How to Consult with Specialists as a Direct Primary Care Doctor

How to Consult with Specialists as a Direct Primary Care Doctor

This is a big one for folks taking the plunge into Direct Primary Care - how do you as a Direct Primary Care doctor consult with specialists? Because you’re not “in-network”, how do you get patients the care they need outside of your office?

There are a number of ways to go about this and I’ll tackle three of them in this blog below. This blog post was prompted by a community question:

Message: Dr. Thomas,
I am about to start a DPC clinic. I completed family medicine in 2005 and am tired of the headache and hurdles of traditional primary care. One of the biggest things holding me back is how to refer to specialist? In one of your videos--you mentioned using a specialist service(for difficult ekg reading, endocrinology..etc). What was the name of that service?
Also--how do you deal with preventive stuff---like colonoscopy? stress test--if needed?

Any help in this category is greatly appreciated.

I am glad you got away from the insurance companies. I own a medical and day spa and will incorporate the monthly fee to cover facial/massage on the months the members do not need medical care.

Thanks again,

Option #1: Use the time that you have

Because you’re a Direct Primary Care doctor, you now have more time to read up on diagnoses and more time to guide your patients through the care that they need. By leveraging the increased time that you have, you can take care of more problems in your office and therefore have to refer less often.

Option #2: Develop close relationships with specialists in your community

If you are able to develop close relationships with specialists in your community, especially the private and non-hospital-affiliated specialists in your town, you can discuss cash prices for your patients.

I try to keep in close contact with my physician colleagues, and that’s part of the reason why I attend Wayne State University School of Medicine alumni networking events. Many of the opportunities that you find to lower the cost of care for your patients will come from your network.

I try to keep in close contact with my physician colleagues, and that’s part of the reason why I attend Wayne State University School of Medicine alumni networking events. Many of the opportunities that you find to lower the cost of care for your patients will come from your network.

For example, by working with a local gastroenterologist in our region that owns a free-standing endoscopy suite, we were able to get cash prices for Esophagogastroduodenoscopies and Colonoscopies. They are roughly $1,000 each, which pays $400 for the facility, $300 for the Gastroenterologist to perform the procedure, and $300 for the Anesthesiologist.

Another example is Cardiology. We worked with a local cardiologist to get pricing on common tests that we need for our patients. Specifically, the Echocardiogram is $199, an Exercise Stress Test is $99, and a Holter Monitor is $99. These are very reasonable prices and they help us make better decisions for our patients.

Additionally, you can request visit prices/appointment prices from the specialists in your community.

Option #3: Leverage an online or e-Consult platform

As a Direct Primary Care doctor, you have the option to consult with specialists via online or e-Consult platforms. The platform that I, and many DPC doctors, use is Rubicon. Rubicon allows you to write up a consult and include PDF files or image files - EKGs, skin lesion photos, pathology reports, lab tests - and send this information to the consultant/medical specialist of your choice. The Rubicon platform has over 100 specialists and sub-specialists from Cardiology (Electrophysiology, Pediatric, Heart Failure, Lipid Disorder) to Endocrinology, Plastic Surgery, Transgender Health, and Women’s Health. The spectrum of consultants is quite broad here and the responses are very often thoughtful and helpful.

This is a great service and I enjoy using it, but be aware that you are liable for any decisions that you make for your patients based on using this service. Finally, if malpractice litigation was brought against you or Rubicon for an outcome related to using this service, you would be responsible for not only your only legal costs, but the legal costs related to Rubicon’s involvement. Caveat Emptor, read the Indemnification clause from Rubicon’s Contract:

14.      INDEMNIFICATION; LIMITATION OF LIABILITY:

14.1.    General Indemnity: RMD and CUSTOMER will each indemnify, defend and hold harmless the other and its officers, directors, employees, agents and Specialists from and against any and all direct third party claims, costs or expenses (including reasonable out-of-pocket attorneys’ fees), and payment of damages awarded by a court of competent jurisdiction in a non-appealable final judgment or agreed to in settlement (“Claims”), resulting from the gross negligence or willful misconduct of the indemnifying party; provided, that the indemnified party promptly notifies the indemnifying party of the Claim, gives the indemnifying party sole control over the defense and settlement of the Claim, and reasonably assists the indemnifying party in the defense of the Claim at the indemnifying party’s expense, provided such settlement provides for a full release of all Claims against the indemnifying party and its affiliates. For clarity, CUSTOMER’s indemnification obligation will include indemnification for the gross negligence or willful misconduct of all of the Users and Drafters.

Yeesh.

Thanks for reading, thank you for the question, and let me know what topic you’d like me to tackle next!

-Dr. Paul Thomas with StartUpDPC