'Direct primary care' practice cuts costs | May 6, 2011 | Mountain View Voice | Mountain View Online |


Mountain View Voice

News - May 6, 2011

'Direct primary care' practice cuts costs

Patients pay directly for care, cutting out insurance middlemen, doctor says

by Nick Veronin

A new primary care practice, which promises patients highly affordable care without any of the hassles often associated with health insurance, opened May 4 in Mountain View.

Founded by two medical doctors, M. Samir Qamar, and his wife, Hisana Qamar, MedLion charges patients a monthly $49 membership fee for access to an unlimited number of appointments. Patients are charged an additional $10 per visit — and that's it.

"It does sound too good to be true," Qamar said with a chuckle, noting that he is often asked whether his practice is some sort of underhanded scheme. "It is something that is almost a deterrent to our growth."

The key word being "almost." Qamar founded MedLion in 2009 in Monterey, and said he began turning a profit within seven months, he said.

Qamar said that in bypassing insurance companies and having patients pay him directly, he saves a great deal of money. That's because dealing with insurance companies is an incredibly complex, and pricy, process.

"A lot of the costs that doctors undertake are due to insurance companies' regulation," he said. "There is a lot of staff that is hired just for the insurance side of things. If the gym had to chase you down after every visit it would be quite taxing for them."

First a doctor's billing department calls the insurer and gives them a specialized code — one for the appointment itself and others for tests conducted or blood drawn. The insurance company then reimburses the doctors for each procedure. Sometimes the same insurer will pay different rates for the same procedure, depending on the individual patient's policy. This process can take a long time, leaving doctors footing the bill until the insurance company finally reimburses them, he said.

By eliminating the need for insurance specialists, MedLion's system of "direct primary care" saves Qamar somewhere in the neighborhood of 35 percent in operational overhead.

The MedLion system is not entirely new. Prior to the 1970s, Qamar said, most people paid their doctors directly for primary care. Those who had health insurance paid into plans that were intended to keep them from going bankrupt in the event of a catastrophic accident or the onset of a deadly disease. These plans had high deductibles, and, because they were a lower risk to the insurance company, lower premiums.

However, as the health insurance industry grew, it expanded into primary care. Premiums inched ever higher and the system became more convoluted each year.

The direct care model never entirely disappeared, but as all-encompassing health plans gained in popularity, doctors who offered direct care began charging exorbitant membership fees for "V.I.P." service. These doctors care for a small group of patients, and still make house calls, but charge hundreds, if not thousands, on a monthly basis.

In fact, Qamar has a V.I.P. practice of his own, and if it weren't for his experience caring for extremely wealthy patients as the house doctor for the Pebble Beach Resorts, he may have never founded MedLion

Back in 2009 Qamar's wife — who runs Qamar & Qamar Medical Practice, an insurance-based primary care office in Monterey — began noting a sharp decline in business, as many of her patients lost their jobs and subsequently lost health coverage.

"I thought, 'I'm taking care of the rich and famous. Why not scale it down to cater to the masses and help as many people out in the community as possible?'" she said.

By cutting out house calls and other V.I.P. services, and increasing his patient load, Qamar figured he could significantly lower the cost of offering direct primary care. It worked, and the proof is in the opening of his second office, as well as in his optimism that MedLion will soon expand even further, he said.

He hopes to open new offices in the near future and said he is open to either hiring doctors and nurse practitioners, or even franchising the MedLion model out to other states.

Qamar is the first to acknowledge that MedLion is not a comprehensive health care plan.

"We're not promising care for the catastrophic," he said, and recommended that anyone who chooses to become a member of MedLion should also look into a high-deductible health plan in case of the unexpected.

"We try to teach our patients to think of the health insurance industry like the car insurance industry," he explained. Car insurance companies pay for totaled cars or hospital bills those injured in wrecks. But the individual foots the bill for oil changes and blown gaskets.

Americans need to be more involved in the consumption of health care, Qamar said, and he sees MedLion, along with other growing direct primary care organizations — such as Qliance in Seattle and Symbeo out of New Jersey — as a means to that end.

It will be a challenge, Qamar said — "People are creatures of habit, and for the past 20 years we have expected our insurance companies to take care of us" — but the sooner "we break the mold" the better.