New to N.H, direct primary care offers unhurried, personalized service for a monthly fee
By Meera Mahadevan, Granite State News Collaborative
Primary care doctors, feeling the weight of industry-wide changes, say the pressure from outside forces – such as insurance companies and corporate ownership of hospitals and doctor practices – has forced them to see more patients in a shorter amount of time; spend a good chunk of their day talking to patients’ insurers to get prior authorization; catch up with electronic medical records; and spend too much time on their electronic portals communicating with patients at the end of the day on their own personal time, all in the name of their employer’s bottom line.
Gone are the days when a family physician could spend extended time with their patient and get to know them on a deeper level. The steady shift away from that traditional model has drastically impacted and reduced a doctor’s own quality of life or even resulted in burnout.
“I felt like I couldn’t practice medicine the way I wanted to,” said Dr. Kelly Parker-Mello, a pediatrician in Portsmouth. “I couldn’t make the same impact I wanted to make. It was that hamster wheel all day long. Barely eating, I used my lunch to catch up. I take a lot of time with my patients. I’m really thorough. I wasn’t finishing my notes. I was running late with patients. I felt terrible for my next patient. It was this constant churning and then running out at 6:30 to see my kids. I only worked part time, but I had this constant feeling I was behind on my notes. I worked on my days off. As a mom, it felt horrible.”
Dr. Kelly Parker-Mello during a home visit. She started Tailored Pediatric Medicine, a concierge medicine provider in Portsmouth, because ‘I felt I couldn’t practice medicine the way I wanted to. I couldn’t make the same impact I wanted to make. It was that hamster wheel all day long.’ (Courtesy photo)
As a result, some doctors, including Parker-Mello, are turning to innovative ways to cut out insurers, and improve their own quality-of-life issues and going directly to patients through a membership model of payment known as concierge service or direct primary care.
Proponents say that under this model, which is relatively new to New Hampshire, patients can have direct access to doctors at every visit, can see their doctor for a longer period of time than they would under a traditional model, and can get seen much sooner for appointments. Concierge medicine also provides the opportunity to develop strong patient-doctor relationships and offers what they say is transparent pricing. Some practices even offer home visits from the doctor for an added fee.
The rates of membership and the services they offer vary at various practices. For instance, at Dr. Parker-Mello’s practice, Tailored Pediatrics, the fee is $315 a month for patients who are newborn to 12 months. For ages three to 22, the fee is $179 a month. The fee is higher for the first year because infants require more frequent visits and more checkups.
At Winding Brook Direct Primary Care in Wolfeboro, the monthly membership fee is $125 for those 55 and over and $75 for those 18 to 35. Add-on services, such as lab testing or joint injections, cost extra. The doctors say they always let the patient know ahead of time what the services will cost before they are charged.
To be sure, direct primary care doctors still encourage patients to have health insurance in case of hospitalizations or catastrophic illnesses, but opting for the new model can give patients the opportunity to return to the days when a doctor could really get to know a patient and give them the time it takes to treat them. Concierge doctors also say that the membership fee ends up being not much more than what patients might pay in co-pays and deductibles under a traditional insurance model.
There are currently eight direct primary care practices in New Hampshire, according to the New England Primary Care Alliance, a regional association of concierge providers. In comparison, Maine has 46 such practices; there are none listed in Vermont.
“It has been the best decision I have ever made,” said Winding Brook’s Dr. Rebecca Owen, a primary care doctor who switched over to the concierge model after being employed by two hospital systems for several years.
Her patients agree.
Lewis Gurnari, 72, of Gilford, says he is glad he and his wife have chosen Dr. Owen as their primary care doctor after what he described as seeing a revolving door of practitioners after their primary care doctor retired five years ago.
“It’s all about the physician,” said Gurnari. “I don’t care what you call the service. .. You need to have a physician who becomes your advocate and helps manage scenarios, all of it – - the specialists, the follow-ups, developments and interpreting it. She can define it for me and give me options.”
“It gives you an advocate,” Gurnari added. “It gives you accessibility at all levels, which you do not have in the current system. I can call her tomorrow and get it done. If I call my general practitioner, I’m three to four weeks out unless it’s a critical event. If she calls (for a CAT scan for example), I get moved to the top of the list. What you’re purchasing is accessibility.”
However, some analysts say concierge medicine runs the risk of excluding patients who may not be able to afford the membership costs and does not alleviate concerns over the workforce shortage in primary care.
Dr. Karl Dietrich, director of Dartmouth Health’s family residency program at Cheshire Medical Center in Keene, says the “challenge’ with concierge medicine “is that it is wonderful for a small set of folks, but it doesn’t solve the global issue and it doesn’t create more primary care for everybody. I want to both applaud the emphasis on provider wellness and people setting boundaries around what is reasonable expectation, but at the same time how can we make sure that we’re solving the global problem, because if every doctor moves to direct primary care panels, we are going to need a whole lot more (physicians) than we even need right now. So how can we continue to think about ensuring physician wellness and offer an equitable access to care that would put a family doctor in every community that needs one?”
This story is part of Critical Condition: What hospital consolidation means for care, access, and your community, a special series co-produced by partners in the Granite State News Collaborative. These stories are being shared by media outlets across New Hampshire. We want to hear from you! Take our short survey athttps://tinyurl.com/3au39uctabout your healthcare experiences. For more information, visitcollaborativenh.org.