After 12 years as a primary care physician at MaineGeneral Medical Center, Jennifer McConnell was tired of feeling as though she could never keep up. Though she adored her colleagues and thought she had grown into herself as a doctor during her time at MaineGeneral, McConnell had become increasingly frustrated working in a health care system that required her to see more and more patients, each for less time, in order to make a living.
As a primary care physician, McConnell earns about half what her more specialized peers make. In addition to earning her own wages, she needed to help cover the costs of the administrative staff and complex computer systems needed to work with and bill insurance companies.
But under the insurance fee-for-service model, McConnell was paid only for the time she spent face to face with her patients, so she would need to see a set number of patients each day to cover costs and make a living. By the time she left MaineGeneral, McConnell was carrying a caseload of around 2,000 patients and seeing up to 22 patients a day.
“I was always behind in my charting because I was so busy seeing patients,” McConnell recalled in an interview.
So after seven years in private practice, where she encountered many of the same problems, McConnell has decided to stop accepting most forms of insurance. She is starting to transition her Readfield practice to a direct primary care model, where for $60 a month she will offer patients unlimited primary care.
McConnell’s embrace of the new model comes at an uncertain time for the national health care system as Congress crafts legislation to repeal and replace the Affordable Care Act and insurance premiums continue to skyrocket.
Meanwhile, the Maine Legislature last month passed a law defining direct primary care and codifying the relationship between providers and patients. The new legislation, which Gov. Paul LePage signed into law June 1, clarifies that direct primary care is not a form of insurance and requires providers to inform patients that their direct care contract is not a substitute for insurance and covers only certain types of services. The law also says such direct care is not subject to regulation by the Department of Professional and Financial Regulation, Bureau of Insurance.
Proponents of the direct primary care model say it removes the insurance middleman from the provider-patient relationship, lowering costs and freeing up doctors to spend more time focused on their patients.
Sen. Rod Whittemore, R-Skowhegan, said he sponsored the legislation, L.D. 1385, “An Act Governing Direct Primary Care Membership Agreements,” because he believes the direct primary care model can play an important role in bringing down health care costs.
With around a dozen providers offering or shifting to direct primary care, the model is already spreading in Maine. Maine’s legislation makes it the first state in New England with a direct primary care law on the books and the 23rd state in the country, according to DPC Frontier, a website that tracks and provides information about the direct primary care model.
DPC Frontier estimates there are currently around 632 direct primary care providers across the United States.
“With this arrangement, people aren’t going to be as hesitant to go to their doctor when they have an issue, because most of the insurance plans have high deductibles and a lot of people just wait until they’re really sick and then end up in the emergency room, which costs more,” Whittemore said.
Paired with another bill passed this month, known colloquially as the “right to shop” – which will require insurance companies to provide patients with pricing information they can use to shop around for the most affordable provider of a particular service as well as, for at least some groups, incentives to do so – Whittemore thinks the Legislature has taken significant steps toward lowering health care costs in the state.