The News & Advance

FOREST – Sara Coleman leans forward, her coffee cup now empty, and considers her answer carefully. She and her husband, Roy, haven’t been patients of Dr. Douglas Farrago for long. In fact, Forest Direct Primary Care just had its soft opening a few weeks ago.

She mulls over the health insurance premiums she used to pay, how Farrago has motivated her to take better care of herself, and the advice Farrago gave to her husband — who is having problems with his shoulder — to exercise rather than seek out a shot, and comes to a decision.

“I think at some point,” Coleman said, “he’ll be turning people away.”

Fast forward one week. It’s a Thursday evening and Farrago stands on a podium in front of a 30-plus crowd of curious and somewhat skeptical adults who pepper him with questions for more than an hour.

Yes, he’ll make house calls.

No, he won’t accept insurance.

Yes, he’s serious.

It’s a bold pronouncement but one that the 49-year-old entrepreneur and physician appears to have been headed toward for years.

Unlike concierge medicine, which caters to the wealthy with pricey membership fees, this is direct primary care, a small but growing field where patient loads are small — about a fourth of the number the average family physician cares for, according to national statistics — and fees are affordable, $75 to $150 a month.

Farrago, one of the first in the area to try it on this scale, calls is a “more personal, comprehensive” kind of health care.

Confident and energetic, Farrago has appeared in magazine and newspaper publications across the country for everything from the patented Knee-Saver he developed for baseball catchers to the “The Placebo Journal,” a long-running MAD magazine for physicians.

Throughout it all, one thing has remained the same: his disdain for what he feels family practice has become — a 15-minute visit defined by codes and insurance companies.

“We’re being overburdened with bureaucratic dreg,” Farrago said one afternoon from the same office where he meets patients face-to-face before and after exams to discuss their well-being. Exams are done just down the hallway, sans computer.

Over the last 20 years, Farrago has worked in traditional family practices and immediate-care clinics, like those that have cropped up across the Lynchburg area in the last few years.

Last month he decided to go off the grid, following in the footsteps of some 4,000-plus direct-care physicians nationwide who have cut out insurance companies and directly bill patients monthly.

The practice has gained enough of a following that, last year, the American Academy of Family Physicians formally recognized its benefits and created a policy for these kind of physician practices.

“The model eliminates the insurance middleman and provides revenue directly to the practice to innovate in both customer service and quality of care for the patients they serve,” said AAFP Board Chair Glen Stream, M.D. in the policy. “This is one option that is particularly well suited for small family medicine practices that are struggling financially in environments not yet supporting (Primary Care Medical Homes) with a viable payment model.”

Clients are billed monthly and in exchange they have unlimited access to physicians with no co-pays for office visits. In Forest, Farrago’s rates are competitive with other direct primary care physician’s rates, $75 a month for individuals, $125 for couples, and $150 for families. Farrago said he can attend to 90 percent of all medical needs — osteopathic manipulation, cortisone injections and skin procedures are included, for example — but acknowledges that there are all kinds of outside services not included in the monthly fee.

Blood tests, flu shots and diagnostics like CT scans, X-rays and MRIs are among the services that would require out-of-pocket costs. Farrago tells patients that he has partnerships with radiologists, the Lynchburg Health Department and area laboratories that will provide discounted services.

Farrago, like other direct primary care physicians, also urges patients to get catastrophic insurance should something major happen; “that’s a mistake to not have insurance,” he said.

Cutting ties with insurance helps Farrago become “the doctor I want to be.”

“I want to bring back medicine to the old-fashioned way. I can’t be Marcus Welby without time,” he said, referring the 1970s television show about a doctor with a kind bedside manner. “They’re squeezing us on time.”

The average primary-care physician has about 2,300 patients, according to the Annals of Family Medicine. The American Academy of Family Physicians reports that physicians see about 19 patients a day.

In practice, it means physicians are generally allotted about 15 minutes to take care of a patient, Farrago said.

Farrago will accept only 600 patients, seeing three to six patients a day, while all will have access to him via phone, text and email wherever he is. He’s using an electronic medical records system that can connect email correspondence with patient records just as easily as it accepts the data from their Fitbits. Made for direct-care physicians, the program lets Farrago track data over time. It’s his job to interpret the numbers.

As a result, Bedford County resident Larry Compter said, Farrago is able to “go outside the box.”

Compter and his wife Barbara, a cancer survivor, have only been to see Farrago a few times, but they are two of the nearly 100 patients who already have signed up for Forest Direct Primary Care. They met Farrago when he was working at a family practice in Forest and decided to follow when he opened his own practice.

Compter said his experience with Farrago helped him realize there is another way to get health care and it doesn’t involve a diagnosis code and high-volume.

“What Dr. Farrago is doing, it’s a more personal kind of medical care,” Compter said, calling direct primary care “a step in the right direction.”

“It’s a step back to medicine as it ought to be — between the doctor and that patient.”

When Sara Coleman’s physician of 35 years retired, she couldn’t imagine finding a comparable replacement so the Coleman’s, who are self-employed, agreed to pay full price at immediate care sites.

The physicians there were fine. The wait was not.

So, she tried Farrago and, like Compter, encouraged her spouse, Roy, to consider signing on as Farrago’s patient as well.

“Anything that bucks the system I’m good for,” Sara Coleman said, explaining why she and Roy are now patients at FDPC. “I don’t mind paying somebody but I want what I pay for.”

“When you get pieces of the medical system that’s what you get, pieces, and you’ve got to piece it together,” Coleman said. “I want somebody who can tell me what all those pieces add up to.”

Coleman said, with this model of care Farrago has the time and takes the time. Roy had been getting injections to cope with shoulder pain for a while, but Farrago started him on a physical therapy routine, personally taking him through strengthening exercises that he now does daily.

At last week’s visit, Roy didn’t feel the need for a shot.

Although Direct Primary Care is catching on — Collaborative Health Partners, a collaboration between Central Virginia Family Physicians and Medical Associates of Central Virginia, began offering residents Direct Primary Care earlier this year — it won’t be for everyone.

Skeptics at an informational meeting wanted assurances that Farrago wouldn’t eventually become greedy and take on more patients leaving less time for them, that he wouldn’t raise his rates or festoon his office with religious paraphernalia. He won’t get greedy, he said, but he may hire an associate; if rates have to rise he’ll talk with his patients and no, no religious paraphernalia.

The meeting ends and people mill around waiting for the opportunity to speak with Farrago, to look him in the eye.

Surrounded by a cluster of friends, Ron Justice asks Farrago a few questions before deciding to sign on.

He vividly remembers his mom dying of cancer and the way healthcare providers made him feel. At 51, Justice is healthy but knows at some point, “I’m going to need health care.”

“I don’t want to go through this time of life and feel like I don’t have a doctor.”