By going “back to the future,” Dr. Paula J. Frantz has become a trailblazer for an innovative health care model that is quickly changing the way patients pay for and experience primary health care.

The local family physician is on a mission to change the way people view health care by taking a trip back in time to re-visit a concept grounded in our collective medical history. The concept known as “direct primary care” can best be described as a return to the simplicity of the doctor-patient relationship by cutting out the middle man, eliminating high premium insurance and removing complicated payment methods.

In short, the direct primary care model is what American health care was before the insurance industry began taking over and subsequently driving up health care costs.

“It’s obvious that a lot of people are coming in between the physician and the patient and impacting the care that’s delivered and not necessarily in a positive way, “said Frantz, who operates Inspire Health Direct Primary Care, LLC at 108 Delmar St. in Sterling.

Frantz took a bold step after years of participating in the fee-for-pay insurance model and launched her own direct primary care practice. In the process, she restored her passion for practicing medicine.

“First and foremost, I was getting frustrated with the traditional practice because it felt like you could never see enough patients to make everybody happy,” said Frantz who found herself increasingly caught up in a system that focused more on profits than on providing affordable, quality health care.

The pressure on doctors in traditional practices to continually meet increasing expectations by their employers has contributed to a shortage of doctors, high rates of burn out and even physician suicide.

Frantz said she started looking for a new way to deliver health care after she began experiencing burn out under the traditional model. Her research led her to the direct primary care model and in 2015, she attended a DPC Summit Conference in Kansas City sponsored in part by the American Academy of Physicians.

The conference proved to be a life changing experience for Frantz, who returned to Sterling and with her husband’s encouragement used her personal retirement fund to finance her new direct primary care medical practice.

“Once he said I could use my retirement money, I registered my business name the next week,” said Frantz, who was able to pull her new practice together in a matter of months.

The once “burned out” doctor received a new lease on life when she opened Inspire Health Direct Primary Care LLC, on Jan. 4, 2016, after leaving her family medical practice at Colorado Plains Clinic.

Because Inspire Health DPC is built on the direct primary care model it allows Frantz to receive direct payment from the patients she serves. And rather than being paid by the number of patients that can be crammed into a day’s schedule, Frantz can set her patient enrollment at a small number of clients.

Frantz, who currently has 200 patients enrolled in her practice, said she sees between eight and 10 patients a day with appointments lasting from 30 minutes to an hour. The extra time allows her to do educational teaching, necessary documentation, perform minor procedures and follow up with specialists who are also treating the patient.

Frantz said she decided to cap her patient enrollment at 400, so she still has plenty of room for new patients. If the concept catches on, Frantz said she would consider hiring an additional physician or a nurse practitioner. At present, Frantz has only one other employee in her practice and between the two they are able to see patients, make appointments and do all of the billing in house.

Under the fee for pay model, doctors spend as much or more time documenting a patient visit on a computer than actually listening to the patient. Even worse, patients can expect to dedicate 3 hours of their day to a doctor’s visit including drive time, sitting in a waiting room for 30 to 45 minutes and enduring an additional 20 minutes in the examination room before being seen by their doctor.

Doctors serving in the traditional model are expected to see anywhere from 25 to 30 patients per day. That translates to shorter patient visits averaging around 10 to 15 minutes a visit. On average, doctors in the insurance model are expected to carry 1,500 to 3,500 patients as part of their patient care load, depending on where they practice.

The physician is paid by his/her employer, who also must pay administrative staff to handle all the coding and billing to the patient’s insurance company, collecting co-pays and following up on any billing errors. The system is top heavy, with administrative staff often outnumbering medical staff.

In the insurance model, physicians are rewarded for playing the “coding and numbers game.” The higher doctors can code an appointment for insurance payment plus the more of those appointments a doctor can do in a day equals higher pay for the doctor. And while most physicians make a decent living with the traditional model, DPC doctors claim they make up to 30 percent more than their fellow physicians even when they drastically reduce the number of patients the see per day.

“I am actually rewarded for taking better care of my patients. If I can get them stabilized and doing well, that’s where I actually get my reward,” said Frantz, who is able to set longer appointment times with her patients, which results in better care. Frantz said she can now meet her patient needs, ask questions and build trust where before, she was overwhelmed by administrators who pushed for higher and higher numbers of clinic visits per day.

“It really changes the dynamic in the room when the patient knows that they are paying you directly and when the physician knows that this person sitting right here are the ones who are writing the check to pay me,” Frantz said.

Inspire Health DPC charges $35 per month for children, $75 per month for adults and $200 for a family with two adults and two or more children. Clients who pay for a full year receive one month free.

“When patients pay my monthly fee, it includes almost everything that I do,” Frantz said. “It includes all their office visits, it includes basic labs such as CBC, thyroid tests, diabetes screening, basic chemistries — whether they need it one time a year or if they need it every month, it’s all included.”

Frantz said the monthly membership fee also includes EKG’s, pulmonary function testing and after hours visits where patients can call her directly on her cell phone. Patients can also see Frantz as many times in a month as they need and they can often get same day or next day visits.

“If one of my patients gets an injury or sick and they need to be seen after hours they don’t pay me more. They just pay their single monthly fee; that way they know ahead of time and then I’m available,” Frantz said.

Frantz said the direct primary care model can be compared to how consumers use their personal car insurance.

“Car insurance is not used for oil changes, new tires or maintenance on the motor; rather car insurance is used for catastrophic events,” said Frantz, who explained that the direct primary care model functions much the same way. Since up to 80 percent of health care is handled by a primary care physician, many families can save money by paying a monthly doctor fee and then purchasing a low premium catastrophic health insurance plan.

One advantage to direct primary care is that it can often save patients money on prescription medications. Inspire Health DPC has access to roughly 130 to 140 medications that they dispense at 10 percent over cost. According to Frantz, many blood medications cost her patients as little as $2 or less for a three month supply. The cost is added to their monthly bill.

If a patient needs labs that are not covered by the monthly fee, Inspire Health DPC only charges the patient at cost with no mark up. Meaning that whatever the lab bills Inspire Health DPC is what the patient is billed and typically those labs are inexpensive compared to what insurance companies bill.

Another advantage of the direct primary care model is the ability for doctors to negotiate with medical vendors for lower out of pocket expenses not covered by the monthly DPC fee. Frantz is able to negotiate prices for her patients on other services by joining with larger DPC practices.

“I shop around and do comparison prices on MRI’s and CT scans and if I find a place that’s willing to do a good cash price, I let my patients know,” said Frantz, who then passes the information on to her patients. She then encourages her patients to make the necessary calls and be a “good consumer” by contacting their insurance to see how it will be affected by their regulations.

The final decision on what services and how much they pay is up to the patient, who may choose to bill their insurance or pay out of pocket for the service. Frantz said the best way to know if joining a direct primary care provider will work for you or your family is to set up a free consultation by calling Inspire Health DPC at 970-526-6131.

Lisa Young: 970-526-9281, lyoung@journal-advocate.com