Dr. Zach Smith talks alternative payment model

Published 11:00 am Saturday, February 5, 2022

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WEST POINT — During the noon hour on Thursday, Dr. Zach Smith of Valley Direct Primary Care discussed a new business model that’s fast gaining acceptance in the medical community. He was the guest speaker at the weekly meeting of the West Point Rotary Club.

Valley Direct  Primary Care has been serving the local area from its office on Fob James Drive in Valley since last August. Dr. Smith and nurse practitioner Stephanie Chappell are co-owners of the new business. Smith is a native of Columbus, Georgia. and a graduate of the Georgia campus of the Philadelphia College of Osteopathic Medicine. He completed his family medicine residency in Tuscaloosa at the University of Alabama. Smith and his wife are currently raising four young sons. Chappell is a native of Valley and earned her nursing practitioner degree from Auburn University.

Direct primary care (DPC) is an innovative alternative payment model that has been shown to improve access to high-functioning health care with a simple, flat, affordable membership fee. There are no fee-for-service payments and no third-party billing. The defining element of direct primary care is an enduring and trusting relationship between a patient and his or her primary care provider. Patients have extraordinary access to the doctor of their choice, often for as little as $75 per month. Physicians are accountable first and foremost to their patients.

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Direct primary care is being embraced by health policymakers on both the left and the right, creating both happy patients and happy doctors all over the U.S.

Smith said he first learned of this new business model while attending a conference of the American Academy of Family Physicians. When he first heard some presentations on this new model, he was very skeptical.

“Doctors are never going to do that,” he said to himself.

He noticed, though, that those who were speaking about it were very excited about it and said that patients were very excited about it, too. The more he thought about it, the more he liked it.

“I was blown away about the possibility of practicing medicine this way,” he said. “Many times with the old model, I had to see as many as 35 patients in one day. Patients had long waiting times, and by the time I got around to seeing them they were upset about waiting so long. Doing this every day isn’t sustainable for the long term. This was one reason I went to work as an emergency room doctor.”

In doing it the direct primary care way, Dr. Smith doesn’t see as many patients as he once did, but he can spend more time with each one. The patients, of course, like the shorter waiting times and more time with their doctor.

“What I love about direct primary care is that it’s a chance to do medicine in a different format,” Smith said. “It gets to the root of the doctor-patient relationship. We have found that this is a good thing. We are enjoying it, and our patients are enjoying it.”

Smith said that health insurance is a good thing but can be very frustrating and time-consuming to deal with. Sometimes, a patient will pay a co-pay on their visit to the doctor only to later receive a bill from an insurer for what they have already paid for.

“We don’t deal with insurance, period,” Smith said. “To charge insurance under direct primary care, your doctor has to have a billable encounter where he takes your blood pressure or checks your heart rate.”

Cutting out the middle man, said Smith, is a benefit for the doctor and the patient.

“They don’t know when insurance will pay,” he said. “This puts you in the position of having to see a lot of patients and charging them a lot just to be in position to get a portion of it. A huge team is at work to make it all happen. With insurance, you have to chart patient encounters the way the insurance company wants you to. Sometimes you will spend more time doing that than you do with the patient.”

The pressure of continually having to deal with this is a heavy load for many doctors.

“A fair number of them are retiring early so they can get into direct primary care,” Smith said.

Direct primary care, said Smith, is bringing back an old way of practicing medicine.

“This business model has been very enjoyable for me and my patients,” he said. “We don’t have to have a patient load of 4,00o to 5,000 people. We can have 300 to 400. The patient doesn’t have to wait three-and-a-half hours to see their doctor, and they can have 30 to 45 minutes to spend with them. It allows the doctor-patient relationship to become what it was always meant to be.”

Smith said that direct primary care is ideal for small businesses with no more than 50 employees.

“It’s much cheaper to do it this way,” he said.

Direct primary care allows for affordable, transparent costs based on a periodic overall flat rate (i.e. membership or subscription). Patients pay for their care directly to the physician. There are no third parties for fee-for-service billing, which inflates costs.