Awash in Paperwork, Maine Doctors Abandon Conventional Treatment Model

May 20, 2015

FALMOUTH, Maine - Many primary care doctors commit to the profession because of their passion for caring for patients. But the reality of the job often requires doctors to pack each day with patient appointments. As time with patients shrinks and administrative tasks swell, the quality of care can suffer.

Out of frustration, some Maine doctors have decided to abandon the conventional treatment model for something called direct primary care.

Last July, Catherine Krouse was just about done with her career choice. Fresh out of medical school and her residency in family medicine, she didn't feel eager for her future. She felt jaded.

"I knew for myself that signing a contract with a conventional model would be the end of me, that I wouldn't go back," she says. "I'd probably quit medicine."

Quit, because Krouse says the way health care has evolved, patients often come second to the other demands on doctors:  Filling out reimbursement forms. Calling insurance companies to battle for claims. Reviewing and signing off on stacks of patient paperwork.

"You just end up getting drained and drained and drained," Krouse says. "And then when your cup is completely empty, then you just get guarded and angry. And then you put up walls, and that really creates barriers."

So Krouse decided to set up a direct primary care practice. Earlier this month she opened Lotus Family Practice in Falmouth. She doesn't accept insurance. Instead, she charges patients a monthly membership fee. "So it's very direct. It's just patients and doctors. There's no one else in between."

Membership is $60 a month for adults, $20 for kids. It covers an unlimited number of visits, which last about 45 minutes. Patients can also call or text Krouse any time they want. She also provides generic drugs at wholesale cost. Those savings alone, she says, can cover the cost of membership. "Pennies. They cost pennies."

So, is direct primary care too good to be true?

"I don't think it is," says Dr. Mike Ciampi, one of a handful of physicians in Maine who practice direct primary care. The model is gaining traction nationally, but is relatively new to the state. Ciampi started using it at his South Portland practice about a year ago.

"Medicine in general - the way you survive is fill your day up with as many sick patients as you can," Ciampi says. "And I really wanted to do something different. I wanted to maintain the health of my patients."

Ciampi went from a traditional practice of 2,000 patients to a practice that currently has 150. He needs 300 to be sustainable, but would like to grow to 500 or 600. He has a convert in patient Karl Ronhave.

"I pay a yearly fee, and I can see him as many times as I want," Ronhave says. "And it allows him to do more doctoring. And I think that's - to me as a consumer - that's really the most important thing."

Ronhave has diabetes. He needs to see a doctor at least four times a year. Last year, he saw Ciampi nearly once a month. He says he has a better understanding of his health and more strategies to deal with issues that crop up.

Direct primary care doctors recommend patients carry catastrophic insurance to cover serious health needs. Ronhave has employer-based insurance. But he says his $50- a-month membership doesn't add up to an extra expense.

"I'd say I'm probably saving a little bit of money doing it this way," he says. "I don't think it's huge savings. But the difference is the quality of care I receive, I perceive to be much stronger than what I was getting before."

Catherine Krouse says patients in direct primary care practices are less likely to need referrals to specialists, which also saves money. "A lot of things can be handled by the primary care physician. They just don't have time to."

At Lotus Family Practice, Krouse has added a slightly different spin to the direct primary care model. She includes yoga classes in the monthly membership. "I talk about it all the time and I encourage people to do it, but I think it's really hard for a lot of people to go home and do it, to find the right resources, find the right teachers - or cost is a barrier, you know?"

The direct primary care model, she says, allows her to move beyond just treating illness to focusing on health, well being, and the individual patient. And that's the kind of doctor that Krouse has always wanted to be.

Tune in to Maine Calling Thursday, May 21, for a discussion on direct primary care.