EP272: COVID-19—Why This Pandemic Is a Game Changer for PCPs and the Employers and Plans Who Pay Them, With Guy Culpepper, MD

A lot of people are wondering why independent PCPs are furloughing nurses and talking about shuttering their practices in the middle of a pandemic. Conventional wisdom would assume that PCPs would be just fine if they stand up telehealth and can take some sort of majority of their patient visits virtually. After all, it would make a lot of sense that a lot of patients are calling their doctor right now.

In this health care podcast, I interview Guy Culpepper, MD. Dr. Culpepper sets us straight about what is actually going on day to day for PCPs right now. He also suggests that, right now, this pandemic is a flash point. It’s a game changer. It’s the trigger for an abrupt and transformational change in the business of providing patients with primary care.

Just a couple of vocab words to keep us straight here:

DPC stands for direct primary care. This is when a doctor bills a patient directly—no insurance in the picture. So, the doctor sends a bill for, say, $70 a month to the patient and the doctor will then take care of that patient no matter how many questions they ask or texts they send or office visits they require or don’t require.

Direct to employer means that the doctor contracts directly with an employer—usually a self-insured employer, again without insurance. So, the employer pays the doctor usually some capitated lump sum per month or per year for primary care. Goodbye, fee for service (FFS).

Dr. Culpepper is a founder and CEO of an independent physician group in North Texas with 550 providers. He served in that role for 25 years, but as he says, his day job is being a board-certified family doctor.

You can learn more at benttreemd.com. You can also connect with Dr. Culpepper on Twitter at @DrCulpepper. 

Guy L. Culpepper, MD, founded Bent Tree Family Physicians in 1987. His enthusiasm for health care and his focus on each patient as an individual has been rewarded by numerous recognitions as one of America’s premier family physicians. Disease prevention is the primary goal of his work. He has expertise in diabetes, cholesterol management, and osteoporosis; however, caring for children is his greatest joy.

Dr. Culpepper’s leadership has been seen at every stage of his career. During training, he served as both chief resident in family medicine and as the president of the medical/surgical house staff of St. Paul Medical Center. He was the founding chairman of the department of family medicine at Texas Health Resources Presbyterian Hospital of Plano, where he was honored to serve as the president of the medical staff. His dedication to primary care continues to be seen in his leadership of the Jefferson Physician Group, an organization of more than 230 internists, pediatricians, and family physicians improving North Texas health care since 1995.

A Dallas native, Dr. Culpepper lives in Frisco with his three sons, whose support has made his work possible and his leisure time joyful. He enjoys reading, writing, movies, sports, and collecting medical antiques and is a lifelong fan of the Dallas Cowboys.

02:22 What a PCP’s average day looks like during the pandemic.
03:48 How likely is it that PCPs can transition easily to telehealth?
06:00 Why the pandemic is a flash point game changer for telehealth and PCP reimbursement.
08:54 “It’s like a perfect storm of multiple tragedies coming together.”
10:47 How primary care is going to alter after this.
13:24 “We need to totally change the way that our country pays us.”
14:29 What is the incentive for health plans and hospitals to change financial models in all of this?
16:26 “The ones who are going to change are the ones who need to change.”
18:13 Why the employers will be demanding this change in financial model.
19:12 Why being independent vs being part of an accountable care organization matters during this pandemic.
21:07 “If we don’t save the independent doctors, there’s nothing to break this chain of abuse.”
24:34 “Higher income doesn’t always mean more happiness; it often means less sense of freedom.”
25:53 “There’s a point where a little bit more money and a loss of freedom are no longer properly balanced.”
27:53 Untangling the FFS reimbursement.
30:00 Why right now is a flash point for PCP reimbursement.
30:38 “No one else can do what we can do in effective primary care. No one … in this market.”
31:49 What payers should be doing right now.
33:27 EP270 with Dave Chase of Health Rosetta.
33:39 Dr. Culpepper’s message to Medicare.

You can learn more at benttreemd.com. You can also connect with Dr. Culpepper on Twitter at @DrCulpepper.