A Boutique Primary Care Practice that Serves the Poor

By Temma Ehrenfeld @temmaehrenfeld
January 20, 2022
A Boutique Primary Care Practice that Serves the Poor

St. Luke’s Family Practice, a California nonprofit that specializes in direct primary care, fills a gap in healthcare services for the uninsured.

Robert Forester, MD, a family medicine doctor in Modesto, Calif., and a devout Catholic, had a moment of inspiration while he was praying.

Could he provide primary care to the uninsured in a private nonprofit?

Less than four years later, St. Luke’s Family Practice opened for business. It now has three doctors and a physician’s assistant who serve about 550 patients who pay yearly fees. It costs $2,100, for example, to join as one adult under the age of 60.

Called benefactors, the fees from these patients help support care for a slightly bigger group of patients who are uninsured and not eligible for government programs.


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Direct primary care

St Luke’s is one of a growing group of practices, called direct primary care, that do not take insurance. About 1,200 practices on this model  serve more than 300,000 U.S. patients in 48 states, according to the Direct Primary Care Coalition, an advocacy group. The fees are generally under $100 a month. You’ll also need insurance — typically a high-deductible plan — to cover a problem that is beyond standard primary care. Your doctor is likely to have fewer patients than other primary care doctors.

Direct primary care is far less expensive than practices called concierge medicine, which bill insurance and also charge additional fees.

A few direct primary care firms, owned by investors rather than doctors, offer tech-based care around the nation. A decade ago, Amazon founder Jeff Bezos and others provided funding for a Seattle-based group, but the practice died in 2017. Amazon, however,  does provide healthcare services to its employees.

For services it doesn’t cover, St. Luke’s is sometimes able to find big discounts for its uninsured patients, working with radiology groups and Quest Diagnostics, the world’s leading provider of diagnostic testing. A local foundation recently gave St. Luke’s a $75,000 grant to cover the cost of imaging, lab tests, x-rays, and some prescription drugs.

As a tax-exempt nonprofit, St. Luke’s attracts donations from local businesses that sometimes employ uninsured patients who use the practice.

Every year, St. Luke’s sends paying patients a statement detailing the dollar value, based on Medicare prices, of the services they used. Patients can take a tax deduction on any additional money they paid as part of the yearly fee.

Erin Kiesel, MD, told Kaiser Health News that she now earns $60,000 less a year than in her previous practice, but she appreciates “having more time with patients, less paperwork, and better work-life balance.”

Pro-bono work

It is a long-standing tradition for lawyers to have pro-bono clients, and many doctors often volunteer some of their time to treat patients, typically overseas, or work in a community clinic. Some providers discuss their patients’ finances during an office visit and cut fees or offer creative payment options.

According to Daily Nurse, nurse practitioner H. Lee Adkins of Ft. Myers, Fla., offers a flat fee to some patients with chronic illnesses. Other nurse practitioners “are basing their costs on a sliding scale, providing free telephone consultations, or seeing two members of a household at the same time and charging for only one office visit. Still others donate their time to charitable organizations that run free clinics for uninsured or underinsured individuals.”


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January 20, 2022

Reviewed By:  

Janet O’Dell, RN