Direct Primary Care Membership

In order to preserve my vision of how primary care medicine should be practiced, as of January 1, 2018, we are out-of-network with all insurance companies and have transitioned to a new membership model called Direct Primary Care. 

I went into medicine with the intention of developing enduring, trusting, and meaningful long-term relationships with my patients. This is the cornerstone of good medicine.

In the ten years since opening my practice, the health insurance companies – and the industry as a whole – have consistently escalated their disregard and disrespect for the doctor-patient relationship. In the current system, patients are treated like cattle, doctors function like assembly line workers, and the average office visit lasts only seven minutes. Patients are expected to find a new primary care doctor every few years – each time their insurance company, network status, or employment status changes – seemingly on a whim. Urgent Care facilities are now everywhere – because nobody has an accessible primary care doctor anymore. The opacity and obfuscation in billing and network participation issues have reached intolerable levels. I applaud many aspects of President Obama's reform efforts (the ACA), but the industry continues to behave badly. I do not expect any positive developments from the current administration.

As I cannot expect the industry or the government to fix the situation, I have taken the initiative myself. In order to preserve my vision of the doctor-patient relationship, I have innovated the practice and transitioned to a membership model known as Direct Primary Care. It's a progressive new model that's exploding in popularity around the country. And for good reason. You see, the defining element of this model is the indispensable relationship between patient and physician – you and me. 

Primary care should be affordable, accessible, and transparently priced. The membership fee of $99 a month reflects this. Keep in mind that this investment is less than a smartphone or cable bill, a gym membership, or what many spend on Starbucks each month – and that your health is a priority. Your health insurance (which you need and should continue to have) should be used how it was originally intended: for expensive items, like medications, laboratory studies, blood tests, vaccines, imaging, specialist fees, emergency room visits, surgeries, and procedures. (Please note: NY State law requires us to charge a small fee of $30 for any in-office visit that is not your Annual Physical, and the fee will be higher if you exceed 15 in-office visits per year. See the FAQs below for information on medical acupuncture.) At this point in my career, I believe health insurance companies and their perverse incentives should not play a role in the delivery of routine primary care

Many patients are tweaking their health insurance plan to one with a higher deductible and lower monthly premium – and using these savings to offset the membership fee. Others are looking at FSA/HSA options. Please see the FAQs section below for further information on fees, visit limitations, and other important details.

Here are just a few of the innovations with the new model:

  • Enhanced access, availability, and communication – including telemedicine consultations when appropriate

  • This means you'll no longer necessarily need to come in physically to the office for discussion of routine lab results or routine prescriptions (time is your most precious resource!)

  • Preservation of our long-term doctor-patient relationship, regardless of changes in insurance network status, employment status, or location – even if you work, travel, or move outside of the NYC area

  • Extended and unhurried office visits will typically last 30-60 minutes

  • Same-day and next-day urgent appointment scheduling if you need us

  • Custom wellness plans, with accountability checkpoints to help you reach your goals (Want to run the NYC Marathon next year? The Brooklyn Half? Cut back on drinking? Improve your diet?)

  • Blood draws at our office later in 2018

  • Options for at-home STI/swab self-testing later in 2018

  • A new pharmacy partnership that promises prescription delivery right to your door within 2 hours 

  • Evening office hours

I am convinced this is the way forward for primary care. By cutting out the middle-man (insurance companies), we'll save you precious time and expense. And those resources will be devoted to your health and well-being. This model also very importantly delinks your primary care from employment status (we are the only industrialized country in the world where health care access is tied to full-time employment). In the new model, I work for you – not some health insurance company.

I truly believe this is an exceptional opportunity, and if you highly value the doctor-patient relationship and the services I provide – you should join. I wish a similar opportunity was available for my own family's health care. Please note that space is limited.

If your questions are not answered in the FAQs below, or if you have any other questions, please contact our office. We'll be glad to help. 

I truly hope that you will consider joining our community.

With humble thanks,

Eamonn A. Vitt MD

 

FAQs

I have insurance through my job, and could go find a different in-network doctor for only a $30 copay. Why would I pay $99 a month to continue with you?
 
It's simple. If you believe:
 
·       We have a fantastic doctor-patient relationship

·       Our personalities mesh

·       You're comfortable being yourself here

·       My areas of expertise apply to your situation

·       I'm easy to get in touch with, friendly, and I communicate with empathy

 
Then the value speaks for itself and the answer is obvious. You should join. 
 
It is extremely difficult to find a physician anywhere who meets the above criteria. Also keep in mind that this investment is less than a cable bill, a gym membership, or what many spend on Starbucks each month – and that your health is a priority.
 
Sure, you can get a rushed fast-food meal at Taco Bell for $1.98. But wouldn't you rather enjoy an exceptional meal at your local 12-seat restaurant where you are well-known, warmly welcomed, treated like a person and not a number, and the food is healthy and delicious? Especially if that restaurant was affordable? It's all about value and the long-term relationship.
 
Another way to think about it – imagine you really love your apartment. Ideal location, quiet neighbors, friendly landlord, a place you want to call home for the long-term. If the rent goes up $99 a month, would you move out? Probably not. In New York City, finding a great physician is even harder than finding a great apartment!

 

I’m quite healthy and don’t go to the doctor often. Will I benefit from membership even if I don’t require frequent medical attention? 

Yes – you will benefit. Even if you don't require frequent medical attention, membership is a smart idea.

Unfortunately, health issues are unpredictable, and at some point you will be sick or injured and need acute care. Now more than ever, it is essential to have a doctor who knows you as a person, and who will advocate for you. I will provide first-class care and also do my best to protect you from the perils of the rampant overtreatment and excessive intervention that characterize so much of modern medicine.  

Our office is a place when you can feel comfortable being yourself, and be honest about achieving your wellness goals, which may range from weight loss to HIV prevention. We can create custom wellness plans, with built-in accountability checkpoints to help you reach your goals. Do you want to run the New York City Marathon next year? The Brooklyn Half? Cut back on drinking? Lose weight? I'll work with you to create a custom plan that will yield results.

The core philosophy is a back-to-basics approach, emphasizing a healthy lifestyle, diet, and exercise. No nonsense. I'll remain a voice of reason in the age of information (and misinformation) overload.

If we can save you just one trip to the ER over the next two or three years – then just a single year of membership will pay for itself.

 

I understand your services will be out-of-network. So how will I pay for my medications (e.g. Trvuda PrEP) and blood tests, again?

You will use your insurance to pay for your medications (e.g. Truvada PrEP, etc.) and bloods/urine/swab tests – just as you do now.

For example, your bloods will be drawn (and/or other urine/swab tests done) and sent to the lab (e.g. Quest or Labcorp). The lab will charge your insurance company, and your insurance company will pay the bill.

Regarding medications – I will write/electronically prescribe the prescription, and it will be filled by your pharmacy. The pharmacy will charge your insurance company, and your insurance company will pay the bill. 

 

Which type of health insurance would be reasonable to pair with membership? Can I adjust my health insurance plan so it works better with the DPC model? And save me money?

It is now open enrollment season, and many patients are tweaking their health insurance plan to one with a higher deductible and lower monthly premium – and using these savings to offset the membership fee. Others are looking at HSA/FSA options. If you are buying insurance on the exchange, a low-priced Catastrophic or High Deductible may be a great idea, depending on your situation. 

Your health insurance (which you need and should continue to have) should be used how it was originally intended: for expensive items, like medications, laboratory studies, blood tests, vaccines, imaging, specialist fees, emergency room visits, surgeries, and procedures.

At this point in my career, I believe health insurance companies and their perverse incentives should not play a role in the delivery of routine primary care.

 

Is the Direct Primary Care model the same as Concierge Medicine, or One Medical?

Not at all. Our Direct Primary Care model is affordable for everyone.  We are not a Concierge practice. Concierge practices indeed certainly exist in NYC. The fee can be thousands of dollars a month

Practices like One Medical charge an annual membership fee, but they still bill insurance (in-network) and are a large company with a group practice model. This unfortunately means you are still subject to the toxic problems of insurance companies controlling your primary care. And it will be challenging to develop a long-term, meaningful relationship with your doctor, as it's a large company with the usual staff turnover. 

 

Is there national support for this model? And what is Health 3.0?

The American Academy of Family Physicians supports this innovative new model as an alternative to the broken fee-for-service system. Click here to read more.

For most of human history, personalized care was prized and the doctor-patient relationship was paramount (Health 1.0). In the current world, science and technology have enabled wonderful advances, but the system has become industrial, commoditized, and the human touch has been lost (Health 2.0).

There is an emerging national conversation about a hopeful vision for the future – Health 3.0. The paradigm is to reintroduce the all-important humanism in medicine and combine this meaningfully with the wondrous scientific and technological advances that are now available.  

 

If I move out of town, can you still be my doctor?

With the new practice model, I can continue to be your doctor whether you relocate to Los Angeles, Lagos, or London – if you'll pass through NYC once in a while. We will remain extraordinarily accessible and available to you, and optimize emerging tech solutions to provide you with the most convenient and efficient care possible. Ultimately, some care must be provided in-person, so we must be realistic about expectations.

 

What about innovative tech solutions?

The new membership model will optimize emerging tech solutions to deliver the most convenient and efficient care possible.

That being said, our main focus is the essential human element that is at the heart of the doctor-patient relationship. Technology can be liberating, but at the end of the day, a person is not an algorithm.  

Along with Sophia and Stephanie, our spectacular office staff, we’ll continue to help you navigate the red tape and administrative absurdities plaguing the rest of the health care system. 

 

Can I skip the membership fee and just pay to come in once a year, or when I need to?

No. The monthly fee structure reflects the value of an ongoing and meaningful relationship, as the nature of our practice is not just simply transactional (like a visit to the dermatologist’s office, for example). Our practice is person-focused, not problem-focused. If you decline to enroll, I will no longer be your physician after December 31, 2017.

 

What if I decide to cancel my membership? Can I re-enroll later?

We expect to have a straightforward, honest, and respectful relationship with you. There is no minimum commitment beyond two months. We ask that you give us 30 days' notice if you wish to cancel. If you choose to re-enroll down the road, and the practice is full, you will be placed on a waiting list for new patients. The re-enrollment fee will be $399. 

 

Will you accept health insurance for your services?

No. Our office will be out-of-network, and we will not submit claims to your insurance company for our physician services. The Direct Primary Care model liberates us from corporate health care’s nonsensical, opaque, impersonal, and expensive approach to primary care – and allows us to provide you the convenient and phenomenal care that you want and deserve.

Your health insurance (which you need and should continue to have) should be used how it was originally intended: for expensive items, like medications, laboratory studies, blood tests, vaccines, imaging, specialist fees, emergency room visits, surgeries, and procedures.

 

Will I still need health insurance?

Yes. This membership is not insurance, and you should maintain insurance. We recommend a high-deductible plan, which may be offered through your job, the NY State of Health exchange, or a broker.

Many patients are savings hundreds of dollars a month by choosing a plan with a lower monthly premium. They are applying these savings towards membership with our practice.

 

Is my membership fee tax deductible?  What about FSAs (Flex Spending Accounts) and HSAs?

FSA/HSA funds may be used to pay for your included Annual Physical (a qualified health expense according to the IRS), once this service has been provided. In general, there is currently a lack of clarity in the tax code about how Direct Primary Care (DPC) agreements should be treated vis-à-vis Flexible Spending Accounts (FSAs) or Health Savings Accounts (HSAs). The Affordable Care Act clearly recognizes Direct Primary Care as a delivery reform, and that it is not insurance. The NY State Department of Insurance indeed recognizes that this retainer model with prepaid services is not insurance. Please contact the office for more information on this. 

 

Why is there a copay for in-office visits?

NY State Law requires that a membership model practice must charge an additional fee (copay) for care related to fortuitous events.

This copay does not apply to your Annual Physical, however.

Basically, there must be a $30 copay for any in-office doctor's visit that is not your Annual Physical.

 

Is there a limit to the number of in-office visits per year?

After 15 in-office visits per year, we must charge a higher copay for in-office visits. This is in accordance with NY State Department of Insurance regulations. Click Enroll Now and see the Member Contract for more information.

 

What about medical acupuncture?

In-office visits for acupuncture will be subject to a higher copay. Click Enroll Now and see the Member Contract for more information.

 

I am uninsured. Can you still be my doctor?

Yes. But we strongly recommend you maintain health insurance.

 

How are membership fees paid?

The credit card or bank account provided at enrollment will be charged automatically each month.

 

Can you refer me to specialists?

PPO and EPO plans (carried by the vast majority of our patients) do not usually require that a referral be processed by an in-network doctor. Some HMOs have strict network requirements, and may not accept a referral from our out-of-network practice. You should check with your insurance company for more information.

 

What is your policy on controlled substances?

Abuse and diversion of controlled substances is a serious problem. We have a general policy of not prescribing controlled substances. These include, but are not limited to: Ambien (zolpidem), Adderall, Vyvanse, Ritalin, Focalin, Concerta, Valium (diazepam), Klonopin (clonazepam), Xanax (alprazolam), Ativan (lorazepam), Lunesta, Halcion, Tramadol, Percocet, Vicodin, Methadone, Oxycodone, Oxycontin, Soma, anabolic steroids, and so on.