great benefits for its holders. However, some of the administrative red tape, insurance company practices, and focus on productivity in our current healthcare system have increased costs and lessened patient personalization.
DPCs like Uncommon Healthcare focus more on each individual patient than most primary care offices. Primary care is the most common form of healthcare, consisting of doctor checkups, diagnoses, injury treatment, and more.
“It’s not that [doctors] don’t care for their patients or don’t provide quality care for their patients,” Dr. Macik said. “It’s just that [quality care] is my main prerogative…We should be incentivizing quality, not quantity.”
Uncommon Healthcare’s payment structure further sets it apart from traditional clinics.
“There is no copay,” Dr. Macik said. “Patients pay a monthly membership fee to be a member of the practice. That includes all of their primary care: pediatric well-care, management of chronic medical problems like high blood pressure and diabetes, and other problems,” she said.
Copays are the fees patients usually must pay to visit a medical professional, regardless of the actual cost of care. They vary according to your health insurance plan and what kind of doctor you are visiting.
For example, a patient may have to pay $25 out-of-pocket for every routine checkup, or $50 to see a cardiologist.
Copays are not the only payments the clinic eliminates. “We don’t accept or process any insurance, although most of our patients have it,” Dr. Macik said. “They use it for everything except me. So they’ll use it if they need an MRI, or an X-ray, or a lab test,” she said.
Health insurance is supposed to save patients money by covering most of their medical bills after the patient has paid off their deductible. A deductible is the amount of money a patient must pay for medical expenses that year before insurance kicks in. Last year, the estimated average deductible for individuals in the U.S. was $1,644.
Health insurance can prevent people from losing catastrophic amounts of money: instead of paying $30,000 for a surgery, they may only have to pay $8,000, for example. However, according to Dr. Macik, health insurance can sometimes bring about unnecessary expenses that do not pay off.
“The only thing insurance does in a primary care setting is make it more expensive,” she said.
Before Dr. Macik founded Uncommon Healthcare, she worked at a normal clinic. “Whenever I was working in an insurance-accepting practice, I had at least three, sometimes four or five, people in the front processing insurance claims…That’s overhead,” she said. “For patients paying cash, or who have a high deductible plan, that cost gets passed on to them.”
Imagine car insurance as an illustration of this concept. Cars are insured against major repairs and accidents; insurance does not apply for tire changes, scratches, or other minor repairs. If these smaller matters were part of an insurance plan, car repair companies would have to pay for the expense of processing that insurance—and consumers would thus have to pay higher prices for the service.
But if the cost is already insured, isn’t the insurance company covering all of it? Not exactly. Remember the deductible: insurance only starts to cover costs after you have paid a certain amount. Additionally, under most insurance plans, insurance only pays for a percentage of those post-deductible costs—often 70-80%.
Health insurance drives up the cost of primary care, but that higher cost is not always balanced by better quality care. Doctors can experience pressure from insurance companies to prioritize efficiency over quality.
Insurance companies have significant influence over physicians who accept their insurance. “If I’m accepting insurance, [that company] would rank me based on my quality, but really it’s about my efficiency and how I provide care with reasonable cost,” Dr. Macik said.
This might mean not sending a patient to four weeks of physical therapy when she only needs two or prescribing older medicine that is cheaper than brand new forms of medicine, Dr. Macik explained. In this way, insurance companies can minimize their coverage of medical costs.
Dr. Macik still recommends that everyone hold some form of health insurance in case of emergencies and major medical costs. But by eliminating the need for health insurance in primary care, she seeks to make those services more affordable for her patients.
“There are so many steps to getting care…We’ve lost the ability to trust one another,” Dr. Macik said. “Patients are very confused and find it very difficult to navigate the system.”
Many doctors do care about their patients, and most people still receive high-quality healthcare in the U.S. Health insurance also provides great benefits for its holders. However, some of the administrative red tape, insurance company practices, and focus on productivity in our current healthcare system have increased costs and lessened patient personalization.
Direct Primary Care clinics across the U.S., like Uncommon Healthcare, are reversing these trends in their own practices.
“Can all patients see Direct Primary Care physicians? I don’t think so, because there wouldn’t be enough physicians to provide that type of care for everyone,” Dr. Macik said. “But I think there’s definitely a place for this kind of care, and there has been a big demand.”
One reason there are fewer DPCs than big practices is because of the additional work required to start one.
“It’s very difficult to run a business,” Dr. Macik said. “It was a huge leap of faith. My husband and I were both very serious about it, and we had to really trust God to make it successful. I tell my patients, ‘This is God’s practice and I get to work here.’”
Although they may not be for everyone, DPCs provide a feasible alternative to modern healthcare—one that stands for the free market and the fair treatment of patients.
