Health membership


Dr. Stania DeJesus’s primary care practice sits along a row of nearly identical storefronts in an office park next to Trident Medical Center.

From the outside, the Family Wellness Center of Charleston looks like its neighbors.

But on the inside, there’s one big difference. DeJesus accepts patients without health insurance, and she’s planning on turning a profit.

This is direct pay primary care, a newish model of medicine gaining traction across the country. Patients pay their doctors a flat fee each month. There isn’t an insurance co-payment or a deductible to worry about.

Direct pay, similar in some ways to its glitzier cousin “concierge medicine,” has become increasingly popular as the federal Affordable Care Act continues to drive patients into high-deductible health plans and physicians grow ever more frustrated with insurance companies.

A paper last year by the American College of Physicians cited 2013 surveys that show approximately 6 percent of physicians already work in “concierge or cash-only practices” and that nearly 10 percent considered moving in that direction within three years.

DeJesus, who opened her practice a year ago, charges her adult patients $59 a month and her pediatric patients $39 a month. That “membership fee” covers a maximum six office visits per patient and several in-house lab tests.

“You don’t pay anything extra. That’s it,” DeJesus said.

Some of DeJesus’s patients already have health insurance, but they find this direct pay model easier to deal with.

“It’s extremely convenient,” said Tonique Morrison, one of DeJesus’s patients.

Morrison’s health insurance deductible is $2,700, meaning she must spend that much money out of her own pocket before her insurance coverage kicks in.

“For me, that’s pretty high to try to reach that,” she said.

Instead, it makes more financial sense for Morrison to pay DeJesus $59 a month and to save her high deductible insurance plan for emergencies.

Now, her health insurance plan works kind of like car insurance. The policy covers significant damage, but she pays cash for regular maintenance.

“I pay the monthly membership and the awesome thing is, if I have any questions, I can call her,” she said. “I think the big thing is, a lot of people deal with this, where you wait forever to see your doctor and then you might spend five to 10 minutes in the room with (her). (DeJesus) will take up to 30 minutes, 45 minutes if she needs to see you that entire time. I think that’s pretty huge for me.”

More and more physicians across the country are branching out on their own to practice medicine this way, without restrictions imposed by insurance companies.

Direct pay is considered an affordable offshoot of the “concierge” medicine movement.

“Concierge” doctors typically charge their patients a pricey annual (or monthly) retainer, which pays for better access, extended hours, shorter wait times and the ability to reach a physician by phone or email. But many concierge practices still bill insurance companies on top of that retainer, which may exceed $2,000 a year. So patients pay the annual or monthly fee and still owe a co-payment for appointments and must meet their deductible before any cost-sharing kicks in.

DeJesus, formerly a primary care doctor at a large Walterboro practice, said she opened her direct pay practice in North Charleston because she was sick of working in a “hamster wheel of patients.”

“By the time I left, I was being pushed to see probably in the 30s (patients per day),” she said. “I was exhausted. I definitely reached the point of burn-out. I knew I didn’t want to practice that way. ... I said I’ve got to do something different.”

Now, DeJesus is a small-business owner. She’s confident that she’s on the right track, but the Family Wellness Center has so far struggled to find many patients willing to try something new. In the meantime, DeJesus accepts some customers who prefer to pay for her health care services through their insurance company. Her practice has become a hybrid of sorts.

“With the traditional model, with insurance, you’re constantly thinking about numbers, how many patients you have to see to generate overhead. It’s all about volume,” she said. “Moving away from volume you’re able to just give the extra time to the people that you see.”

Reach Lauren Sausser at 843-937-5598.