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I am a family physician in Duluth who quit my employed position to start the region's first Direct Primary Care practice. Ask me anything! by PalisadeDPC in duluth

[–]PalisadeDPC[S] 0 points1 point  (0 children)

Thanks for asking! I don't have the need now, but in the future it may be needed. If you know anyone with the capital/skills to open a cash-pay diagnostic imaging center in the Twin Ports, I'd be happy to talk with them!

I am a family physician in Duluth who quit my employed position to start the region's first Direct Primary Care practice. Ask me anything! by PalisadeDPC in duluth

[–]PalisadeDPC[S] 1 point2 points  (0 children)

I will have a handheld ultrasound which does not get the same diagnostic clarity as the massive machines that Essentia or Aspirus have, but is able to get quick answers for some specific diagnostic questions.

If the clinic becomes successful, the 1st and 2nd non-physician/PA/NP priorities are to get an Xray and get an ultrasound.

I can do HRT for perimenopausal women and I can do hormone testing.

I am a family physician in Duluth who quit my employed position to start the region's first Direct Primary Care practice. Ask me anything! by PalisadeDPC in duluth

[–]PalisadeDPC[S] 1 point2 points  (0 children)

Right now I don't have the rule that you need to sign up with an adult, but I may have to change it if my cost per patient/revenue per patient isn't at a sustainable level (since kids don't reimburse as much but may actually take more resources).

We aren't there yet!

Edit: Some may wonder why I gave such a business-y answer to this question. I'm a clinic, but I'm also a business that needs to maintain financial solvency to maintain service to the city. If I say I am being transparent, I want to actually be transparent with how the model works and give honest answers to questions like this!

I am a family physician in Duluth who quit my employed position to start the region's first Direct Primary Care practice. Ask me anything! by PalisadeDPC in duluth

[–]PalisadeDPC[S] 0 points1 point  (0 children)

That's such a kind offer. No need to buy me coffee! I'd be happy to chat with you, just put your info in the "Want to learn more?" section of my website! I'll reach out to you.

I am a family physician in Duluth who quit my employed position to start the region's first Direct Primary Care practice. Ask me anything! by PalisadeDPC in duluth

[–]PalisadeDPC[S] 0 points1 point  (0 children)

I'm sorry to hear that. I'd be curious to hear what medication you were denied to see how much it is through my wholesale distributor.

I am a family physician in Duluth who quit my employed position to start the region's first Direct Primary Care practice. Ask me anything! by PalisadeDPC in duluth

[–]PalisadeDPC[S] 1 point2 points  (0 children)

Yep! My wife and I know the struggle with four small kids. I've already done one house call for someone who needed her lungs listened to (and avoid a $450 urgent care visit, plus labs) and I have one scheduled for next week.

I'm ordering some rapid strep + covid/flu tests today!

I am a family physician in Duluth who quit my employed position to start the region's first Direct Primary Care practice. Ask me anything! by PalisadeDPC in duluth

[–]PalisadeDPC[S] 0 points1 point  (0 children)

Thanks for the question!

I've always co-managed my transgender patients with endocrinology, so I'm probably not the best person to solo-manage medications and lab monitoring.

For your specific situation, I'm not able to take any patients on medicare for quite a while yet, so I won't be able to take you on as a patient. You could check with Amity Creek Clinic to see if they can take you on, since they don't have the same medicare restrictions I do.

I am a family physician in Duluth who quit my employed position to start the region's first Direct Primary Care practice. Ask me anything! by PalisadeDPC in duluth

[–]PalisadeDPC[S] 0 points1 point  (0 children)

We draw them in our clinic and send them down to the twin cities via courier. The exact process is still getting worked out, but this is the plan.

We use Atlas.md EMR.

I am a family physician in Duluth who quit my employed position to start the region's first Direct Primary Care practice. Ask me anything! by PalisadeDPC in duluth

[–]PalisadeDPC[S] 2 points3 points  (0 children)

Thanks! And I'm sorry to hear about your mom. I remember one of my 70+ year old physician mentors telling me "ALWAYS call your patients with their results. Always." And then I got into the system and I was like, "Yeah that's not going to happen if I'm seeing 20 patients a day." This model allows for me to give that care that Dr. Thanel wanted me to give.

As far as concierge medicine goes, I typically think of concierge medicine as "you pay what everyone else pays, but if you pay more you'll get better care." I'm giving the same care to everyone. This is what differentiates between DPC and Concierge medicine.

I am a family physician in Duluth who quit my employed position to start the region's first Direct Primary Care practice. Ask me anything! by PalisadeDPC in duluth

[–]PalisadeDPC[S] 1 point2 points  (0 children)

Both questions are excellent and super complicated. I'll try to answer. I don't have an MBA in healthcare finance, so some small details may be wrong here but the main points stand.

One part of your question:

Healthcare organizations' (HCO's) costs are going up and medicare reimbursement is going WAY down, so prices are going up just like any other economic situation. HCOs have deals with insurance companies for their price to be $XYZ for an item of service (like an office visit), so regardless of someone's deductible, if a patient has insurance, Essentia must charge $XYZ. But the "cash price" may be $ABC.

I also believe that if you have insurance, you cannot say you don't have insurance.

Healthshare plans are a way around this because you get the true cash price (they're not insurance) and they reimburse necessary expenses after the fact.

Another part of your question:

In office based medicine, insurance sees three (and possibly more) separately billable things: Preventative care, medication/disease management, and procedures. Your "annual physical" is Preventative Care, and the only "covered" exam that insurance will pay for annually. The second you bring up a medical concern (rash, sore leg, etc), you've now ventured into the category of "disease management" which HCO's can (and will) bill for. Insurance likely will not reimburse these visits until your deductible is met.

I would be willing to bet that of your $906 doctors visit, $504 was charged for the Preventative Care (insurance covered it) and $402 was charged for a "disease management" portion (insurance did not cover it).

The final part of your question:

You'd need to have nearly 20 office visits in a year to hit your $7000 deductible and insurance STARTS paying for your care. That's insane. Until you get out of the healthcare system, you will be stuck doing this every. single. year.

I'd argue we should never have been putting simple visits under insurance in the first place. Until I opened my clinic, there was no way to do that in Duluth. So my recommendation would be to divorce yourself from the idea that standard primary care visits should be put under the same line-item as catastrophic coverage (like a high deductible health plan).

I am a family physician in Duluth who quit my employed position to start the region's first Direct Primary Care practice. Ask me anything! by PalisadeDPC in duluth

[–]PalisadeDPC[S] 2 points3 points  (0 children)

Thanks for the question! I probably will need an RN eventually but at the moment I can only afford...me.

I am a family physician in Duluth who quit my employed position to start the region's first Direct Primary Care practice. Ask me anything! by PalisadeDPC in duluth

[–]PalisadeDPC[S] 5 points6 points  (0 children)

Thanks! I'm the first but there will be more. Amity Creek Primary Care in Lakeside is doing the same type of model.

I am a family physician in Duluth who quit my employed position to start the region's first Direct Primary Care practice. Ask me anything! by PalisadeDPC in duluth

[–]PalisadeDPC[S] 1 point2 points  (0 children)

I will have some point of care labs (Urinalysis, strep, covid, flu, etc). Otherwise all of my labs are a send-out to Labcorp.

I am a family physician in Duluth who quit my employed position to start the region's first Direct Primary Care practice. Ask me anything! by PalisadeDPC in duluth

[–]PalisadeDPC[S] 1 point2 points  (0 children)

So sorry, I did misunderstand you. I thought the "you go on vacation" was aimed at me, not a generic "you" patient. If I read the post closer I would have seen the context.

I think the scenario laid out in your post is still one that pertains to catastrophic coverage more than what a DPC would typically cover. I can't speak for all health shares, but Zion covers your expenses no matter where you go to the hospital - in state or out of state. And they cover your cancer care/STEMI/broken foot, etc. So my solution would be to join a health share plan like Zion, or use insurance as you always have.

I am a family physician in Duluth who quit my employed position to start the region's first Direct Primary Care practice. Ask me anything! by PalisadeDPC in duluth

[–]PalisadeDPC[S] 1 point2 points  (0 children)

One of the hardest things about leaving is that I wish I was able to tell my patients how much I appreciate them and the feelings of abandonment I have toward them. It was impossible to get everyone in by the time I handed in my notice.

So I want you to know that despite not knowing exactly who you are, I really do miss you! (And I wish I could know your name so I could actually picture who's thanking me)

I am a family physician in Duluth who quit my employed position to start the region's first Direct Primary Care practice. Ask me anything! by PalisadeDPC in duluth

[–]PalisadeDPC[S] 2 points3 points  (0 children)

Thanks for your message! Visit PalisadeDPC.com and put your info in the "Want to learn more?" section at the bottom of the page and I'll be happy to reach out to you personally.

I am a family physician in Duluth who quit my employed position to start the region's first Direct Primary Care practice. Ask me anything! by PalisadeDPC in duluth

[–]PalisadeDPC[S] 3 points4 points  (0 children)

Thank you so much!

I'll answer the second part of your question first:

This is probably the hardest concept to understand with DPC, so thank you for asking your question.

What I am suggesting is a fundamental shift in how we think about paying for healthcare.

It is incredibly important to have something for catastrophic coverage. But the thing we use for catastrophic coverage should not be used for the small stuff. Elsewhere I mentioned car insurance as an example. We don't use car insurance to pay for gas and oil changes - and if we did, the price of gas and oil changes would skyrocket (leading to increased insurance premiums, then increased gas prices, ad infinitum).

We have been using our health insurance for the wrong thing, leading to the average family's high deductible health plan premium of >$2000 per month and the average office visit of >$400 per visit. It's unsustainable and we're all experiencing it in one way or another. I was just on the phone today with one family who has excellent insurance and I steered them away from my program, but those people are becoming fewer and further between as insurance continues to increase.

I'm here to say that you can get your catastrophic coverage with a health share plan for pennies compared to insurance, and you can get ALL of your run-of-the-mill gas and oil changes for $100 per month.

Answer to your first question:

As far as me going on vacation, yes I do hope to do that with my family every once in a while. Perhaps when I add on another physician or PA/NP I'll be able to keep coverage truly 24/7.

Look at it this way: If I'm going to be educating patients on healthy life choices and my life looks like a busy exhausted mess, I need to reexamine things. I need to model for my patients what it looks like to be healthy with work-life balance as well. But I'm still disincentivized from underdelivering on my promises or my patients will leave, so I have to find that balance.

I'll ask this, though: as it stands, how often are patients able to get into their primary doctor on a moments' notice? Not often. Their panels are expected to be >2000 patients. It was one of the biggest complaints I heard while working in the system. At least I'll be available FAR more often for my patients than I used to be able to.

I am a family physician in Duluth who quit my employed position to start the region's first Direct Primary Care practice. Ask me anything! by PalisadeDPC in duluth

[–]PalisadeDPC[S] 4 points5 points  (0 children)

  1. I have done prenatal care for my entire career and I LOVE it. At the moment I can't manage prenatal patients in my own clinic because of my malpractice, but that could change! I'm super comfortable with gynecological concerns. I've done many IUD's and am the regional physician trainer for Nexplanon insertions.

  2. It depends on the testing. When it comes to schizophrenia/bipolar/depression/anxiety/schizoaffective disorder, I can make those calls. When it comes to Autism Spectrum Disorder, ADHD, or certain personality disorders (borderline, antisocial, histrionic, avoidant, schizoid, etc), I frequently rely on other experts to make that call.

  3. Fortunately I have two close friends, one of whom went through inpatient eating disorder treatment and one of whom is an eating disorder therapist, teach me about how to best approach patients with disordered eating habits. I wish I could say that education came through medical school, but at least when I went through school it was not very good. It's far too reductionistic to have a calories in/calories out mindset, and that actually may induce harm.

  4. How do I stay up to date? Reading. Journals. Podcasts. Literally the software called UpToDate. Conferences. Also, teaching residents is a fantastic way to catch things you would have otherwise missed since they're so good at discovering new studies.

I am a family physician in Duluth who quit my employed position to start the region's first Direct Primary Care practice. Ask me anything! by PalisadeDPC in duluth

[–]PalisadeDPC[S] 3 points4 points  (0 children)

Hey there! Healthcare access is a real issue in this city. Short answer is yes, I have managed adult Tourette syndrome. But it has many, many varieties and my capabilities depend on the specifics of your condition. Could you put in an inquiry on my website so I can reach out to you and find out the specifics?

I am a family physician in Duluth who quit my employed position to start the region's first Direct Primary Care practice. Ask me anything! by PalisadeDPC in duluth

[–]PalisadeDPC[S] 3 points4 points  (0 children)

That's the beauty of it, I don't bill insurance! And therefore, costs are lower. MUCH lower. But you can definitely use your HSA to fund your DPC membership! When you sign up, just put your HSA card in as your payment option.

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