Giving up health insurance for more personal service

Giving up health insurance for more personal service

Giving up health insurance for more personal service

November 8, 2013 by Dr. Emily Szewczyk

When Mildred unexpectedly found herself in need of a new primary care physician at age 89, she sought a doctor who would take time to get to know her. She wanted a physician who could help her live independently for as long as possible, and see her quickly if she fell ill.

Above all, she wanted a doctor who would coordinate all of her medical care so it wouldn’t be burdensome to her children. She had a long list of providers who accepted Medicare, but picked my practice instead.

My frustration with the increasing oversight by Medicare and private insurers contributed to my decision to leave my traditional family practice office several years ago to join Priority Physicians, the largest privately held direct care medical practice in Indiana.

We don’t bill Medicare or private insurers. Rather, to participate in our direct care practice, patients pay an annual membership fee that varies by age, averaging $5,500. This covers all of our medical services, including a comprehensive annual exam, extended office visit times, same-day sick visit appointments, after-hours care, and house calls when necessary. We see our patients when hospitalized to ensure they receive the best possible care.

Priority Physicians also limits the number of patients each doctor sees to 200 adults. This allows us to get to know each of our patients better and provide personalized care tailored to their needs.

Because we rely on membership fees from a limited panel of patients, those patients end up paying more for their primary care. But they report finding the time and attention of the physician to be well worth the cost.

Medicare asks physicians to assess a patient’s medical history, family history, surgical history, medications, mood, hearing, vision, and their ability to manage activities of daily living, perform a thorough physical exam and counsel on preventive health within a 20-minute office visit. We don’t believe that’s adequate.

In our practice, we allow up to three to four hours to complete an annual exam. We cover preventive health topics in detail, providing information on smoking cessation, an exercise prescription, nutrition counseling, immunizations and cancer screenings. Where I might spend one to two minutes to talk about weight loss in my prior practice, I can now spend 20 minutes detailing steps to shed pounds. We also review patients’ chronic medical issues from diabetes to migraines, and perform additional tests as necessary, along with reviewing labs. Patients leave the office with their questions answered and a care plan in place.

When Mildred, whose last name we’re not disclosing for privacy sake, was admitted to the hospital with shortness of breath and fatigue, she didn’t have to relay her many years of medical history. We did it for her, while she focused on healing; and we arranged for follow-up care before she left the hospital.

Participating in our direct care medical practice helped Mildred avoid moving into an assisted living facility, in step with her wishes to remain independent. Practicing in this model, giving patients that kind of dignity, has allowed me to find the joy in medicine again.


Dr. Emily Szewczyk is board certified in family medicine. She has practiced at highly rated Priority Physicians in Indianapolis since 2010, and is currently accepting new patients of all ages.


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