What’s Direct Primary Care (DPC)?
Direct primary care is a model of care that strips away the intermediaries between the doctor and the patient. Instead of paying for care via insurance premiums, patients pay directly for the care the doctor provides. This eliminates many of the head spinning problems with healthcare by getting rid of the red tape, and focusing on the relationship between the doctor and the patient. Many direct care practices also provide wholesale labs, deeply discounted prescription prices, imaging discounts, and find other ways of saving patients money as well.
What is Sequoia MD?
Sequoia MD is Sacramento’s first direct care practice. We provide care that is convenient, comprehensive, affordable, and very personal. This means treating patients when they need it, and meeting them where they are. It means not rushing through appointments. The doctor-patient relationship is between the doctor and the patient, period. There is no insurance company, government agency, or other party trying to dictate how the care should be provided.
Is this the same as concierge medicine?
There are some similarities, and the terms are sometimes confused. There is no standard definition of either concierge medicine (some work with insurance, some don't) or direct care, so a direct comparison is hard. Both direct care and concierge medicine are focused on organizing care around the patient. However, concierge medicine is usually more focused on "luxury services." This might mean a fancy waiting room with coffee and flowers. While we don't have anything against that, its not our focus. We strive to be affordable, not exclusive. We are interested in saving our patients money by offering discount labs and medications-- this is not usually the focus of concierge medicine. We think this is a model that can work for pretty much everyone, and so we want to make sure our prices allow most people to join.
I thought healthcare was really expensive. How can you offer so much at such a low price?
We could write a novel to answer this question, and most of it would focus on the insanity of the current system (plus, doing so would get us upset, and who needs that?). In short, direct care allows us to keep our overhead much lower, which in turn allows us to charge less, and pass the savings on. Because the overhead is lower, and the number of patients we see is lower, the amount of time we have per patient is higher. Because we do not have to structure our care to meet the needs of third party billing, we can redesign care to fit the patient's needs. This saves both physician time and patient time; what was an office visit could now be a phone call. By focusing on the elimination of waste (in effort, time and money), our costs (and the patient's costs) drop, and the service level rises.
What is different about Sequoia MD?
The practice has been optimized to take care of patients, not to generate billing codes. Red tape? We took a machete to it. Many of the restrictions that doctors in traditional healthcare settings are forced to deal with are simply not there. That leaves time to spend where it's needed: with patients. Our focus and energy is on helping our patients, not filling out paperwork.
I don’t require frequent medical attention? Why should I join?
Sequoia MD is designed around you. That means if you don’t need to come in much, that’s ok. In a sense, that’s the beauty of this model of care— its there when you need it. We can focus not just on helping you when you are sick, but also on keeping you healthy in the first place. This model of care means visits are relaxed and thorough, focused on addressing your questions and needs.
Does Sequoia MD accept health insurance?
No. Blissfully, blessedly, no. This is perhaps the key difference that allows us to spend so much time with patients, focused on patients. The relationship you have between you and your doctor is between you and your doctor. Being paid by our patients means we are focused on serving patients’ needs, not insurance company (or government) dictates.
This also allows us a tremendous amount of flexibility. Have questions about a new medication? Want your doctor to look at a picture of a rash? Insurance companies don’t compensate doctors for that time spent on the phone (helping patients), reviewing blood sugars, or many of the other things patients would like help with. Since our goal is meet your needs, we are free to do that however, and wherever, that suits you best.
Cutting out insurance also saves our patients from the capricious, controlling decisions that make sense third-party payors, but not to anyone else. It also allows us to offer wholesale prices on laboratory tests, imaging, and medications, which are often not otherwise allowed by insurance contracts.
As a patient of Sequoia MD, will I still need health insurance?
We recommend our patients have some insurance for unusual or high cost events. The idea behind insurance is to take care of the unusual or the unexpected. Life happens, and if something catastrophic were to happen, its best to have a financial backstop. Realistically, the medical care we offer is much more predictable than that.
If I have Medicare, can I still join Sequoia MD? What about if I have Medi-cal (Medicaid)?
Yes. You need only sign a waiver declaring that neither you nor your doctor will directly bill Medicare for our services. Medicare will still cover any laboratory testing, imaging, medications, or hospitalizations we prescribe. The same is true for Medi-Cal. However, if you have Medi-cal or Medicare, you will be responsible for the subscription cost.
Is my membership to Sequoia MD tax deductible?
At the moment, no. This is pretty frustrating, given that you are paying for medical care, but the IRS does not define this type of expense as a “medical expense.” Go figure. There are several organizations that are lobbying hard to win deductibility for these expenses. In the meantime, confer with your tax consultant to clarify tax consequences in your particular circumstances.
What happens if I need to go to the hospital or see a specialist?
This probably (hopefully) will not happen much. Because of the access that Sequoia MD provides, and the time available for each patient, it is possible to handle problems in the office rather than the hospital, and to take care of problems as an outpatient rather than in the hospital. Sometimes a specialist, or a hospital admission, is required. In those cases, we expect to be able to work closely with your hospital team or specialist. The goal is to take good care of you, and sometimes we need to rely on these additional doctors to manage your care.
Can children join Sequoia MD?
Yes! We are happy to accept patients of any age. Children need to have one parent enrolled in our practice. At this time, we do not offer routine childhood immunizations (though we do recommend them), but will work with you to obtain them for your child.
Can I contact my doctor after hours? And how?
But of course. Life doesn’t stop at 5 o’clock, and neither do your health needs. The idea behind Sequoia MD is that you can reach your doctor when you need help. Sometimes, that is not during normal business hours. As to how, there is telephone, email, text message...
I travel. What do I do if I need help when I am away from home?
For people who are often on the road, we are able to offer a level of care that is nearly impossible to match. The fact that we know you, and many illnesses can be managed over the phone or via video, means we can help things stay on track even if you can’t come in to the office. If needed, we can even send some medications to the pharmacy for you. Or, if your symptoms sound like they really need to be managed more urgently, direct you to a local hospital.
Do you share my medical records with insurance carriers or pharmaceutical companies?
Only if you ask us to. Otherwise, what you say in private remains private.
How do I know if I will like the doctor?
Give us a call! The doctor is happy to chat with you, so you can get a sense of what we can offer.
Why does treatment for opiate dependency cost more?
Treating opiate dependency requires a higher level of ongoing care and time. Because of this, our long-term costs are to provide this level of care are higher. However, you will likely find the cost of treatment with Sequoia MD to be less than the cost of most other providers in the Sacramento area-- plus, we can take care of your other primary care needs at the same time for the same price.
If I have a regular doctor already, can I still see you just for opiate dependence?
Of course! If you already have a primary care doctor, you are welcome to see us only for opiate dependency treatment— whatever works for you.
Can I keep my regular doctor, and see you just for my type 1 diabetes?
Sure thing. If you already have a primary care doctor, you are welcome to come in only for diabetes— whatever works for you. Conversely, you can keep your specialist, and see us just for primary care. The choice is yours.
What about privacy?
Because we do not contract with insurance companies, your information stays with us. We will never share it (unless you ask us to) with any third party. In fact, some patients turn to Direct Care because the level of privacy is so great.