News & Releases

JET-24 News - Part 1 of 2 with David Belmondo.  After interviewing Drs. Harry & Jon Izbicki on Erie's 1st Direct Primary Care Practice, David Bemondo gives a very nice explanation how Direct Primary Care practices help improve access to quality affordable health care for the Erie, and the surrounding communities.  Check out Part 2 of this series on our news blog for the rest of the story. 

As he was nearing the midpoint of his career in family medicine at the Mayo Clinic, David Usher, MD—like many primary care physicians—knew something was missing from his professional life, and his personal life.

He found his answer in 2010 after reading an article in Medical Economics about a direct-pay primary care practice in North Carolina.

“I was experiencing the same thing a lot of PCPs are. The system just over time ratcheting down what you get paid and forcing you to work harder and harder to get it,” Usher says, adding there was too much hassle to get paid and patients couldn’t afford the care he was recommending.

He showed the article to his wife, and that’s when his life changed.

Nearly 2 years later, he built an independent family practice in Wisconsin to about 2,000 patients that he describes as “loyal and happy.” Yet Usher says he is starting to feel some of the same old pressures. “You’re continuously looking at the bottom line and how many patients you are seeing a day and counting the dollars,” Usher says.

Squeezing as many patients as possible into a day and having to be more focused on which codes will result in the highest reimbursements isn’t the kind of practice many physicians envision. For physicians whose ideal was simply hanging a shingle out, the outlook is even worse.

The number of independent physicians dropped from 57% in 2000 to 39% in 2012, and those that are left are looking to new practice models to hold their ground, according to the Accenture Physicians Alignment Survey.

Accenture estimates that one in three remaining independent physicians—their ranks decline by 5% each year—will look to adopt subscription-based practice models to achieve higher yields, and that trend will continue to increase by 100% annually over

Dr. Jon Izbicki from Izbicki Family Medicine very first interview on Erie's 1st insurance-free medical practice, known as Direct Primary practice

Family Physicians, Patients Embrace Direct Primary Care

AAFP Recognizes Benefits, Creates DPC Policy

As Medicare whacks away at what doctors are paid and health insurers move away from paying fees for service to bundled payments, more physicians who own their own practices will start direct pay or concierge medicine in the next one to three years.

New data from a national survey of nearly 14,000 physicians conducted by physician staffing firm Merritt Hawkins for The Physicians Foundation, analyzing 2012 practice patterns, found that 9.6 percent of “practice owners” were planning to convert to concierge practices in the next one to three years.

Certainly, plenty of baby boomers have done the math and deemed the investment worthy. In the typical concierge experience, a primary-care doctor accepts insurance for routine services but also charges a non-reimbursable fee that pays for amenities like 24/7 access to the doctor, same-day appointments, longer appointment times and a greater degree of personalized attention. The annual fee for such practices currently averages about $1,800.

Business Week Article 11/29/2012
Is Concierge Medicine the Future of Health Care:

"There are 4,400 concierge doctors in the U.S., 30 percent more than there were last year, according to the American Academy of Private Physicians, their professional association. 'This is all doctors want to talk about,' says Jeff Goldsmith, a health-care industry analyst and trend spotter. Some health policymakers are encouraged by this trend. They think an increase of direct-pay doctors—especially affordable ones—could lead to better healthcare in the U.S., which has the highest costs and some of the worst outcomes of any wealthy nation. 'I think it's great,' says Kevin Schulman, a professor of medicine and business administration at Duke University. 'We're rediscovering that if we just ask people to pay for services, we could provide them with better value. Primary care is affordable.'”

There are distinct advantages for the patient who pays the primary care physician (PCP) directly: higher quality, lower cost and greater satisfaction.

The fundamental problem in health care delivery today is a payment system that is highly dysfunctional leading to higher costs, lesser quality and reduced satisfaction. The core problem? The patient is no one’s customer. With employer-based insurance, the physician’s customer is the insurance company that sets the rates, defines the rules and accepts or denies the bill. And the insurer’s customer is the employer. This is much different in concept and function than the professional-client relationship with your lawyer or tax accountant. Those relationships are direct; you establish your requirements, negotiate the fee or choose a different provider. In medical care, the patient has no standing in the financial arrangement whether employer-based insurance or Medicare or Medicaid.

Add to this the non-sustainable business model PCPs find themselves in today. Insurers have kept reimbursements flat for a decade or more. Meanwhile office costs have risen. With more expenses and static revenue, the PCP tries to “make it up in volume” by seeing more patients for shorter visits. Twelve to 15 minutes may be fine for a quick blood pressure medication check or a sore throat but it is not enough for good preventive care. Nor is it adequate for the patient who has a complex chronic illness (e.g., diabetes, heart failure or cancer), which consumes 70-85% of insurance claims paid. This patient will need a multi-disciplinary team of providers to render all the care needed. But the team needs a quarterback and if care is not well coordinated by the PCP, the number of specialist visits will skyrocket, as will tests, procedures and expensive prescriptions

Probably the hardest part of making the change from a traditional to a direct-care practice is the effect it has on relationships.  I am only taking a maximum of 1000 patients (less at the start) and will be no longer accepting insurance.  These changes make it impossible for me to continue in a doctor-patient relationship with most of my patients.

For some, this transition will be more hassle than anything.  Some people do everything they can to avoid my office, and so are not going to be greatly affected by my absence.  They will simply choose another provider in our office and continue avoidance as always.  There are others who see me as their doctor, but they haven’t built a strong bond with me (despite my charm), so the change may even be a welcome relief, or a chance to avoid initiating the change to another doctor.

But there are many people, some of which have already expressed this, for whom my departure will be traumatic.  ”Nobody else knows me or understands me like you do,” one person told me this week.  ”I’ve seen you for so many years, you just know so much more about me than any other doctor,” said another.  I’ve seen tears, have gotten hugs, and get frequent demands for a clearer explanation as to what I am doing and why.  It’s been a rough week for me, as I don’t feel I can cut off these relationships without some sort of closure.  Fore someone who sometimes goes overboard in the importance of others not being mad, it’s been hell.

In truth, the depth of the response I’ve seen underlines the main reason I am going to this new kind of practice: I care too much.  I have always run behind because I talk to people, joke with them, tickle the kids, and ask open-ended questions.  When I am running behind (I try to keep it under an hour), I don’t let that stop me from giving my full attention to the next person in the exam room.   Despite my chronic lateness, people don’t complain much.  They know that I will give them the time they need when I am in with them; I can’t cheat them of the time they need (and are paying for).

"Partnering with Marquette’s team just made perfect sense to us because we are a hometown name with hometown values," states Dr. Jonathon Izbicki, D.O. "We recognized a need in the Erie community for quality relationship-based medical care, where people are not just a number. Marquette is a hometown bank with hometown values, and they recognized the value of the relationship for the Erie community. "