Filling healthcare void, physician opts for direct primary care model on Bainbridge - Kitsap Sun

BAINBRIDGE ISLAND – Dr. Payton Skawinski knows he’s stepping into a void as he opens up his primary care practice.

In a major disruption to medical care on Bainbridge Island last year, Swedish Medical Group shuttered its Winslow primary care clinic. It was estimated that the clinic served nearly 8,000 patients.

As he prepared to open his practice, Skawinski was drawn to Bainbridge Island: “There’s plenty of places to get care in Seattle, but there’s a void here, especially with Swedish leaving. That’s really all that I’ve wanted going into this, is to be able to be a valuable member of a community in work and in play.”

Direct primary care

As he neared the end of his medical training, Skawinski applied to Virginia Mason’s primary care program but also began cold-calling local primary care practices. He got in touch with Dr. Jared Hendler, who has practiced on the island for more than 40 years, and the two connected. Now Skawinski is opening his own practice – Bridge Direct Primary Care – with Hendler as a mentor as he enters health care. They share a location off Madison Avenue in Winslow.

Like Hendler, Skawinski will operate his new practice independent of a large health care system on a direct primary care model that sees patients pay a regular subscription fee to get broad access to their doctor. And like other direct primary care practices, he won’t bill insurance, cutting out the influence and overhead that goes with it from his practice. Skawinski encourages patients to carry high deductible health insurance or find a health sharing plan to protect against emergencies.

“I think that the primary care that’s delivered in bigger systems is not great,” he said. “It’s suboptimal. I firmly believe that’s not because of the doctors or anything, it’s because of the system that has evolved with American health care. It’s a system that’s predicated on money at the end of the day, and the bottom line. The system is complicated by other systems that get involved and also are focused on the bottom line, like health insurance companies and other players.”

Under the direct primary care model, he’ll see fewer patients – he’s aiming to have a panel of around 100 patients total – and be able to spend more time with those he sees. He’ll be able to build relationships with those patients, know their families and history and be thorough about their care, which improves outcomes, he said.

Unlike doctors in a larger system, he won’t see large patient volumes in a day. Primary care doctors are encouraged or required to see 18-22 patients a day have just a few minutes to work with each individual they see, he noted.

In that setting, “You really only have time to focus on one issue or maybe a couple issues,” Skawinski said. “If people have complex issues, then that appointment often turns into a, ‘This is the medication we’re going to give you and this is how it works and these are the problems you might have.’ I think in that time, it’s impossible to really optimize health, and it’s really putting Band-Aids on problems that are there and hoping that in the future, you’ll be able to take care of them.”

At Skawinski’s practice, patients pay a monthly fee directly to the practice and have unlimited access to their doctor, even in same-day and next-day visits. They’ll get Skawinski’s personal cell number, and patients will be able to contact him at any time. He’ll do house calls when necessary or visit a patient at work over lunch.

“There’s a lot of different options when you’re outside of the restrictions of a big system,” he said. “We’re able to get creative and to craft the practice that is best for each individual patient.”

The freedom to ‘do it right’

Another of Skawinski’s mentors as he enters the field: islander Garrison Bliss, a retired doctor who is credited with pioneering the direct primary care model and is now the chairman of the Direct Primary Care Coalition, an advocacy group. According to the coalition, today, about 1,600 direct primary care practices in 48 states provide care to more than 300,000 Americans.

Bliss assures young doctors going into the field that they won’t ruin themselves financially by walking away from insurance companies as a source of income. With reasonably sized patient panels, they can make a living without compromising their work and get patients healthier, he said.

“Anybody can build a practice in the United States by signing up with an insurance company who will send them thousands of people,” he said. “There’s not enough primary care in the United States and getting a patient panel is easy. The problem is taking care of them.”

“Once they get started, it’s addicting to have the freedom to actually do it right,” he said. “It’s the opposite of burnout, which most of the health care system is suffering from right now.”