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Quiet revolution

ALBUQUERQUE, N.M. — Dr. Tom Pascuzzi did something a few years back that many of his colleagues could probably only dream of: He gave up a medical practice to start one that’s free from all the rules and paperwork that go with health insurance.

His new enterprise, called GoPrivateMD, is based on the direct primary care model. Pascuzzi, a former Air Force physician, serves both individual clients and employers paying extra to give their workers immediate – and they say less costly – access to urgent care services as well as physicals, flu shots and help setting up wellness programs.

Known as Dr. Tom to his clients, the affable former emergency room physician, who says he also wanted to spend more time with his three pre-teen sons in making the career shift, charges a flat monthly fee of $150 to individuals and employers and is easily reached by text, email and cellphone, or talking via FaceTime or Skype. He has far fewer patients now, but he can spend more time with each one.

The goal of the direct primary care system is a simple one, say other local providers who have started offering services on a cash-only basis. They all charge monthly fees instead of accepting insurance, and they offer customers near-constant access rather than an appointment a few weeks out.

A small but growing number of primary care physicians and other providers have stopped taking insurance. They’re among an estimated 500 such practices nationwide, most of which have opened in just the past three or four years, according to Direct Primary Care Journal, a trade publication.

GoPrivateMD, which also charges a set-up fee of $275, is designed for both individuals and employers, even if they already have health insurance.

The membership and monthly fee cover most primary care procedures, from physicals and EKGs to strep tests, stitches and setting sprains, ordering lab work and making referrals to specialists. There are no co-pays, but there are nominal charges for things like supplies used in procedures.

While the doctor is usually in, he can’t take on all medical problems, such as those needing a visit to the emergency department or the skill of a specialist. Pascuzzi’s focus is on primary care and preventive care visits, during which the patients need help treating common colds, urinary tract infections, cuts, bruises and sprains.

Pascuzzi, who started several urgent care clinics before selling them to Presbyterian Healthcare Services, used some of the proceeds as seed money for the business, at 8801 Jefferson NE. It serves employer-based clients, such as Marpac and the Yearout Cos., both of which operate self-insured health plans. His direct-pay practice offers unlimited visits and 24/7 access. He recently hired a part-time medical assistant to lend a hand for some of the procedures and to record vital signs.

Pascuzzi said he wants to cap the number of self-pay patients to 500 to do justice to their health care concerns and needs. “Consumers want access to care today or tomorrow – not an appointment in May or June.”

And that number, he said, is more than adequate to provide a living. Assisting him in the practice is his wife, Shannon, who takes care of the business side. With his wife on board, overhead is lower and he doesn’t have to employ the 2½ staff members he needed to collect insurance payments at his past practice. “Too much paperwork, too little time to really provide quality care, which can lead to burnout,” he said of his past life.

The average family physician makes $207,000 each year, according to a survey by the medical website Medscape.com. (Those new to the practice may have higher debt because of school loans and the costs of setting up a practice.)

Pascuzzi said some of his private patients, many of them self-employed business owners, carry high-deductible insurance plans for emergency coverage in the event of a catastrophic illness or injury, but seek a program like his for their own primary care.

Employer clients like the Yearout Cos. continue to offer health coverage for the majority of its workers, but use the membership-based care offered by Pascuzzi for about 120 of its non-union staff members and their dependents, said Lian Yearout, chief financial officer for the company, which offers mechanical contracting, nuclear and industrial contracting, pipe and duct fabrication, and energy management services.

She said having Pascuzzi on retainer has been a money saver. The year before signing up with GoPrivateMD, Yearout paid out $100,000 for emergency room and urgent care costs. This year, the company cut the expense by 80 percent with Pascuzzi stepping in during the workday, after hours and on the weekends to sew up stitches, order an X-ray, treat a bad sprain or a baby with a high fever and earache.

Yearout said the company had considered having an on-site clinic, but the problem was coverage after work hours. “Dr. Tom is always available, and you never feel rushed. He wants you to ask questions.”

Yearout said there are extra fees the company racks up on the order of several hundred dollars a month, mostly for medical supplies that GoPrivateMD uses to treat aches, pains, cuts and other minor procedures. “It’s a nominal amount and totally worth it,” she said.

Another Albuquerque provider making the switch to direct primary care is Roger Rounds, an osteopathic physician. In practice since 1982, Rounds said he was on the verge of leaving medicine a few years back. His main motivation, he said, wasn’t money, but the chance to be relieved of overwhelming paperwork and patient demands on him as a solo practitioner.

In 2013, he became an affiliate of MDVIP, a network of physicians with an average age of 58 who offer personalized primary care medical and wellness services.

Through this more personalized program, Rounds said, he is providing more one-on-one patient care. Each appointment is a full half-hour.

The practice is limited to no more than 600 patients, and the cost is $1,650 per year, which is not billable to insurance. Rounds said about 95 percent of his current patients followed him from the previous practice. “Many are comfortably retired and covered by Medicare but still want that extra cushion and access that hiring me brings,” Rounds said.

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Family nurse practitioner KC Devine consults with a patient via Skype. She said she’s building her practice on a fee-only basis rather than working with insurance. (Marla Brose/Albuquerque Journal)

Also carving out a niche in the direct primary care world is KC Devine, a family nurse pratitioner who launched her business, Well Life ABQ, in the Northeast Heights area earlier this year.

In her previous job, Devine said, she was lucky to be with a patient for 10 minutes or less and “spent most of my time charting to make the insurance company happy.” Direct primary care removes the insurance company, “so I can focus on what my patient needs, when they need it and how they need it,” Devine said. No longer tethered by insurance requirements, patients can be seen in person or virtually. They can ask unlimited questions on her company portal, and they can reserve same-day/next-day sick slots.

“I call it a ‘quiet’ revolution,” Devine said of the direct primary care movement. Like similar practices across the nation, Well Life ABQ charges patients a monthly fee of $60 per individual, $80 for a couple and $150 for a family. The fee covers office visits and all the questions in between.

Devine, who has strong skill sets in hormone replacement therapy and pediatric care, hopes to have 300 members by year’s end. She said a typical family practice doctor sees about 900 patients per month. Devine, who moved to Albuquerque when her husband was transferred here for a job with the Department of Energy, said she’s lucky to have a partner “with a decent income” to help cover for the family while she builds her business.


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