Sunset water 1280x400.png

 

What the heck are you thinking, Dr. Cluff?

Simply put, I am fully convinced that this model of Direct Primary Care is the answer. As such, I feel I have the obligation to facilitate this major shift in our trajectory. My patients know that I really enjoy the relationship we’ve developed over the years, but they also know that for years I have expressed concern about the many problems with the current system. This is my answer to years of research and development, and my goal is to reinvent Primary Care. If you are a current or previous patient of mine, I apologize for rocking the boat, but I hope you will jump ship with me – if you do not, I will not be offended, but will miss you and hope that someday you will change your mind.

What is Direct Primary Care (DPC)?

Direct Primary Care (DPC) is a model of, and rapidly growing movement within, primary care that involves a direct decision-making and financial relationship between the patient and physician, eliminating the meddling, costly middle man of insurance (including Medicare) from primary care. And yet insurance may still be used (if financially beneficial to the patient) for lab work, imaging, etc. There is a multitude of different variations, but it usually includes a monthly membership (“retainer”) fee, and purports to improve patient outcomes at an overall decreased cost. It also usually provides extended office visits, short wait times, enhanced access, and other attractive benefits. DPC is an absolute godsend for those without insurance, and almost a no-brainer for those with high deductibles. It's a little harder for those with good insurance and low deductibles (including Medicare patients) to see the value, especially if specialist care is frequently needed; however, DPC physicians believe strongly that even those folks will experience decreased health care costs over time (Medicare is currently doing several DPC pilots), because of a variety of factors, including decreased acute and emergent care visits (due to greater accessibility), decreased hospitalizations (due to improved health), and a reduction in referrals (due to more time with the physician).

How does insurance drive up the cost of health care?

achievement-18134_1920.jpg

There are two main ways in which insurance drastically increases health care costs:

  1. Administrative costs. A significant portion of the health care dollar - some estimate 30-40% - is spent trying to qualify for payment, bill, and collect from insurance companies.
  2. Encourages unnecessary testing. We frequently make decisions to spend precious health care resources based on insurance coverage instead of true need or cost (which should be the primary reasons). Think of what would happen to fuel filters sales if we chose to have it replaced every time it was recommended during an oil change, simply because insurance paid for it (whether we needed it or not, and no matter the cost)!

It is important to further discuss “unnecessary testing.” It also involves ordering tests whose benefits do not outweigh the potential harms or costs, and/or have an unacceptable number of false positives or negatives. Unnecessary testing occurs more frequently if the provider benefits financially (often justified because patients love to be tested for things, and doctors like to learn). Sometimes unnecessary testing occurs to the point that it is outright criminal, believed by the perpetrator that it is acceptable as long as insurance will pay for it (caring more about lining their pockets than the viability of the health care system). Patients are also partly responsible, feeling that since they pay for insurance, they “might as well get [their] money’s worth.” False positives are very expensive, leading to further unnecessary tests, stress, missed work, referrals to specialists, procedures, complications, medicines, etc. The waste is staggering, and we all end up footing the bill.

How can I afford to pay MORE for my health care?

Our goal is to help you spend LESS for your overall health care, allowing you to get MORE of the care you need!  To directly cover the costs, you may be able to change your insurance plan or reduce the amount you allocate to your Health Savings Account (HSA) in order to free up enough funds to pay the membership fee (recognizing that there would be no tax benefit - see below).  In addition, you may realize savings because:

  1. You are responsible for all of your health care costs below your deductible. If you spend less each year than your deductible (as most do*), you will not be spending more, and you will likely be receiving a higher level of care (not to mention all the other Benefits).
  2. DPC saves you a significant amount of money by cutting out the insurance middle man out of Primary Care and reducing burdensome administrative costs and other waste.
  3. DPC allows you to get significant (usually jaw-dropping) discounts on labs and other in-office services, along with imaging and minor procedures you may have been putting off because of the price.

As such, maybe the question should be, “How can I afford NOT to sign up?” Also, it may become more palatable when you recognize that the average daily adult membership cost of only ~$1.60/day is (often a lot) less than what you spend on other things (such as a daily latte).

Can the membership fee be paid for by my Health Savings Account (HSA) or applied to my deductible?

Unfortunately, at this time, probably not (the DPC movement and Congress are working on this – in the form of the Primary Care Enhancement Act of 2017  we encourage you to write your congressman/woman to show your support). However, some accounts may be different, so it is worth asking the powers that be.

Why would I come see you if I have insurance?

TLC Family Health and other DPC practices are perfect for patients without insurance, who are self-employed or self-insured, or have high-deductible or catastrophic insurance plans (and don't usually meet those deductibles). Even if you have traditional insurance, TLC Family Health may provide you with less expensive care overall (see above), i.e., your health care dollar may actually stretch further. As mentioned above, the majority of patients never meet their deductible,* and if you do, you may be able to submit your expenses. These will be “out-of-network” – but we will try to code eligible bills to meet insurance guidelines (remember that membership fees will not be eligible – see above). Another strong consideration may be to get your preventive care (physical exams, vaccines, etc.) with an insurance-based provider, and the rest of your Primary Care with us (à la carte or membership). Lastly, we aim to provide you with enjoyable, personalized care with enhanced accessibility and communication, and a relationship of trust. You also may wish to review our Benefits and Services pages.

Do you accept Medicare?

I see many Medicare patients, but unfortunately I have had to opt out of accepting and billing Medicare.  Just as with insurance, continuing to accept it will not allow me to practice the way I need to in my quest to fix the system.  Medicare patients participate in my model just as anyone else would (see Pricing), but they must complete a Medicare Contract before I can provide any services.  It is my strong belief that Medicare would save TONS of money if they paid for DPC care (there are several pilot studies going on right now), but until then…

My insurance provides a free physical each year. Does TLC Family Health provide one?

Members receive, at no extra charge, one of the following each year:

  1. With the Physician: One extended (35-minute) visit, which may be used as a physical, or
  2. With the PA (Physician Assistant): One extended (35-minute) visit, which may be used as a physical, plus one regular (20-minute) visit

For those who choose the à la carte option, physical exams are billed as an extended or a comprehensive visit, depending on how much time you want or need (see Pricing page for details). The labs usually included with physicals (lipid panel, comprehensive metabolic panel, complete blood count, thyroid stimulating hormone, and PSA) can be billed through your normal insurance or paid for out-of-pocket if the cash-pay pricing (which is amazingly low) we have negotiated sounds more attractive to you.

Can I use my insurance for labs and imaging?

Patients who have insurance can use it for labs and imaging services, which are done at outside facilities. However, we have negotiated significant discounts if you prefer to pay cash, e.g., if you do not have insurance or have a high deductible.

How/Why did you develop this model?

Dr. Cluff first learned about “retainer (periodic fee)-based” models when he was invited (in late 2011) by a concierge medicine company to go to a dinner presentation. Although he loved the idea of having extra time to spend with his patients (the income potential was also attractive), he was immediately concerned both about the cost and the fact that it would exacerbate the primary care physician (PCP) shortage. However, when he heard that such practices also had better patient outcomes (i.e., the patients were healthier), he wanted the same for his patients, and suddenly he had a new mission: To decrease the amount of time required by the physician per patient so that:

  1. More patients could be accommodated, and therefore
  2. The cost could be reduced.

And thus TLC Family Health was born. Dr. Cluff has spent over five years researching and carefully developing this model, which accomplishes the above while still hoping to provide improved care. It could be seen as a combination of various aspects of several different care models, all with the purpose of accomplishing our three-fold mission:

  1. The Ideal Medical Practice Model (among other things, it uses technology to reduce unnecessary utilization of health care resources and to streamline and improve care)
  2. Lifestyle Medicine/Preventive Care Model (a major key to saving the system – 80% of the majority of diseases, including cancer, are preventable)
  3. Patient-Centered/Personalized Care Model (it is all about you – communication and mutual trust are paramount)
  4. Team-Based Care (team members practice to the top of their training, freeing up the physician to address those things for which he/she is needed the most – also remember that you are an active member of the team)
  5. Group-Based Instruction (more efficient and often more effective)
  6. Direct Primary Care/Discount Membership Model (facilitates the above and our mission)

What is the difference between TLC Family Health and other DPC (and what about concierge) practices?

DPC practices are growing in popularity almost exponentially (there were around 140 DPC practices in 2014, and now there are almost 800 – and growth will be even more exponential once I prove my concept), felt by us DPC physicians to be the answer to the majority of what is ailing Primary Health Care in America. Most DPC practices advertise unlimited care for the monthly membership fee, and therefore are 1) usually a little more expensive, and 2) usually have smaller patient panels than TLC Family Health. TLC Family Health is different from most in that we offer 1) a steep discount membership model, and 2) an à la carte option. Remember that all DPC practices run a little differently, with several similarities (CLICK HERE for a nationwide map of DPC practices). Concierge practices are the most expensive type of “retainer” medicine, and usually also bill insurance. They usually provide an even higher level of care (including extensive “executive” physicals) and therefore have the smallest patient panels. Many DPC practices around the country offer discount medicines; unfortunately, Texas law forbids doctors from dispensing their own medicines. TLC Family Health may also differ in that we offer Interactive Group Seminars, patient mentoring, discounted counseling services for members, and an innovative scheduling system.

Why do you charge for portal consultations? It looks like you are trying to nickel and dime your patients.

It is crucial to remove any incentive for providers to try to get patients to come into the office (if doctors can only charge for face-to-face visits, they may try to encourage them). It also reduces unnecessary utilization of precious health care resources; and yet prices are low enough that they do not discourage one from contacting the doctor when one needs to.

If I join TLC Family Health, do I still need insurance?

Yes. We try to provide as much of your care as we can (often >85-90% of your health care needs), and to reduce your need for specialists, urgent care, hospital stays, and higher-cost medicines (consider a prescription discount program such as Blink Health, or use Good Rx to find the cheapest cash-pay prices), but we recommend a high-deductible plan to cover these and other things if needed. Health care sharing ministries may be an attractive option, especially Aliera Healthcare's CarePlus Advantage Plan, which is a great catastrophic plan to combine with a DPC practice like TLC Family Health. You may also wish to consult certain insurance companies that promote level-funded stop loss plans (also see National Association of Health Underwriters):

Are there any contracts to sign? What if I decide to leave the practice?

There are no contracts to sign (just a patient agreement), and you may leave the practice at any time.  If you choose to leave, we will provide a prorated refund of any unused days of the prepaid month.  However, we charge a new registration fee each time you re-enroll.

*Accessed December 26, 2016 at https://www.americanactionforum.org/weekly-checkup/most-exchange-enrollees-will-never-reach-deductible/