Imagine if We Paid for Food like We Do Healthcare

Dr Ryan Neuhofel, a fellow DPC physician, writes this intriguing look at applying our current medical industry regulations to food. I know I would never pay for a $37 burrito twice.

A thought experiment showing just how dysfunctional and distorting our health insurance system is.
— Read on

Buying Health Insurance? The Outlook Is Brighter

As you navigate new low-cost choices, weigh the risks.
— Read on

Pre-existing is non-existent with Trinity Direct Primary Care

Trinity Direct Primary Care takes care of you. Pre-existing conditions are not a hinderance to care for us. Providing healthcare is our mission so we don’t charge more for patients with diabetes or hypertension. We don’t charge more if you smoke or have a family history of major illnesses. We just take care of you. Simple as that. Come see the difference. Call 244-1800 to sign up today.

Open Enrollment may indicate a farewell to savings

November 1st marks the start of’s annual open enrollment period.  Here’s an example of what our neighbors who don’t qualify for a subsidy should expect.  For an  average small business owner family (two parents, two school age kids) with no subsidies, they have this to look forward to.

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It is incredibly demoralizing to think that an average small business owner with a family of four might have to pay the equivalent of their mortgage for a plan that doesn’t pay anything until they’ve spent $11,300 out of pocket.  If they actually need care they might be paying even more out of pocket.

We need a better way.  In part, Direct Primary Care offers a better way.  While we can’t change how much insurance costs when the government buys it (although we do vote and that’s something), we can change how expensive high quality primary care is.

As the largest Direct Primary Care program in the area, we are able to offer the lowest cost option for services.  With your monthly membership there is no cost for office visits, no cost for phone calls, no cost for email contact with your physician (seriously, here’s Dr. McColl’s direct patient email:, and no cost for most in-house labs or labs needed to manage diabetes, high blood pressure, or high cholesterol.  We offer a simple, straightforward plan for you to be able to take care of your health needs.  Everything that isn’t covered by membership is priced as low as we can make it and discussed before it is done.  You’ll never be surprised by a bill.  Just check out our Trinity Direct Primary Care Lab Test Pricing Guide to see some of the savings you can expect.

In the coming year we will be adding medication dispensing at wholesale prices, telemedicine specialty consultations to help us manage complex issues without patients having to see as many specialists, and counseling with a nutrition expert at our office.  Stay tuned for those details.

Give us a call to schedule your own personal Meet and Greet or Medical Consult to get to know us better.  When you’re ready to save money on primary care and experience ‘Healthcare without hassles, built for you’ then sign up online.  We’re offering a special coupon to anyone who signs up the first seven days of open enrollment.  We’ll give you one free month of membership in the form of 10% off membership rates for 10 months.  Just follow this sign up link to get the discount.

We’re ready for a change in healthcare, are you?

Obamacare premiums expected to climb 38% nationwide reported this interesting infographic on the predicted average increases of Obamacare premiums when open enrollment starts November 1st.  It is expected to be a sharp increase again.  Tennessee is slated to be a 20% or higher increase as a statewide average. Knox County has fared worse than most Tennessee regions in the last couple years.  Many patients choose lower tiered plans to shave cost off their premiums only to find that their deductibles are so high they provide no practical help with day to day health needs. Even the gold plan requires  nearly $1200 out of pocket before it starts to cover routine primary care needs. 

Trinity Direct Primary Care stands ready to provide exceptional primary care services for you and your family regardless of insurance coverage or deductibles.  We offer month to month memberships that cover all visits, all phone calls, and emails with your physician and most in house labs such as strep tests and flu tests as well as many labs used to manage common medication concerns such as diabetes and hypertension.  One out of pocket payment for a walk in clinic or urgent treatment center often exceeds 2-3 months of membership costs. One 15 minute visit for the same price as 3 months of access in Direct Primary Care. Which seems like a better deal to you?  

Article: DPC trumps the ACA

America’s current healthcare debate is plagued with confusion and misalignment. We have a diverse landscape of players and agendas where legislators, multi-tier bureaucracy, health insurance companies, hospital systems, the pharmaceutical industry, patient advocacy groups and organized medicine all take part in deals that have replaced your healthcare with a “qualified health insurance plan.”

As our ACA matures, medical care has become an even more complex and expensive industry, representing 18 percent of the United States’ GDP. Amid all this, primary care physicians are losing their autonomy and instead have become a tool of the entities that pay them for patients’ care: Medicare, large insurance companies, hospital systems and employers.

With Medicare’s newest mandate – MACRA – critical concepts like quality and value are now defined by labor intensive metric measurement (box checking). As a result, most of a physician’s time has shifted from patient care to administrative duties. This “corporatization” of medicine focuses on populations rather than individuals, where data is valued above patient wellness. Primary care needs new concepts, innovations and partnerships to fight the rising costs of healthcare under government mandated insurance. It needs a plan that does not have at its foundation the influence of huge power lobbyists. It is not surprising that a new concept will likely be distressing to those power players like large insurance companies and hospital systems, but such is the disruption that is needed.

Direct Primary Care (DPC) is a practical solution that supplants the craziness in the current debate and, in a simple way, provides a clear path for patients to beat all the rhetoric with something valuable, practical, coherent and concrete – the physician-patient relationship. To put it simply – it aligns the incentives of physicians and patients to 1) take care of the patient and 2) fund that care.

As a recent survey by Health is Primary shows, American views on primary care are clear. Eighty-six percent agree that primary care leads to healthier patients, higher quality healthcare and lower costs, representing the triple aim of healthcare. Not only that, a primary care physician saves money (about 33 percent in some studies) and reduces hospital and emergency room utilization and surgery. The truth is that the large, third parties are not necessary or wanted in primary care. When big business invades the exam room, the simple cost-efficient space for primary care devolves into an opaque, confusing, frustrating and expensive morass that invalidates the triple aim. Let’s discuss DPC, agree about our motives and bring transparency to the topic.

Motives of Direct Primary Care

First, DPC is NOT insurance and does not cover medical costs outside the primary care practice. Generally, patients have a high deductible or “health share” plan to be an ACA qualified healthcare plan. The DPC monthly fee (under $100 / member, commonly with family discounts) is a reasonable monthly retainer contract between the patient and physician that covers primary care office visits and services.

Time efficiencies like electronic communication, texting and emailing are encouraged under this model. Depending on the contract, other services are often included, such as flu shots, annual blood tests and common office procedures like minor skin surgery, laceration care, EKG’s and pulmonary function tests.

DPC does not bill insurance. The practices have low overhead costs, fewer patients in the practice (typically 600 – 1,000, as compared to traditional models with 2,000 – 3,000) and fewer office staff. This all means more time for the physician to collaborate, educate and treat patients.

DPC excludes huge third-party interests that do not belong in the exam room. This model of care is based on the power of human interaction and creativity that is born out of the necessity of the physician-patient relationship. It is an alternative to the fee-for-service merry-go-round that leads to complicated, often erroneous billing and escalating healthcare costs. It puts the onus on the people directly impacted to determine quality and value, and as a result, incentives are aligned.

It is easy to see how DPC aligns incentives between the patient and the physician. Patients are encouraged to get their needed preventative care, manage their chronic conditions and evaluate new issues in a timely fashion – before they become an emergency. Specialist care is not discouraged, but appropriate (not excessive) use is guided within the primary care home. Healthy lifestyle and reasonable prescription choices are a collaboration. Time is given for two-way communication, education, explanation and negotiation using up-to-date medical information, creativity and empathy in an atmosphere of respect, compassion, partnership, fellowship and comfort. Barring the big third parties means their oppressive requirements for reimbursement go out the window. Their senseless definition of quality that results in excessive administrative burden is gone, and the physician’s attention can be focused on the patient, not the laptop computer.

Under our current system of ACA required insurance, the physician has become beholden to large third parties who pay for care. Our current system allows insurance companies and hospitals to effectively “employ” the very physicians who direct and provide a patient’s care, often conflicting with a patient’s best interests. Practices must submit tons of information about patients to those companies to prove quality care was provided.

All that data and coding comes at a tremendous cost – current estimates are that over 50 percent of the physician’s time is spent in administrative duties. As a result, codes and documentation prove quality, regardless of how the physician patient relations succeeds. Another result is physician burnout at a monumental rate – 50 percent of physicians feel it most of the time. Wouldn’t it be better if the patient “employed” their primary care physician?

Numerous examples including DPC practices in California and North Carolina put DPC right on track with the Triple Aim, improving the patient and physician experience, while lowering total medical care cost and improving outcomes.

Amid all this we also see some difficulties. As one might expect, when the DPC model for small practice is expanded to a large scale, new issues arise. While over 90 percent of the new DPC practices are doing well, there are some exceptions. For example, two of DPC’s biggest large-scale practices recently closed their doors.

Thankfully, favorable DPC legislation is progressing. To date, 21 states have passed laws indicating DPC is not a form of insurance. This exempts small practices from being required to comply with that mammoth body of law and regulation.

In conclusion, DPC is the new kid on the block: innovative, disruptive and promising. Investigate it. While it is not necessarily the answer for everyone, it is certainly an answer for many.

Article: States Prove Why Direct Primary Care Should Be A Key Component To Any Health Care Reform Plan

Here’s a great article by Katherine Restrepo of Forbes summarizing how DPC programs are improving healthcare in various states around the country.  It outlines how all of the ACA replacement plans that have been proposed so far provide for HSA style savings within a framework of using DPC memberships to lower cost.  Give it a read and let me know what you think.

States Prove Why Direct Primary Care Should Be A Key Component To Any Health Care Reform Plan

Reignite Liberty’s torch with DPC

The American dream for healthcare needs strong medicine.

The inscription on the Statue of Liberty which is taken from the poem New Colossus written by Emma Lazarus says in part,

Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tossed to me,
I lift my lamp beside the golden door!

Over the last several decades the medical economic model has encouraged physicians to seek out otherwise well and healthy patients.  It was inadvertently done and without any malicious intent but the pressures were there.  The system requires such enormous documentation and coding that it has encouraged patients to conform to the box in which they are placed.  It discourages individualism in favor of protocols.  It celebrates documentation of such things as smoking rates yet hinders the affordability of medication to stop smoking.  The system wants to categorize and number patients and let them be a resource to run through it’s machine.  When patients want to be individuals, freely making their own healthcare decisions, then the system runs poorly.  Those individuals with complex and personal needs become burdensome to the system and often are subtlety shunned.

From it’s foundation Trinity has been principled in seeking to serve those who need care.  They are “the tired, the poor and the huddled masses” to whom Ms. Liberty proclaims refuge.  In this week of political celebration or protest (depending on your viewpoint), we want to again reiterate our stance on seeking to serve those who are sick and hurting.  We stand ready to care for all patients of all conditions.

Any new patient that completes their first appointment by the end of the Inaugeration Day and has one of the three biggest chronic, pre-existing conditions of diabetes, high blood pressure, or high cholesterol for which they are receiving at least one prescribed medication  will have their registration fee of $125 waived.

Call to today and schedule your appointment.  Even if you are unable to be scheduled for this week, know that Direct Primary Care is poised to help.  We routinely care for complicated and chronically ill patients.  Often, we do so in a way that is more affordable and less burdensome than the usual care pathways.  Our goal is your good health.  Come see what the difference is all about.

Pre-existing conditions? Have a discount.

Direct Primary Care is about taking care of patients.  It isn’t about insurance companies or government policy.  It is about caring for patients without outside influence.  We don’t base our standard of care on who is in the White House or who controls congress.  We focus on our patients.

So in light of all the anxiety provoking discussion concerning repealing and/or replacing Obamacare and the effect it might have on patients with pre-exisiting conditions, we want to show you what DPC is all about.  We going to give patients with any of the three biggest pre-existing conditions a discount.  That’s right.  We are going to actually make it cheaper for patients with chronic illness to receive healthcare because that is what we do.  Trinity Direct Primary Care focuses on our patients first.

Here are the details: Any new patient who joins as a member and has their first appointment this week who has either diabetes, high blood pressure, or high cholesterol for which they are taking at least one daily prescribed medication will have their $125 registration fee waived.  Monthly membership billing will start at the end of the first month at the usual rates of $30 a month for children 22 years of age and younger, $60 a month for adults through 64 years of age, and $90 for seniors 65 years of age or older.

Sign up now and call the office for your appointment.  This offer expires when the last appointment this week is taken.

Should I Lie About My Beliefs to Get Health Insurance?

I sympathize with her plight and appreciate her perspective on cost sharing programs but she does what so many authors discussing an ACA replacement do: confuse having health insurance with having healthcare. They’ve never been the same and shouldn’t be. That’s one reason the ACA was never going to work. It took something people need, healthcare, and made them pay for it ahead of time in a very inefficient and wasteful method then called it health insurance.  That’s not insurance at all.  It’s kind of like having a prepaid credit card that imposes huge fees to get access to the money you put on it. You stand little chance of getting the same value out of it that you put in it. 
Should I Lie About My Beliefs to Get Health Insurance?