Building a Direct Primary Care Practice

July 09, 2018 08:30 am David Mitchell

Five years ago, Jeffrey Gold, M.D., didn't know what direct primary care was. Now he's teaching others about the DPC model.

[headshot of Jeffrey Gold, M.D.]

Gold, who will be one of the featured speakers at the July 13-15 DPC Summit(www.dpcsummit.org) in Indianapolis, wasn't sure exactly what he was looking for in 2013, but he knew it wasn't a traditional fee-for-service practice. He worked for a private practice for a year-and-a-half after residency, then spent seven years at a hospital's multispecialty outpatient clinic.

"I knew in residency that coding and billing and being told how many people I have to see in a day was nonsense," Gold said. "I was kind of disillusioned with our health care system from the get-go, but I didn't understand how to make it better or fix it."

Things started to change when Gold saw a tweet from Josh Umbehr, M.D., who said his DPC clinic could save patients roughly $200 on the migraine injection drug Imitrex (sumatriptan) compared to what it costs in an ER.

Gold was intrigued and messaged Umbehr on Twitter. He followed up by phone and eventually visited Umbehr's DPC practice in Wichita, Kan.

"I walked out of there thinking, 'I want to do this; it makes sense,'" Gold said. "It was everything I hadn't been able to formulate in my brain. I felt like patients weren't getting the best of me because I wasn't practicing medicine. I was practicing insurance."

Gold researched the DPC model, left his hospital job in December 2014 and started his own DPC practice a month later in Marblehead, Mass. His practice added a second physician in 2016.

Massachusetts does not allow physicians to dispense medications (as some DPC doctors do in other states), but Gold has negotiated discounted cash pricing with a local independent pharmacy and also helps patients research better pricing. His nurse draws blood samples on-site, and he has negotiated low cash prices for labs -- $8 for a cholesterol panel, for example -- with a third-party lab. He's done the same with an imaging center.

"I've done a lot of grunt work to try to make things work for people," he said.

The monthly fee patients pay Gold covers unlimited primary care, as well as procedures such as mole removals. To date, he and his partner have about 1,000 patients.

"I work really hard," he said. "It hasn't been easy. We tell people how great DPC is -- and it is -- but I don't sugarcoat it. We're not profitable every month, and we're still building our patient panel. It takes a lot of learning business and marketing skills, things we're not trained to do."

But the growing pains, he said, have been worth it because the DPC model has allowed him to get away from "assembly line" medicine, with its administrative burdens and quality measures.

"Third-party payers have their cookie-cutter requirements," he said. "They want every patient to have a hemoglobin A1c below 7.5. If a person is homeless and comes in with HA1c that's 13, and I help them get it down to 9, does that mean I'm doing a bad job? The beauty of this model is there's only one person determining the quality of my care, and that's the patient."