Direct care: New model focuses on old-fashioned doctor – patient relationship

October 2017 Posted in Community, Your Health

By Melissa Wagoner

Two years ago Dr. Rob Rosborough was fed up with his career and looking for a change.

“It was either do something different altogether in medicine or open a taco truck,” he laughed.

Rosborough, who began in family practice in Silverton in 1996, was averaging 25 patients a day as well as maintaining charts and other behind-the-scenes tasks. This gave him, on average, seven minutes to spend caring for each patient.

“It was becoming such a grind and I didn’t feel very satisfied,” he said. “I was getting incredibly frustrated with the insurance model of medicine. That relationship was being challenged; too many clicky boxes, too many computers.”

That’s when Rosborough stumbled upon a radically different practice design which eliminates the need for insurance and Medicare billing while also giving doctors more quality time with patients. Known as Direct Primary Care (DPC), it allows patients to pay the bulk of their medical costs up front, cutting down on administrative costs and allowing practitioners to see fewer patients.

“It’s a monthly membership just like Netflix,” Rosborough explained. “It’s $60 or $120 for families. Kids are no charge. Everything’s included. The only thing we charge extra for are medications and we pay pennies on the dollar.”

DPC also creates a closer relationship between doctor and patient because the patient has one primary care physician whom they have unlimited access to.

“Everybody gets a half-hour appointment. New patients get an hour,” Rosborough said. “They have my personal number.”

Although Rosborough’s new clinic, Township Health DPC, has only been open a few weeks, he has already noticed a change in the relationship he has with the patients who followed him.

“The cool thing about this model is I’ve had time to talk to someone I’ve known over a decade and found out something new,” he said.

Township Health DPC is in a small space in downtown Silverton with a staff consisting of office manager Janet Daffron and medical assistant Sara Quijano, both of whom have worked with Rosborough for 20 years.

“I thought it was a good idea, a good concept,” Quijano said. “The hours are better for my life. I had been working really long hours.”

The hours, as listed on the front door, are “catered to the patient needs.” Rosborough explained that he is available to patients at any time and even makes house calls on occasion for those who cannot make it into the office.

“I think the biggest misconception is when you open up your access people will bug you all the time,” he said, adding he rarely gets calls on weekends and almost never at night, He feels that open door policy is important.

“It’s how do you take care of people and how do they have access to you?” he said.

That openness is a theme across his entire practice including the in-house pharmacy, laboratory tests and x-rays.

“It’s completely transparent pricing. I have a book that has all the costs,” he said. “There are no prior authorizations. You don’t have to get approved through the insurance. It’s completely outside the insurance base.”

Because Rosborough pays cash for outside testing upfront, he is often able to save his patients money and by working with a wholesaler he stocks his pharmacy with prescription and over the counter drugs as well as vitamins and supplements for much cheaper than usually priced elsewhere.

For many of Rosborough’s patients who fill multiple prescriptions every month this has been a huge savings.

“I have a patient who came in and filled seven medications for $36,” he said. “He’s seeing me for free because of the (reduced cost of the) medicine and he’s getting more personal care and time with me.”

Typical of most DPC clinics, Rosborough said about
10 percent of his previous clientele, around 200 patients, followed him to the new office. That number has been increasing, on average, by about 10 per week.

“A lot of people think, ‘OK, this is some kind of snake oil medicine,’” he laughed. “We’re so ingrained that you have to use insurance. You absolutely don’t.”

He does caution, however, that although Township Health DPC offers many services including setting of simple fractures, laceration care, vasectomies, circumcisions and wart removal, it is a good idea to have insurance to cover emergencies and catastrophic health issues.

Overall Rosborough said he is very pleased with his new practice and is enjoying getting to know his patients on a deeper level.

“You have to like people. You have to like socializing,” he said. “This is the most fun I’ve ever had being a doctor.”

Township Health DPC

113 South Water St., Silverton

Direct Primary Care is a new healthcare model in which there is a closer doctor/patient relationship and most of the costs of care are settled upfront. Members pay a monthly fee and are given unlimited access to the care provider. No insurance is billed and care does not count toward an insurance deductible. However it is recommended that patients have a catastrophic care insurance plan as backup.

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