November 29th, 2014, 9:53 pm
Virginia doctor makes house calls but doesn’t take insurance
FOREST, VA —Dr. Douglas Farrago stands on a podium in front of a 30-plus crowd of curious, somewhat skeptical adults who pepper him with questions.
Yes, he’ll make house calls. No, he won’t accept insurance. Yes, he’s serious.
It’s a bold pronouncement but one that the 49-year-old entrepreneur and physician appears to have been headed toward for years.
He operates Forest Direct Primary Care in Forest, southwest of Lynchburg in Bedford County. it recently had its soft opening.
Unlike concierge medicine, which caters to the wealthy with pricey memberships, this is direct primary care, a small but growing field where patient loads are small—about a fourth of the number the average family physician cares for, according to national statistics. Fees are affordable at $75 to $150 a month.
Farrago, one of the first in the area to try it on this scale, calls is a “more personal, comprehensive” kind of health care.
Confident and energetic, Farrago has appeared in magazine and newspaper publications across the country for everything from the patented Knee-Saver he developed for baseball catchers to the “The Placebo Journal,” a long-running MAD magazine for physicians.
Throughout it all, one thing has remained the same: his disdain for what he feels family practice has become—a 15-minute visit defined by codes and insurance companies.
“We’re being overburdened with bureaucratic dreg,” Farrago said from the same office where he meets patients face-to-face before and after exams to discuss their well-being. Exams are done just down the hallway, sans computer.
Over the last 20 years, Farrago has worked in traditional family practices and immediate-care clinics, like those that have cropped up across the Lynchburg area in the last few years.
CUTTING THE ‘MIDDLEMAN’
Last month he decided to go off the grid, following in the footsteps of some 4,000-plus direct-care physicians nationwide who have cut out insurance companies and directly bill patients monthly. The practice has gained enough of a following that, last year, the American Academy of Family Physicians formally recognized its benefits and created a policy for these kind of physician practices.
“The model eliminates the insurance middleman and provides revenue directly to the practice to innovate in both customer service and quality of care for the patients they serve,” said AAFP Board Chair Glen Stream, M.D. in the policy. “This is one option that is particularly well suited for small family medicine practices that are struggling financially in environments not yet supporting (Primary Care Medical Homes) with a viable payment model.”
HOW IT WORKS
Clients are billed monthly and in exchange they have unlimited access to physicians with no co-pays for office visits. In Forest, Farrago’s rates are competitive with other direct primary care physician’s rates, $75 a month for individuals, $125 for couples, and $150 for families. Farrago said he can attend to 90 percent of all medical needs—osteopathic manipulation, cortisone injections and skin procedures are included, for example—but acknowledges that there are all kinds of outside services not included in the monthly fee.
Blood tests, flu shots and diagnostics like CT scans, X–rays and MRIs are among the services that would require out-of-pocket costs. Farrago tells patients that he has partnerships with radiologists, the Lynchburg Health Department and area laboratories that will provide discounted services.
Farrago, like other direct primary care physicians, also urges patients to get catastrophic insurance should something major happen; “that’s a mistake to not have insurance,” he said.
Cutting ties with insurance helps Farrago become “the doctor I want to be.”
“I want to bring back medicine to the old-fashioned way. I can’t be Marcus Welby without time,” he said, referring the 1970s television show about a doctor with a kind bedside manner. “They’re squeezing us on time.”
IT COMES DOWN TO MATH
The average primary-care physician has about 2,300 patients, according to the Annals of Family Medicine. The American Academy of Family Physicians reports that physicians see about 19 patients a day. In practice, it means physicians are generally allotted about 15 minutes to take care of a patient, Farrago said.
Farrago will accept only 600 patients, seeing three to six a day. all will have access to him via phone, text and email wherever he is. He’s using an electronic medical records system that can connect email correspondence with patient records just as easily as it accepts the data from their Fitbits. Made for direct-care physicians, the program lets Farrago track data over time. It’s his job to interpret the numbers.
As a result, Bedford County resident Larry Compter said, Farrago is able to “go outside the box.”
“It’s a step back to medicine as it ought to be— between the doctor and that patient,” says Larry Compter, one of about 100 people who have signed up.