Insurance is never billed at On Point Primary Care, run by Dr. John Thomas, a Colorado native who set up the practice as a first of its kind south of Colorado Springs. Photo by Jason Prescott
Dr. John Thomas, a family doctor in Pueblo, is sidestepping Washington politics on healthcare with his practice.
The back and forth between congressional Republicans and Democrats on repealing and replacing The Affordable Care Act even had President Donald Trump admitting, “Nobody knew health care could be so complicated.”
But Thomas doesn’t think the topic has to be. He wants to help simplify things by changing the way Puebloans, at least, view health care.
Thomas runs On Point Primary Care, which he describes as an “efficient three-room family medicine clinic” where he offers patients “unheard-of access … via email and text, spends up to an hour with them during office appointments and provides a lot of medical services and prescriptions at seriously discounted rates.”
On Point takes advantage of an alternative payment model for primary care that bypasses insurance companies altogether. In the model, called Direct Primary Care or DPC, patients are billed a monthly “membership” fee, which for adults runs between $35 and $75 depending on age.
“The fee covers all of their basic primary care needs, and their insurance plan (if they have one) is never billed,” Thomas says. “The model allows for improved access, unlimited visits, discounted medications, labs and radiology services without insurance copays or deductibles.”
Dr. Thomas’s practice comes as a godsend to those unable to take advantage of Colorado’s expanded Medicaid program but who can’t afford health insurance. “A majority of our patients are hard-working citizens whose income is too high to qualify for Federal programs and who simply cannot afford even the least expensive insurance offered on the marketplace,” Thomas says. “We offer a cost-effective way for these people to get primary care. Otherwise, they would probably use emergency room or urgent care centers for routine care. That is too costly for everyone and does not give these folks any continuity of care.”
The people who Thomas treats are considered outlaws under the current Affordable Care Act, which mandates that those who do not receive government medical assistance or who are not covered by their employers buy health insurance on their own, regardless if they can afford the insurance or not, or pay an ever-increasing annual fine to the IRS.
Under the most recent GOP plan that passed the U.S. House of Representatives on May 4, the individual mandate under ACA would be eliminated. So it stands to reason the Republican plan would be a win-win for Thomas’s Direct Primary Care model and the majority of his patients should the individual mandate’s elimination remain in the Senate version. In addition, the DPC model can share its victory with certain health insurers who provide less-expensive catastrophic plans that insure against cancer, heart disease and other serious ailments that the DPC model does not address.
Yet what might or might not happen to ACA is not what has Dr. Thomas excited. ACA’s possible repeal was only a secondary legislative interest to the doctor compared to an action taken this year by the Colorado General Assembly. Gov. John Hickenlooper signed the Direct Primary Health Care Services Act (HB 17-1115) into law on April 24.
“The bill will further elevate DPC as a viable practice model to achieve the quadruple aim in health care — improving population health, increasing patient satisfaction, reducing per-capita health care spending and addressing clinician and staff satisfaction,” Thomas said. “With the possible elimination of the individual and employer mandates under the Republican federal health care plan, we have an opportunity to provide cost-effective, quality primary care to people who are in need.
“We have no pre-existing symptoms restrictions, and we welcome those who cannot afford insurance coverage. We would like to see the development of an inexpensive catastrophic care plan that would pair perfectly with the DPC model. Unlike our complex third-party insurance system, there’s no great mystery to On Point Primary Care: you simply pay for a service and you get that service. That is how health care once worked, and we are bringing it back with the human element at center stage.”
However, Thomas elaborates although he encourages his patients to have insurance coverage as a “back-up plan” against catastrophic events or in-patient hospitalizations, “it is important that our patients understand that our monthly subscriber fee is not an insurance premium and that we do not offer insurance.” Yet if his patients want such insurance, Thomas said he is happy to point them in the right direction.
Thomas’s DPC practice is not limited to patients with no health insurance and, in fact, prefers to work with patients who have cheaper insurance with higher deductibles and copays. “We also see a group of patients who participate in Medical Health Share programs. Although not for everyone, these programs facilitate sharing of health care costs among individual members. The programs function similar to insurance and are probably the best alternative to conventional health insurance for about half the cost. Some programs will even reimburse members for our monthly subscription fees, too.”
You might call the DPC model a career obsession for Thomas. A Denver native, he received a degree in Kinesiology at the University of Colorado Boulder. From there, he completed his Doctor of Medicine at the Medical College of Wisconsin in 2002. After that, he received his board certification in family medicine through a Medical College of Wisconsin-affiliated program and later became an assistant clinical professor with that college in 2005. He opened On Point Primary Care about a year ago.
“We came to Pueblo because I had an opportunity to be at the forefront in changing primary care in America,” the doctor said. “When my children ask me later in life why we left Wisconsin, I wanted to be able to reply, ‘Because I wanted to create a medical practice I believed in.’ I’m blessed that we have opened a clinic with integrity as its foundation. I’m able to provide my patients with the quality of medical care that I was taught and that they deserve.”
Thomas’s practice is one of 620 that operate using the DPC model in 47 states. More than 10 percent of those clinics are in Colorado. On Point was the first independently owned DPC clinic to open in the state south of Colorado Springs.
“We just don’t need insurance for common medical issues in primary care. Removing ourselves from the traditional fee-for-service model reduces costs from both a business and a care perspective by 70 to 90 percent,” Thomas said. “Therefore, we are able to pass these cost-savings on to our patients by providing better care and increased services for less out-of-pocket expense.”
Thomas says the typical DPC clinic sees 700 patients per year whereas the average fee-for-service provider, which takes health insurance, sees between 2,000 and 3,000 patients per year. And that explains why Thomas can spend much more time with his patients than most other doctors in Pueblo.
“We have been well-received in the community,” Thomas said. “Our patients have been the most vocal proponents and supporters of On Point Primary Care. The clinic’s growth has exceeded my initial expectations for its first year and will achieve 50 percent of our total capacity by July.”
He adds he will stop taking new patients when he is unable “to deliver accessible, cost-effective quality care to my patients.”
Although Thomas would be content to leave his clinic as is. He is open to the possibility of expansion. “Currently, I am considering the logistics of creating satellite clinics in the southern area of Pueblo and in Pueblo West, but I think this is a few years away. Creating additional clinics to serve more people would require that I connect with like- minded care providers who share similar care philosophies. I have other ideas about establishing a multi-provider integrative clinic as well. Time will tell.”
And time will tell if a new GOP-inspired national health care plan would make clinics like On Point Primary Care more popular among patients, particularly those in Pueblo.