Feature

Flat-fee primary care helps fill niche for Texas’ uninsured


 

As a safety net, it’s a stretch

Erika Miller first came to see Dr. Graham 2 years ago for severe headaches. The 30-year-old mother of three, who is working on her college degree and has a full-time job, doesn’t have insurance.

Dr. Graham diagnosed high blood pressure. Getting that under control helped alleviate her headaches, Ms. Miller said. She also has shed 50 pounds under Dr. Graham’s guidance.

But Dr. Graham can’t handle everything for her patients. Last year, Ms. Miller went to the emergency room at Scott & White Medical Center in nearby Temple with severe abdominal pain. It was her appendix, which had to be removed. The safety-net hospital started Ms. Miller on a payment plan based on her income, totaling roughly $500.

“If the question is: ‘Is [direct primary care] better than nothing?’ Then I would say, ‘Yes,’ ” Ms. Engelhard said. But along with leaving uninsured patients financially vulnerable to a medical curveball, she said, these smaller practices – by seeing fewer patients per doctor – risk aggravating the nation’s primary care shortage if they become more common.

Dr. Graham countered that she nearly left medicine, but these days – as she continues to build her practice – she’s reaching some patients who had previously fallen through the health system’s cracks. On that summer morning, Mr. Kenyon left Dr. Graham’s office with a prescription for a blood pressure medication and an appointment to return in several weeks to discuss his lab results.

Mr. Kenyon and his wife, Denise, later described how they had signed up last year for a family policy through the Affordable Care Act. But the monthly premium was $750 and the deductibles were $3,500 per person, Denise Kenyon said.

She called around and couldn’t find a family doctor who would take the coverage. After several months, they stopped paying the premiums, figuring that the money they saved would pay for a lot of medical care.

Both are now patients of Dr. Graham’s; their combined monthly bill totals $125, which they can budget for, Darrell Kenyon said. “I do have good months and bad months, as far as pay is concerned,” he said. “If I have a bad month, it’s still affordable.”

Kaiser Health News is a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

Pages

Recommended Reading

Prescription drug monitoring programs improve, but challenges remain
MDedge Family Medicine
What can happen if you fail to check the PDMP?
MDedge Family Medicine
Effectively engaging patients in everyday health-care decisions
MDedge Family Medicine
HHS Secretary resigns amid flight criticism
MDedge Family Medicine
Ruling: Apologies can’t be used against doctors in court
MDedge Family Medicine
The AHRQ Toolbox: Tools for negotiating shared decision making
MDedge Family Medicine
VIDEO: How a public health approach can cut opioid abuse, suicide risks
MDedge Family Medicine
HCA is the country’s highest-volume health system
MDedge Family Medicine
U.S. House passes 20-week abortion ban
MDedge Family Medicine
Now missing in EHR charts: a good impression
MDedge Family Medicine