It is difficult to navigate the health system. Insurance is a whole different ball game. People know they need it, but have no idea what programs they even qualify for.
I firmly believe that family medicine is rooted in communities. It is the only way the physician can develop an understanding of the local culture, industry, and lifestyle to “get it” from the patient’s perspective.
Live, work and serve in the community was a principle articulated by Ian McWhinney in his Introduction to Family Medicine in 1981. Cost shifting, that is using your revenue from paying patients to care for those who could not afford care, was a time-tested method of paying for healthcare for decades. This was a tacit understanding between paying patient and physician which exists no longer. Although it is not a direct part of the physician-patient relationship, it has always been part of the landscape and responsibility that a physician embedded in a community would be expected to live up to. It is also part of the responsibility of a community in taking care of their own.
There remains a remarkable stigma over mental health. Counseling is profoundly personal and incredibly effective when the chemistry is right between patient and counsellor.
One of the neat things about health coaches is that they can offer mental health counselling but also practical advice on motivation, behavior change, diet and exercise in relation to chronic disease.
It;s a great combination that expands the usefulness of a behaviorist working hand in glove with the family physician.
Well the longer you’ve been around, the more you realize everyone needs therapy. But for those where the posture is too much, realize that life coaches approach therapy from a really practical perspective, rather than the stereotype of a navel gazing, pipe smoking “shrink.” Also for those whose counselling needs are not very acute, we can always stand to improve ourselves, be more effective in relationships, health habits and goal achievement.
Low income individuals are often uninsured or under-insured, on medicaid or bouncing on-and-off. Generational poverty, substance abuse, environmental deprivation are all contributors to a profound psychosocial malfunctioning.
These bad decisions we see and urge people to take responsibility for are often beyond the capacity of the more unfortunate. Teaching adaptive behaviors goes a long way to enabling personal responsibility. Combining medical care, prevention, care coordination, behavioral counselling and connecting to the rest of the community as a hub connects to the spokes of community services is a fantastic way to lift people out of generational dysfunction… one person at a time.
Integrating Primary Care and behavioral counselling has been talked about for ages, but the models are becoming more mature. We think co-locating and working hand-in-glove is the best model.
DPC fees are not tax deductible or applicable to health savings accounts (HSA’s) due to an IRS regulation that views DPC as insurance, although it is clearly not. Several state legislatures ahve passed enabling legislation that specifically states DPC is not insurance, nor is to be treated as such. Currently, Senate Bill 1989 at the Capitol will make this the law of the land and open the possibility of allowing Medicare money to be directed by patients to primary care physicians who are willing to accept such payments.
The taint of concierge care for the elite sticks to DPC, although it is an inherently advantageous way to provide primary care and is ideal for people who cannot afford going to the doctor or taking care of themselves.
There is so much more to the stubborn misunderstanding of the role of DPC in the health system, but this is why we have blogs and record brief videos.
This is my version of a definition, but the best legal definition of direct primary care is here:
FOR THE PRACTICE TO QUALIFY AS A DIRECT PRIMARY CARE PRACTICE THE PRACTICE MUST:
1) CHARGE A PERIODIC FEE
2) NOT BILL ANY THIRD PARTIES ON A FEE FOR SERVICE BASIS, AND
3) ANY PER VISIT CHARGE MUST BE LESS THAN THE MONTHLY EQUIVALENT OF THE PERIODIC FEE
Thank you Dr. Eskew.