After logging in some 15,000 hours as an ER doctor, Samaritan member Robert Berry knew he needed to make a drastic change in employment. “I was convinced that I was part of a system that was gouging patients—my neighbors—and I figured I could provide 95 percent of the services I was providing in the ER in a high capability urgent-care practice while also taking care of their chronic problems well enough to keep them out of the hospital,” he says.
So he started PATMOS (Paid at The Moment Of Service) Emergiclinic. For 18 years he ran the only insurance-free, fee-for-service practice in northeast Tennessee until he switched over to the Direct Primary Care model just this year, renaming it DirectMD Greeneville.
He made the switch “primarily because no similar movement ever developed among the insurance-free, fee-for-service practices,” he says. “This became abundantly clear to me last year when I requested that Samaritan Ministries list my direct pay practice on its site and learned that it did this only for DPC practices. I realized then that our model was way out of date.”
He also learned that at least 1,000 DPC practices have been started over the past decade in the United States, and the number continues to rise “in response to the perfect storm of skyrocketing insurance deductibles and hospital consolidations leading to impersonal and costly care.”
The movement is being led by young physicians who share his vision of restoring humanity and sanity to primary care by not signing contracts with government, insurance companies, or hospital systems, something that works in his favor when considering retirement down the road.
“I would like to a have a smaller, more manageable practice—one that might attract a young DPC-minded physician when I decide to retire,” he says.
We recently asked Dr. Berry some questions about his practice. Here are his answers:
How does your practice differ from a typical one?
The difference hinges on who pays, because, as the old adage goes, “He who pays the piper calls the tune.”
In our previous 18 years as an insurance-free, fee-for-service practice, patients Paid At The Moment Of Service (PATMOS). Thus, most of our patients until recently—with the predominance of high deductible insurance policies—have been uninsured. Those whom most other practices have declined—“the foolish things of the world … the base and despised” (1 Corinthians 1:27-28)—we have welcomed.
In order to attract this undesirable population, we have made public the prices of our fees, labs, and procedures, putting them on billboards, in brochures, and posting them on a sign in the front of our building. They are typically one-fifth to one-half of those of other practices, which might explain why no other practice has ever followed suit.
We can do this, of course, because not signing insurance contracts enables us to operate with three fewer employees per physician and one-third of the overhead. Since the uninsured have few options, and since I am board-certified in Internal Medicine with 15,000 hours of ER experience and formerly board-certified in Emergency Medicine, we have provided services most other primary care practices don’t, such as IV therapy for dehydration and mild diabetic keto-acidosis, suturing complex lacerations like chainsaw wounds, and providing the only care for patients with rheumatology disorders until they can obtain insurance through disability.
Finally, you won’t see us with the patient off to one side while we face a computer screen, furiously inputting data for the purpose of billing insurance companies “aggressively.” Here the patient pays and thus calls the tune, so we face them directly, jotting down notes while formulating the most cost-effective diagnostic strategies and therapeutic interventions on their behalf.
What are some of the advantages to your practice that patients most appreciate?
The feedback we most receive from new patients is, “Wow, he actually listens,” which I believe says more about the state of medicine today than about the care I provide, since diagnoses and the impact of symptoms upon a patient can be ascertained only from a thorough history. They also appreciate the down-home, personal feel provided by our staff.
What are some of the problems with regulation of health care that you avoid by having a DPC?
Having not been exposed to these regulations directly for nearly two decades, I have been blissfully ignorant of most of them and can answer this only secondhand from the complaints of some of my colleagues. Since this practice has never signed contracts with private insurers, Medicare, or Medicaid (TennCare in my state), we have not had to implement electronic health records, be concerned about violating HIPAA (Health Insurance Portability and Accountability Act), suffered through insurance audits, or be threatened with possible imprisonment for unwittingly committing Medicare fraud and abuse.
Can you elaborate on your slogan, “Like having a doctor in your family?”
It conveys many ideas at once, but primarily that the physician follows the Golden Rule and will care for you and your family as he would his own. He knows your family intimately and can be counted on to be available in a time of medical need to do what he is trained to do and what he is experienced at while advocating for and helping you navigate our complex, impersonal system when the problem exceeds his expertise. At the same time, this physician expects to be treated like family as well and not like a slave. You wouldn’t call your Uncle Joe or Aunt Pat at 2 a.m. about something minor that could easily wait until morning, now, would you? For the self-employed and small employers, I think my slogan should read, “Like having an on-site clinic at your business.”
Why did you join Samaritan Ministries?
We joined Samaritan Ministries over a decade ago because the premiums for our high deductible health insurance policy with an HSA had quadrupled and because I believed I could trust fellow believers over insurance companies to be good on their word. I had witnessed from my own patients how insurance companies succeeded in “fine-lining” their way out of meeting their obligations, and there was little one could do to fight them.
What has your experience been with having a need?
We have had three needs since joining SM—all surgical—and they have all been met.
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