 When we took an oath to do no harm that should imply do no financial harm We make it cheaper than a cell phone if you can afford a cell phone You can afford the most basic aspect of health care delivery in the United States The patients of doctors William Crouch and Lee Gross know exactly what services will cost before they receive them a radical concept Only in health care. They don't have to deal with benefits packages coverage denials hidden costs in network versus out-of-network Or any surprises whatsoever instead their patients buy the medical equivalent of a Netflix subscription We charge $75 a month for an adult $30 a month for one child and $15 a month for each additional child After that we charge nothing for the services that are provided in our office Doctors Crouch and Gross of Northport, Florida are pioneers in a growing national movement called direct primary care Physicians around the country who are tired of dealing with insurance companies when it comes to routine medical services Have exited the traditional system and are saying that they can provide better care at a lower price by charging their patients a nominal monthly fee Directly COVID-19 has pushed many doctors offices Which have been hard hit by the pandemic to start doing telemedicine for the first time and Insurance companies in the government have started paying them for this service for now But direct primary care practices have proven far more agile and responsive to the needs of patients They're demonstrating that making American health care flexible and affordable Requires abandoning the use of third-party insurance for routine care and adopting a free market approach Direct primary care is about as close to a free market in health care as you've ever seen in our country You know people say that we while we tried we tried free market. It didn't work. That's why we need the government to take over That's why we need a single-payer health care system We have never tried a true marketplace in health care when I was in a fee-for-service system I felt like I was playing a game of whack-a-mole with Medicare We had to find ways of doing as much stuff to as many people as possible to generate as much revenue Just to pay for the computer systems that I needed to build Medicare so that I could get paid You kept seeing that people were being denied care and a lot of it was cost prohibitive They were able to afford their insurance premiums But then they couldn't afford the needed test and every time I found a way to prop up and be able to generate revenue to Support this monstrosity that we were required to build Medicare would knock the knees out from under us and take away that revenue source Where eventually we just said you know what no more direct primary care practices are demonstrating that routine health services Covered by Medicare and insurance companies cost so little that most patients could easily afford them out of pocket So how did this third-party payer system develop the government created it through the tax system during World War two the IRS started allowing employers to provide health insurance as a form of pre-tax compensation But if employees purchased their own health care, they had to use after-tax dollars This led to a system in which insurance companies and large health care providers negotiate prices behind closed doors Leaving patients out of the mix what we have done is we've essentially disrupted that entire paradigm as we've said Let's have price transparency Let's show people what these services actually cost because they do have a dollar value You can put a price tag on this that we've proven that today. There are approximately 1,400 independent direct primary care practices with a presence in 49 states Virtually all of them charge a subscription fee that's between 50 and 100 dollars monthly to consult with the doctor at any time In-person or from home crouching gross provide routine services like preventative checkups EKGs minor procedures like biopsies joint injections removal of cysts and small cancers and some urgent care such as sewing Lacerations and splinting uncomplicated fractures no extra charge in office tests like those for strep and pregnancy are included as well If a test needs to leave the office Patients pay cash prices that gross and crouch have negotiated on their behalf if you ask the lab What they'll tell you is the most expensive thing that they do is not the lab It's the cost of the human labor associated with processing those claims and getting paid So if we eliminate their number one line item expense in their in their service delivery Then we can bring those prices way down and that's exactly what we saw We would see 95% discounts on the laboratory services according to a survey conducted in July 78% of physicians had seen a decline in patient volume because of COVID-19 in March the Center for Medicare and Medicaid Services issued a temporary waiver stating that Medicare would pay the same rate for certain kinds of video telemedicine visits as in-person Ones but the types of visits it would cover changed over the course of the year and are still changing whether or not Insurance companies in the government continue covering online visits after the pandemic has no bearing on crouching grosses practice And they didn't have to wait for insurance companies in the government to okay telemedicine in the first place And we immediately flipped a switch and instantly from in-person practice. We were an online practice We were a parking lot practice We did whatever we had to do in order to get the patient the proper care at the proper time Telemedicine has added complexity to the billing process that has no impact on crouching gross So we didn't need to wait for blue cross to convene a committee to pay for telemedicine services I didn't need to wait two months or three months for Medicare to create a new billing code in order for you to Provide technology visits for a patient. I just did it for what Medicare pays for a single technology visit I provide two to three months of unlimited technology visits unlimited office visits unlimited home visits unlimited email visits And so you know the model is again pandemic tested. It's proven that it's actually a superior model Because we have the built-in flexibility to do what we need at the time we need it 32 states in dc have passed laws Requiring insurance companies to reimburse doctors at the same rate for telemedicine visits as they do for comparable in-person visits Crouch and gross say that shouldn't be decided by lobbyists lawmakers or government administrators prices should be set through market competition The very first time I went to washington and made a presentation on direct primary care I gave it to a group of physicians and after I gave my presentation on our practice and what we were doing Doctor raised his hand and said what happens if some doctor sets up right next door to you and charges 40 dollars a month And I said it's an excellent question I said because if the first question out of the audience is what are we going to do when we bring down the price of health care We're on to something because that question has never been asked in the american health care system ever I said here's what's going to happen I said that doctor and I are going to have to compete on price equality And i'm going to have to justify why my price is twice as much Maybe I provide better service. Maybe i'm just better trained have better credentials have more experience But something Tangible is going to have to justify that or I'm going to have to lower my prices and to compete or I'm going to lose patience To the person down the street the myth is that profit by its mere definition is it does not belong in the american health care system And and it's evil and it creates perverse incentives The key to making that profit work is again that elimination of that third party in the middle of that profit Which just starts up cost but ends in a value