Question 1

What is Direct Primary Care (DPC)?

Accepted Answer

Direct primary care (DPC) is a growing model of healthcare that puts patients first. DPC practices do not bill or file insurance claims; instead, the patient pays directly for the services provided through a membership model. This model of care provides freedom for both the physician and the patient, allowing physicians to have substantially fewer patients, so we can better provide highly individualized, comprehensive care. You will see your own doctor, every time. It also allows the physician and patient to focus on prevention and lifestyle to help patients achieve and maintain optimal health throughout the lifespan.

Question 2

What is Internal Medicine?

Accepted Answer

Internal Medicine is the medical specialty that focuses on the diagnosis and treatment of adult medical conditions. We provide preventative care, treat acute illnesses, and help manage chronic diseases. With our experience and training we are equipped to handle more than 80% of all adult care needs. For those who require specialists, we work closely with them to provide comprehensive care when needed. Most patients find they have less reliance on specialists when they have an internist who knows them well and is able to spend time managing their overall health.

Question 3

Do you accept my insurance?

Accepted Answer

No. As a direct care practice, we are out of network for all insurance. The monthly fee covers all services provided by Dr. Gierer. Although we do not accept insurance, insurance is still important for hospitalizations, diagnostic testing, specialist care, and  medications. Many patients in direct care practices have high-deductible PPO plans, catastrophic plans, or traditional Medicare + supplement plans.
 
We think our model is best compared to car insurance. We use our car insurance for major accidents and large expenses, not for routine oil changes and maintenance services. It is important to note that the direct primary care model is not insurance and does not meet the criteria for insurance as set forth in the Affordable Care Act.

Question 4

How much does it cost?

Accepted Answer

Our current rates are: 
$195/mo - age 18-99
$1/mo - age 100+

More information about fees and discounts can be found here.

We accept payments via check, ACH/e-check, Visa, Mastercard, and Discover. Sound Internal Medicine is a CASHLESS business.

Question 5

Can I pay the membership fee from my Health Savings Account (HSA)?

Accepted Answer

The state of Michigan recognizes direct primary care as an eligible medical expense but federal laws surrounding DPC memberships frequently change. It is essential that you discuss this with your trusted tax or benefits advisor.

Question 6

Can I really contact my physician directly?

Accepted Answer

Yes! We are readily available during the business day via secure patient portal, email, and phone. In most cases, if you need an in-person visit, you will be seen same-day or next-day.

You may reach Dr. Gierer directly by phone when the office is closed. To maintain a healthy work life balance, only urgent/emergent needs will be managed after-hours, overnight, weekends, or holidays. Non-urgent communications will be triaged and attended to on the next business day.

Direct care means that we are here for you, no matter what the health-related circumstance.

Question 7

What if I need to see a specialist?

Accepted Answer

Many patients find a reduced need for specialists with a direct care internist because their doctor has the time to get to know them and manage their chronic conditions. However, we will still refer you to a specialist if needed and you may continue to see any existing specialist you choose. In that case, you will continue to see him/her using your insurance and we will work closely with your specialist to coordinate your care.

Question 8

What if I need testing? What if I am admitted to the hospital?

Accepted Answer

Patients may still utilize their insurance for all testing, hospitalizations, procedures, and specialist visits ordered by Dr. Gierer. Dr. Gierer will help to obtain insurance prior authorization for necessary services.

Dr. Gierer has ambulatory privileges at Corewell/Beaumont Royal Oak. She also has access to the electronic medical record of many major hospital systems, including Corewell, Henry Ford, University of Michigan, Trinity Health, Mayo Clinic, and Cleveland Clinic.

If you are admitted to the hospital she will remain in close communication with your hospital team to coordinate and advocate for your care.

Question 9

I am still confused. How is all this possible?

Accepted Answer

​In the traditional insurance model, doctors' pay is determined by how many patients they see and how high each visit is billed based on complexity of documentation. In order for big hospital systems to make a profit, most primary care doctors need to care for a patient panel of 2500-4000 patients and limit visit to 15 minutes or less. All billing must go through insurance, requiring layers of administrative staff, leading to high overhead. 
 
In DPC, none of this applies. The physician is paid by the membership fee only. We don't bill insurance so our overhead is low. Our only financial incentive is to provide such excellent care that our patients remain members and refer their friends. We maintain a panel of only about 200 patients, all of whom enjoy direct access and the highest level of care from their physician.

Traditional healthcare encourages reactionary medicine, leading to a "sick care" system. In direct primary care, we practice proactive preventative care through personalized medical, lifestyle, and anticipatory guidance.  You benefit from having a close relationship with a doctor who knows you, your medical history, your risk factors, and your care preferences.

Question 10

What if my doctor is on vacation?

Accepted Answer

We will always give advanced notice for any planned absences and the doctor will be available via telemedicine for urgent needs. If the doctor is unable to be available via telemedicine, we will arrange for a covering physician.

Question 11

Do you treat chronic pain? Do you prescribe controlled substances?

Accepted Answer

Primum non nocere = First, do no harm.  The use of opioids/narcotics for the management of chronic pain has consistently been shown in the medical literature to worsen patient outcomes. In keeping with evidence-based medicine, we do not prescribe these medications. Rather, we will work with our patients who suffer from chronic pain to identify a personalized regimen that optimizes function and overall wellbeing. Patients who require ongoing opioids/narcotics will be referred to a pain management specialist.

Question 12

What's the catch?

Accepted Answer

There is none! Please feel free to email us any further questions at info@soundinternalmedicine.com. We look forward to speaking with you!