HUDSON, Wis. — Dr. David Usher said being a physician is about more than treating a patient’s physical and mental health. It also means addressing the ability to afford those services.
“If, as a health care provider, you’re not paying attention to the financial wellbeing of your patient, you’re not treating the whole patient,” he said.
That approach is front and center at ReforMedicine, a direct-pay family medicine practice with offices in western Wisconsin. The newest location in Hudson opened this month at 596 Outpost Circle, Suite G.
“We’re built on the notion of doing things in a more cost-sensitive way,” said Usher, ReforMedicine founder and CEO. Part of that means giving patients a price list so they know exactly how much they’ll have to pay.
Being seen for an ear infection, sore throat or pink eye? $100.
Well child check or adult physical? $150.
Common lab tests? Starting at $48 a piece.
At ReforMedicine patients pay their bill with cash, credit or check before leaving the clinic — no insurance companies involved. The simplicity for billing means less overhead and administrative duties, Usher said, giving doctors more time and attention to devote to patients.
“It allows us to practice medicine more like we wanted to when we first got into primary care,” he said, adding a typical appointment at ReforMedicine is 30 minutes.
Beyond seeing patients on an individual basis, ReforMedicine contracts with area businesses to provide employees unlimited office visits for a monthly rate, something Usher likened to a gym membership.
The practice also meets with contracted businesses and human resources departments to understand company culture, provide referrals for specialty care and address employee health concerns such as obesity.
Direct primary care
Direct-pay clinics have been opening in communities across the U.S. in response to rising health care and insurance costs. There are more than 1,000 direct primary care practices spread across 48 states, according to industry advocacy group Direct Primary Care Coalition.
The model has gained acceptance from health care organizations such as the American Academy of Family Physicians, which says direct primary care works well for patients with high-deductible insurance plans who end up paying out of pocket for medical care anyway.
Critics of the model have questioned whether direct primary care physicians spending more time with fewer patients could contribute to a growing physician shortage, particularly in rural or underserved communities.
Usher said for years he heard patients’ concerns about paying for health care. As a physician, he also felt like he was pressuring patients to do things they couldn’t afford. When the Affordable Care Act, former President Barack Obama's health care law, passed in 2010, Usher said he suspected health insurance premiums would only continue to rise.
The average annual premium for employer-sponsored health insurance for an individual went up $1,432 to $6,816 from 2010 to 2018 in Wisconsin, and increased by $1,817 to $6,781 during the same span in Minnesota, according to survey data presented by the State Health Access Data Assistance Center. In both states, more than half of private-sector employees were enrolled in a high-deductible plan.
Usher said the direct-pay model focuses on treating patients early before minor issues turn complicated and costly. He compared it to regular automobile maintenance.
“You wouldn’t wait around until your engine’s grinding and smoke is blowing out before you change your oil,” Usher said. “And you budget for those things; you don’t expect your car insurance to pay for those.”