A $600 X-Ray for $45: Another Way Direct Primary Care Can Save Money

Guest Author: Dr. Bruce Jung, The Doc Shoppe, Corbin, KY

The following article was originally posted at http://www.inlightehr.com/guest-post-600-x-ray-45-another-way-direct-primary-care-can-save-money/

When I started my Direct Primary Care practice in 2014, one of my goals was to get back to what I loved about medicine, spending adequate time with patients. I also cherished the idea of getting away from all the unnecessary red tape and burdensome regulations that came with third-party payers including Medicaid and Medicare.  What I didn’t anticipate was the opportunity to save my patients serious money.  But when a patient sought treatment for foot pain, we both received an unforgettable lesson in the economics of modern medicine in the United States.

It all started when one of my patients came to see me about a pain in her forefoot.  Although I did not think an x-ray was warranted, she insisted that I order an imaging study.  I called the local hospital to find out the price.  The billing department indicated that the cost would be >$600 before the radiologist’s fee.  Since the patient had a high-deductible ACA health insurance policy, this entire cost would come directly out of her pocket.

Determined to “shop around” on her behalf, I called another hospital in an adjacent town and was told that the price would be just over $400.  I then called a privately owned, unaffiliated, local radiology center and promptly received a price of $100, if she paid in cash.  I was thrilled that the x-ray would cost $100, not $600.  But then I remembered that another, out-of-state, direct primary care physician had told me that his group had contacted their local orthopedist’s office to do their x-rays. So I called a local orthopedist two blocks down the road and negotiated with him to do all my outpatient x-rays for me.  He now charges me anywhere from $40 to $100 for standard x-rays depending on the type of film.  I then bill my patients for the cost of the x-ray and they bring their films to my office for me to read. That foot x-ray? Yeah, it now costs my patients $45.

By going outside the insular world of health insurance, hospitals, and government regulations, we had just reduced the cost of her x-ray by a factor of thirteen.

This is just one early example that has been repeated over and over again, since I started this fairly recent model of medical practice.  My patients pay me $50 per month for unlimited visits (the average is about four office visits per year). This charge includes all routine lab tests (we offer over 100), most in-house diagnostics, flu and tetanus vaccines, plus my personal cell phone number so they can text me when they need my advice.  I even make occasional house calls.

The two-fold basis for this model is the reduction of clinic overhead and the return of health insurance to its proper place.  Insurance products are designed to help us through rare, emergent, expensive and catastrophic events. They are not supposed to be payment plans for every conceivable cost.  In regards to healthcare, people can pay directly for their own relatively-inexpensive primary medical care services thereby eliminating the unnecessary layers of bureaucracy, regulation and subsequent increasing costs.

Not only can Direct Primary Care reduce healthcare expenditures, it has also been shown to  reduce hospitalizations, emergency room visits, and unnecessary imaging studies.  With unrestricted access to their primary care provider combined with adequate visit times, I believe my patients receive better preventative care and consequently have fewer complications from chronic conditions like hypertension and diabetes.  Recently an analysis of two years of data by Qliance, a DPC provider network, showed a 20 percent reduction in overall health care costs annually per patient, compared to traditional health care delivery systems and improved quality and perception of care.

No one can deny that our present health care system is overpriced and unaffordable for many working people in our country.  The Direct Primary Care movement shows the promise of a brighter future through significant cost savings.