Eventide drops insurance and switches to direct primary care

Eventide drops insurance and switches to direct primary care

Eventide Health will become a direct primary care service on March 31.

This kind of care is akin to a concierge service, but the prices will be lower than what a concierge offers.

Dr William House of Eventide Health said: “Since entering the healthcare landscape in the early to mid-2000s, this model has become the fastest growing type of primary care delivery. It arose out of the dissatisfaction of patients and physicians that our traditional model of insurance and medicare is so fundamentally broken.

The move began to be considered in mid-2021, as Eventide realized their current model of medicine was not going to be sustainable for the small practice. With insufficient income, they acknowledged that they would have to close by summer 2022 if they did not take an alternate route. In direct primary care, instead of going through insurance, members pay an all-inclusive monthly fee for unlimited primary care, usually the same day or the next day. Patients will be able to access their provider directly by phone, messaging, portal, email or telemedicine as well as in person or at home / by boat.

After speaking with many direct primary care practices across the country, Eventide felt informed enough to make a decision.

“Statistically, the results of these programs are MUCH better than traditional medicine and have fewer emergency room visits and fewer hospitalizations,” House said. “People are fed up with being treated like a number and the traditional system broken. They are also fed up with payers, Medicare or insurance, which are inserted between the doctor and the patient, which interrupts and sometimes hinders care.

House also added that to keep up with the high cost of running a healthcare clinic, they have to rush as many patients as possible every day. He said that once patients are rushed through the visit, the provider spends an enormous amount of time documenting, whereby they try to defend the coding that is placed on the visit in order to be paid a fair amount. He said this reimbursement has not been well honored and no longer supports private practices, which is why many small private practices tend to close, be acquired by hospital systems, or convert to direct primary care. .

He also explained that while the membership fee can be intimidating, with a high deductible, many have found it to either break even every month or save money. He is convinced that while it seems affordable, those who do a little research can find something in direct primary care that is within their budget.

House also said the burnout rate in primary care was as high as 79%. Why is it so high?

“Because we spend two-thirds of our time dealing with paperwork, pre-authorizations, evaluation of payments, inefficient systems, unnecessarily high costs, peer reviews to get imaging orders approved, etc., ”House replied. “That leaves little time to do what we have been called and trained for so many years to do – care for patients. This compensatory balance of unnecessary bureaucracy leads to frustrated patients, poor outcomes, medical errors, and, unsurprisingly, large numbers of healthcare providers leaving the field. CPD clinics love that they can focus on their patients and their patients feel it.

Despite what Direct Primary Care has to offer, some Islanders aren’t sure they can afford the cost, especially those with insurance plans they love, Medicare, or veterans.

Local Cynthia Brast, who has been a patient at Eventide since it opened, is one who will find another practitioner, even though she is very fond of Eventide.

“I loved the idea of ​​having an independent family doctor and I also love the nurses who work there. Most of them were there when Dr. Gossom was running the clinic. It was nice to have some continuity with the staff and I felt like Dr House was dedicated to patient care, ”she said.

Brast also added that House was able to coordinate special care visits for her via telehealth that would otherwise have had to take place off the island. With Dr. House helping him plan his telehealth appointments, Brast was able to avoid having to manage the ferry schedule, which could have put his appointment in a compromising position.

“I have to stick with a provider where I can use my health insurance, so overall it comes down to cost and affordability,” she said of her decision not to stay with Eventide during changes.

Although they had to leave to find a more affordable option, Brast and Eventide both share the same view on insurance companies.

“It’s so frustrating that insurance companies have made the paperwork so heavy for providers,” she said. “I would like there to be a way to remake health care so that it is affordable and accessible to all. “

While some, like Brast, have left Eventide due to the new monthly cost, had they not gone the direct primary care route, the island would most likely have lacked another doctor’s office. House is sticking to his decision and said he believes this is what is best for the practice and its patients.

“We know that change is difficult for the community. It’s hard for us. Keeping a rural health clinic open throughout the pandemic has been the hardest thing in my life, ”House said. “I’ve wanted to quit more times than I can count, but I love this community. I wish the current system wasn’t so broken. I wish there was another way, but after several months of agony over what to do, pray, discuss, pray again and do our best to stay engaged despite everything thrown at us . CPD is the way we need to go.

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