When we took an oath to do no harm
that should imply do no financial harm.
We make it cheaper than a cell phone.
If you can afford a cell phone,
you can afford the most basic aspect
of healthcare delivery in the United States.
The patients of doctors William Crouch
and Lee Gross know exactly what services will cost
before they receive them,
a radical concept only in healthcare.
They don't have to deal with
benefits packages, coverage denials,
hidden costs, in network versus out of network,
or any surprises whatsoever.
Instead their patients buy the medical equivalent
of a Netflix subscription
We charge $75 a month for an adult,
$30 a month for one child,
and $15 a month for each additional child.
After that recharge nothing
for the services that are provided in our office.
Doctors Crouch and Gross of North port, Florida
are pioneers in a growing national movement
called Direct Primary Care.
Physicians around the country
who are tired of dealing with insurance companies
when it comes to routine medical services
have exited the traditional system
and are saying that they can provide better care
at a lower price by charging their patients
a nominal monthly fee directly.
COVID-19 has pushed many doctor's offices,
which have been hard hit by the pandemic,
to start doing telemedicine for the first time.
And insurance companies in the government
have started paying them for this service.
For now, the direct primary care practices
have proven far more agile and responsive
to the needs of patients.
They're demonstrating
that making American health care flexible and affordable
requires abandoning the use of third-party insurance
for routine care and adopting a free market approach.
Direct primary care is about
as close to a free market in healthcare
as you've ever seen in our country.
Now, people say that we,
well we tried free market, it didn't work.
That's why we need the government to take over.
That's why we need a single payer healthcare system.
We have never tried a true marketplace in healthcare.
When I was in a fee for service system,
I felt like I was playing a game of whack-a-mole
with Medicare.
We had to find ways of doing as much stuff
to as many people as possible
to generate as much revenue
just to pay for the computer systems
that I needed to bill Medicare so that I could get paid.
And you kept seeing that people were being denied care
and a lot of it was cost prohibitive.
They were able to afford their insurance premiums
but then they couldn't afford the needed test.
And every time I found a way to prop up
and be able to generate revenue to support this monstrosity
that we were required to build,
Medicare would not cut the knees out from under us
and take away that revenue source
where eventually we just said,
You know what?
No more.
Direct primary care practices
are demonstrating
that routine health services
covered by Medicare and insurance companies
cost so little that most patients
could easily afford them out of pocket.
So how did this third-party payer system develop?
The government created it through the tax system.
During world war two the IRS started allowing employers
to provide health insurance
as a form of pre-tax compensation.
But if employees purchased their own healthcare
they had to use after-tax dollars.
This led to a system in which insurance companies
and large healthcare providers
negotiate prices behind closed doors,
leaving patients out of the mix.
What we have done is
we've essentially disrupted that entire paradigm.
Because we've said let's have price transparency.
Let's show people what these services actually cost
because they do have a dollar value.
You can put a price tag on these things.
We've proven that.
Today there are approximately 1400
independent direct primary care practices
with a presence in 49 States.
Virtually all of them charge a subscription fee
that's between 50 and 100 dollars monthly
to consult with the doctor at any time
in person or from home.
Crouch and Gross provide routine services
like preventative checkups, EKGs,
minor procedures like biopsies,
joint injections, removal of cysts and small cancers,
and some urgent care
such as sewing up lacerations
and splinting uncomplicated fractures, no extra charge.
In-office tests like those for strep and pregnancy
are included as well.
If a test needs to leave the office
patients pay cash prices
that Gross and Crouch have negotiated on their behalf.
If you asked the lab, what they'll tell you is that
the most expensive thing that they do is not the lab.
It's the cost of the human labor
associated with processing those claims and getting paid.
So if we eliminate their number one line item expense
in their service delivery,
then we can bring those prices way down.
And that's exactly what we saw.
We would see 95% discounts on the laboratory services.
According to a survey conducted in July,
78% of physicians had seen a decline in patient volume
because of COVID 19.
In March, the center for Medicare and Medicaid services
issued a temporary waiver
stating that Medicare would pay the same rate
for certain kinds of video telemedicine visits
as in-person ones.
But the types of visits that would cover
changed over the course of the year
and are still changing.
Whether or not insurance companies and the government
continue covering online visits after the pandemic
has no bearing on Crouch and Gross's practice.
And they didn't have to wait
for insurance companies and the government
to okay telemedicine in the first place.
And we immediately flipped the switch,
and instantly from in-person practice
we were an online practice.
We were a parking lot practice.
We did whatever we had to do
in order to get the patient the proper care
at the proper time.
Telemedicine has added complexity to the billing process.
That has no impact on Crouch and Gross.
So we didn't need to wait
for blue cross to convene a committee
to pay for telemedicine services.
I didn't need to wait two months or three months
for Medicare to create a new billing code
in order for me to provide technology visits for a patient.
I just did it.
For what Medicare pays for a single technology visit,
I provide two to three months
of unlimited technology visits,
Unlimited office visits, unlimited home visits,
unlimited email visits.
And so the model, is again, pandemic tested.
It's proven that it's actually a superior model
because we have the built-in flexibility to do what we need
at the time we need it.
32 States in DC have passed laws
requiring insurance companies
to reimburse doctors
at the same rate for telemedicine visits
as they do for comparable in person visits.
Crouch and Gross say that shouldn't be decided
by lobbyists, lawmakers, or government administrators.
Prices should be set through market competition.
The very first time I went to Washington
and made a presentation on direct primary care,
I gave it to a group of physicians
and after I gave my presentation on our practice
and what we were doing, a doctor raised his hand and said,
What happens if some doctor sets up right next door to you,
and charges $40 a month?
And then I said, That's an excellent question.
I said, Because of the first question out of the audience
is what are we going to do
when we bring down the price of healthcare?
We're onto something because that question
has never been asked
in the American healthcare system ever.
I said, But here's what's gonna happen.
I said, That doctor and I are going to have to compete
on price and quality.
And I'm gonna have to justify
why my price is twice as much.
Maybe I provide better service.
Maybe I'm just better trained
have better credentials, have more experience,
but something tangible is going to have to justify that.
Or I'm gonna have to lower my prices
and to compete or I'm gonna lose patients
to the person down the street.
The myth is that profit by its mere definition,
it does not belong in the American healthcare system
and it's evil when it creates perverse incentives.
The key to making that profit work is again
that elimination of that third party
in the middle of that profit
which just drives up cost but adds no value.