Eventide drops insurance and switches to Direct Primary Care

Eventide Health will become a Direct Primary Care service on March 31.

This kind of care is similar to a concierge service, but the prices will be lower than what a concierge offers.

Dr. William House of Eventide Health said, “Since arriving on the healthcare landscape in the early to mid-2000s, this model has become the fastest growing type of primary care delivery. It was born out of dissatisfaction of both patients and physicians since our traditional model of insurance and Medicare is so fundamentally broken.”

The decision began to be considered in mid-2021 as Eventide realized their current model of medicine was not going to be sustainable for the small practice. With not enough revenue coming in, they recognized they would have to shut down by summer of 2022 if they did not take another route. Under Direct Primary Care, instead of going through insurance, members pay an all-inclusive monthly fee for unlimited primary care usually on a same-day or next-day basis. Patients will be able to access their provider directly by phone, messaging, portal, email or telemedicine as well as in person or house calls/boat calls.

After talking with numerous Direct Primary Care practices across the country, Eventide felt informed enough to make a decision.

“Statistically the outcomes in these programs are MUCH better than traditional medicine and have fewer ER visits and fewer hospitalizations,” House said. “People are tired of being treated like a number and of the broken traditional system. They’re also tired of payers, Medicare or insurance, inserting themselves between the doctor and patient which interrupts and sometimes hinders care.”

House also continued to add that in order to meet the high cost of running a healthcare clinic, they have to rush as many patients through the door as they can each day. He said once patients are rushed through the visit, the provider spends a massive amount of time documenting, whereby they try to defend the coding that is placed on the visit in order to get paid a fair amount. He said that this reimbursement has not been honored well and does not sustain private practices anymore, which is why many small private practices tend to close, get acquired by hospital systems, or convert to Direct Primary Care.

He also explained that while the membership fee may be intimidating, with a high deductible, many have found that they either break even each month or save money. He is confident that even if it seems affordable, those who do a bit of research can find something within Direct Primary Care that works within their budget.

House also said the burnout rate in primary care is as high as 79%. Why is it so high?

“Because we spend two-thirds of our time dealing with paperwork, prior auths, payment evaluation, inefficient systems, unnecessarily high costs, peer-to-peer reviews to get imaging orders approved, etc.,” House answered. “This leaves little time to actually do what we were called to do and trained for so many years to be able to do- take care of patients. This offsetting balance of unnecessary bureaucracy leads to frustrated patients, bad outcomes, medical errors and unsurprisingly a large number of healthcare providers leaving the field. DPC clinics love being able to focus on their patients and their patients feel that.”

Despite what Direct Primary Care has to offer, some islanders are not so sure they can afford the cost, especially those with insurance plans they like, Medicare, or veterans.

Local Cynthia Brast, who has been a patient at Eventide since it opened, is one of those who will be finding a different practitioner, although she is very fond of Eventide.

“I loved the idea of having an independent family practice MD and I also love the nurses that work there. Most of them were there when Dr. Gossom ran the clinic. It was nice to have some continuity with staff and I felt like Dr. House was dedicated to patient care,” she said.

Brast also added that House was able to coordinate special care visits through Telehealth for her that would have otherwise had to take place off-island. With Dr. House helping her to schedule Telehealth appointments, Brast was able to avoid dealing with the ferry schedule, which could have put her appointment in a compromising position.

“I need to stick with a provider where I can use my health insurance, so overall it boils down to cost and affordability,” she said of her decision to not stay with Eventide through the changes.

Despite having to leave to find a more affordable option, Brast and Eventide both share the same view of insurance companies.

“It’s so frustrating that insurance companies have made the paperwork so burdensome for providers,” she said. “I wish there was a way to redo healthcare so it is affordable and accessible for everyone.”

Despite some, such as Brast, leaving Eventide due to the new monthly cost, if they hadn’t gone in the Direct Primary Care route, most likely the island would have been short of another doctor’s office. House stands by his decision and said he felt it was what was best for the practice and his patients.

“We know that change is hard for the community. It’s hard for us. Keeping a rural healthcare clinic open throughout the pandemic has been the single hardest thing of my life,” House said. “I’ve wanted to quit more times than I can count, but I love this community. I wish the current system weren’t so broken. I wish there was another way, but after many months of agonizing over what to do, praying, discussing, praying again and doing our best to stay committed despite everything thrown at us. DPC is the way we must go.”