My Amazing (and Humble!) DPC Doc (or…the slow financial suicide of a small town hospital)

I have bad tendons.  I’ve had what we used to call enthesopathy, but now know as insertional tendinitis, all over, all my life. For 20 years my heels have driven me nuts. Having failed every conservative treatment there is, it’s finally gotten to the point on my right heel that I’m limping around like an old man half the time, and contrary to what my kids say, I’m no old man.

So I decided to get the opinion of a surgeon. My condition is not particularly common, and there’s no established gold standard surgical treatment for it, and few super-subspecialists who focus on its treatment. 

Right or wrong, my DPC doctor is…me. But I gotta say, this guy is fantastic! I’m really glad I went with Direct Primary Care. 

He researched and identified experts I should consult, who practice over a thousand miles from here.

He quickly communicated with the surgeon’s staff 4 states away and arranged a telemedicine consult in a couple of weeks, saving me 1,250 miles of travel. He even asked them if they’d offer a cash discount, and they immediately quoted a very affordable cash price, which was much less than their standard fee that would have been billed to insurance.

From there, it was time to get the imaging the surgeon will need to advise me properly. I needed an X-ray and an MRI. This is where my doc can really save me money. He has good prices set up in a city about an hour and a half’s drive from here.

But because I want to try and keep my healthcare dollars here in our community, he kindly called a local hospital’s billing department. The best they could do (even with the cash discount they seemed proud of) was $623 for the MRI and $249 for the Xray. $872 total. 

But…that was not all. The hospital’s billing supervisor then told him that the radiology group reading the films would bill me separately. They could not tell him the cost nor how I could find that out. So I’d just have to pay the hospital $872, get the imaging done, and then wait until I got the bill to find out the reading fees. Conservatively, I think it’s safe to assume the reading fee would be at least $100 for each, putting the local hospital’s total bill in the $1,100 range.  They would not budge from there on price.

The price my DPC doc had already negotiated out of town was $300 for the MRI, and $30 for the xray. This price included the radiology reading fees. So rather than keep my money in my community (which desperately needs it) I took my business 100 miles down the road. There, I got an MRI and the xrays I needed–the next day. And they sent me a link so my doctor 1,250 miles away could easily login and view the films. 

My DPC doctor saved me $770 and my imaging tests were scheduled and completed in under 24 hours for $330 in cash.  The radiology reports were in my inbox even before I got home.

I meet online with the surgeon on Friday, if I end up deciding to have surgery, I can’t wait to see what my DPC doc can do to negotiate that price down!

Some thoughts regarding the local hospital’s unwillingness to compete: I know the hospital would have preferred to receive $1,100. I mean, sure–who wouldn’t?  But what did they actually get? They received $0. But they could have received $330, which is a lot more than $0. Honestly, I’d probably have paid say, $500 or more just because it would have saved me 5 hours and a bunch of driving and gas money. While I was driving a 175 mile round trip to save $770, the hospital’s MRI likely sat empty generating no income (despite losing $ on overhead and staffing inherent in its existence).

This whole thing kind of hurts my brain because it seems so stupid from a business perspective. At the same time, it makes me sad because I think the hospital’s financial collapse is inevitable, preventable, and self-inflicted. I have many friends who work there, and our community is well-served by them. But our community won’t be fleeced, and I don’t see this ending well.

In my opinion, my clinic sends far too much money out of town unnecessarily. I think most of our patients feel the same way, and want to support our neighbors at the small area hospitals. But the hospitals really need to compete in the free market, or we’re all just going to keep going around them. Their stubbornness to embrace free-market principles can only harm them in the long run. It’s hard to estimate just how many hundreds of thousands of healthcare dollars -in cash- my patients have taken down the road.

Remember, National DPC Day is November 1, the day when people start enrolling in insurance plans. Get the word out by sending them here.