Having practiced medicine for 30 years and seeing first-hand the changes that have transpired in the health-care delivery system over time, Dr. Castor became worried with the direction that traditional fee-for-service health care was heading. Increasing demands have been placed on primary care physicians. There continues to be a push to see more and more patients daily to generate revenue that covers overhead expenses due to reduced reimbursements for services by insurance companies.
The electronic medical record (EMR) requires more of a physician’s time, documenting everything needed to justify an office visit charge or to meet meaningful use measures mandated by insurance companies. This ate away at valuable time that Dr. Castor wanted to spend with her patients and her family.
The COVID 19 pandemic had a profound impact on fee-for-service health care, forcing a dramatic change in how primary care physicians are reimbursed. Through an emergency ordinance, insurance companies began to reimburse for other types of patient visits, such as telephone and telemedicine visits. Often, however, reimbursement was less than in-office visits, especially if telephone visits were utilized, penalizing physicians who see elderly patients with limited electronic savvy or lack of access to a smart phone. That resulted in health-care systems pushing for more in-patient visits as they tried to make up for revenue losses.
In early 2020, Governor Sununu’s stay-at-home mandate created disruptions in how primary care physicians could care for patients every-day concerns, because reimbursement from insurers was based on in-office visits. Consequently, physicians were not spending as much time seeing patients, even though they were considered essential personnel. Until a reimbursement model was created for telemedicine, Dr. Castor’s practice was essentially shut down and she was spending more time with her family and less time on the EMR and electronic desktop. She enjoyed having the time to experience a better life-work balance, but quickly realized that the current health-care system is heading in a direction that she did not want to go. It was robbing her of the joy that she used to experience in practicing relational medicine. Dr. Castor chose to leave traditional fee-for-service medicine behind to restore the relational health care she enjoys and to maintain a better life-work balance.
What followed was a year of recovery. Dr. Castor enjoyed family time and reconsidered her role in medicine. After working at a local urgent care and performing in-home visits and risk assessments, she rediscovered the positive impact she could have on individual lives while being able to find the right balance for work and family.
During that hiatus, she learned about the DPC model of care delivery and realized that model offered what she had desired and longed for while providing for a healthier work-family balance and the ability to restore the joy she finds with practicing medicine. Integra Direct Primary Care was birthed, and Dr. Castor believes that it meets the needs of many patients who she has encountered over the past 30 years. She looks forward to returning to practicing the art of relational, primary care medicine once again with joy restored for everyone.
Absolutely. While we do not work with insurance or bill your insurance for our office care, you may use your insurance for anything that it would normally cover outside of our office. We are happy to submit any referral with the appropriate diagnosis codes needed for insurance purposes.
We recommend that everyone have insurance coverage for major health expenses (ie: accidents, hospitalizations, catastrophic health issues, high-cost medical expense, etc…) In our DPC practice, insurance coverage can be used for specialists, urgent/emergency room care, hospitalizations or outside testing/procedures. Dr. Castor will assist with any prior authorizations that are needed and will provide appropriate CPT codes.
For heavily discounted services that Integra DPC can offer, the price will be transparent, and members can decide whether to pay outside of their insurance or utilize their insurance coverage.
We can help determine the direct pay price for services outside of our office to help lower your out-of-pocket expenses. In many cases, even if you have insurance, you can save money by paying directly at the time of service rather than paying the higher insurance negotiated rates. This is a good option if you believe that you won’t reach your deductible.
DPC is not insurance, and we recommend that all members have at least a catastrophic insurance plan to cover any costs for unexpected critical illness or accidents requiring hospitalization or multiple specialty care.
Integra DPC’s direct pricing for lab work provides significant savings compared to typical fee for service lab work. Dr. Castor hopes to be able to offer this with in-office phlebotomy soon.
Once in-house phlebotomy and direct pricing becomes available, pricing will be transparent and provided to members prior to service. Should the member opt for direct-lab pricing, they will be charged for the lab work at the time blood is drawn. If the member opts to have lab work done directly at the lab through their traditional health insurance, a hard copy lab order will be provided to the member with the appropriate diagnostic codes.
Concierge Medicine participates with medical fee-for-service insurances (FFS), as well as charges monthly access fees. The access fee enables the doctor to see fewer patients and gives the patients more access to their doctor, however, the doctors are still working for and contracted with insurance companies, the government and, often a concierge management company.
With DPC, the doctor is paid by and works for member patients. Your doctor works only for you and your payments to her include the medical care services received. Being referred by a DPC doctor does not diminish in any way the validity of your health insurance.
Direct Primary Care vs. Concierge Medicine
Absolutely! Your physician can take care of patients regardless of their insurance situation. Your physician works completely outside of the insurance system, therefore none of the billing for health care through the office is eligible for insurance reimbursement.
Membership fees are not reimbursable by insurance and we do not code for office visits because we do not want to be influenced or directed in any way by the coding requirements of insurance. Coding is simply a payment system for insurance and government payers, and has no clinical benefit, making it a distraction from your health care.
We recommend that everyone have insurance coverage for major health expenses (cancer, accidents, hospitalizations, catastrophic health issues and other high-cost medical expenses). Being a patient at this practice does not negate your insurance benefits in any way. Since we have no contracts with insurance providers, we will not be paid by insurance at the office. The primary reason for this is that we want to have a direct relationship with our patients and minimize the influence of insurance and government agencies on treatment options and access to health care which would otherwise influence our medical decision making.
We should be able to save you money, as we are not bound by insurance contracts to charge a minimum rate and our wholesale prices are often lower than the price your insurance has negotiated with other providers. We do not have to inflate our overhead to cover costs, that generally occurs for insurance-based practices, so prices on things like EKGs, in-office testing and other in-house services are significantly reduced. Also, fee-for-service (FFS) insurance-based practices get reimbursed for face-to-face visits and as such, they need to bring patients into the office in order to receive payment for their services. They will often see 18-20 patients a day, thus providing less time with each patient to care for multiple health-care needs, education and prevention.
If we need to send you to a specialists or outside testing, we will provide appropriate medical coding and assist with any prior authorizations that are needed. We want you to use your insurance for those higher-priced services when it makes sense. However, we often find that patients get better pricing from providers by requesting discounted pricing for payment at the time of service. If they pay outside of their insurance, especially if they have a high-deductible plan, prices are often significantly reduced.
You will always know exactly what everything costs because of simple and transparent pricing. While working in my prior FFS practice, I often utilized websites where patients could purchase lab tests directly online to significantly lower costs for lab work for patients who had high deductibles or were uninsured. However, through direct billing to a lab, the costs to me are significantly less, and because I don’t have insurance contracts, I can pass that savings directly on to you.
Insurance-based doctors spend a significant amount of time on computers attempting to satisfy the billing and coding requirements of insurance companies. None of this work benefits patients in any way, and in reality, prevents physicians from being able to spend their time in more clinically productive ways with patients, reading medical journals or researching information. They are often asked by their employers to, “see just one more patient a day,” to increase revenue.
Patients are better served by a physician who can focus on clinical medicine and not clerical or administrative work to meet data collection and entry requirements of insurers. With DPC, you have access to a physician who knows you when you need them.
Under the insurance payment system, most Internal Medicine primary care doctors are responsible for 1,500-2,000 patients, which means that their patients often see other doctors and mid-level providers when they are ill or for follow up of chronic disease or be referred out to local urgent care centers for acute issues. This results in fragmented and de-personalized medical care. You will be able to see your personal physician, often the same/next day for acute visits. You are also guaranteed longer appointments for each visit. Our minimum appointment time is 30 minutes, whether or not you need it. Comprehensive Wellness visits are up to 60 minutes. You don’t have to stay the entire time if you don’t need to but be assured that you will not be rushed through the visit. The FFS 15-to-20-minute acute and follow-up office visits evolved as a response to economic demands associated with rising costs of overhead without any rise in reimbursement from insurances (in many cases a reduction in reimbursement over the years). This created the volume business and industry that medicine has become. Neither the patient nor the physician thrives in that environment and certainly the relationship between patient and physician suffers significantly. Or worse, the relationship never fully develops.
Health-care costs in the United States have escalated beyond control. Patients are paying higher premiums with higher co-pays, deductibles and co-insurance mandates, while receiving fewer benefits. The costs of prescription medications continue to rise. Primary care physicians are often penalized or rewarded by insurance companies for the total health-care expenditures incurred by their patients, even though they have no control over that. Consequently, primary care physicians are often put in that ethically untenable situation of misalignment of financial incentives with their professional duties to their patients. Working in a direct primary care practice, my job is to work for you and only you.
A monthly fee also helps patient’s budget for their health-care needs without redundant or hidden costs, so that there are no surprised.
Your health records belong to you. We do not send your records anywhere without your permission, as explained in the member contract. Information will be sent/shared if you are referred to a specialist, or if prior authorization is needed through your insurance.
After your enrollment is accepted, you will receive an email from Integra DPC with a link to complete a packet of forms online. Please complete this packet in a timely fashion as it must be completed before an appointment can be scheduled. Integra DPC will be notified when the form is completed and will:
DPC practice can take care of 90% of the health-care services an individual needs for a fraction of the cost. Insurance has high deductibles with large out-of-pocket expenses for co- pays, facility fees, co-insurance fees and deductibles that must be met. Other than your annual CPE preventative and basic preventative screening, everything else you pay is 100% out of pocket until your deductible is met.
Early studies show that a DPC model results in 20% lower overall health-care costs when compared to traditional FFS model with overall increased patient satisfaction. This is not due to cherry picking, as the study shows similar chronic health issues with the DPC model having more uninsured members. It is believed to be related to the direct access that patients have with their provider, the time the provider spends with the patient, the opportunities for earlier intervention to address acute and chronic issues, the time to help educate and the DPC model being able to reduce ER visits and avert higher-cost medical care. Early finds also suggest reduced hospitalizations with shorter stays.
Medicare does not permit physicians to participate in Medicare and charge patients a monthly membership fee. Providers who practice in a DPC model opt out of Medicare and do not participate with them. Medicare also requires that a separate contract be signed by patients of a DPC practice, understanding that they agree to a monthly membership fee and that any services provided by a DPC provider cannot be billed or reimbursed by Medicare.
Dr. Castor opts out of Medicare effective 7/1/2022. Individuals previously covered by Medicare for primary care who are interested in becoming members/patients can have their membership start effective 7/1/2022.
Members/patients will use their Medicare benefits for referrals to specialists, urgent/emergency room care, hospitalizations or outside testing/procedures. Dr. Castor will assist with any prior authorizations that are needed and will provide appropriate CPT codes when necessary.
For heavily discounted services that Integra DPC can offer, the price will be transparent, and the patient can decide whether to pay outside of their insurance or utilize their insurance coverage.
We recommend that you consult with your tax professional. Our government is still trying to decide whether DPC service is a qualified medical expense. When applicable law allows patients to use their HSA funds, we will notify you. For now, you can use your HSA for everything but your monthly membership. This includes medications, point-of-care services, lab work and imaging.