DARLINGTON — As of January, Darlington has a new Direct Primary Care medical clinic, which is a growing model of medical office care throughout the U.S.

“Now there are around 1,000 such practices in the United States, an increase from a few hundred a couple of years ago,” said Dr. Michael Robiolio. “Major organizations like the American Academy of Family Physicians now sponsor conferences on Direct Primary Care.”

The idea is simple and is a membership model much like Netflix or a gym membership. Patients pay a monthly fee and the rest of the balance is either included at no additional charge, or at a marginal charge, Robiolio said. Members know the cost for their services and don’t have to fear the financial strain of medical bills each time they need a visit to the doctor.

It isn’t insurance, it doesn’t cover any services outside of the facility and the membership price is not based on risk or pre-existing conditions, which have no exclusions.

Each Direct Primary Care clinic varies on what constitutes “extras,” “but basically we put value into the membership,” Robiolio said.

At DIME Medical, there is a one-time registration fee of $25. For adults, there is a monthly fee of $50. Children with an adult membership are $25 per month and there is a special family package of $150 per month for two adults with two to four children; additional children are an additional $10 per month per child. There are discounts when paying for more than one month at a time.

“We do not charge for blood drawing, or for in-house tests including strep screen, pregnancy test, urinalysis, electrocardiogram, or blood sugar, nor procedures such as removing skin lesions, suturing, splinting or casting,” Robiolio said. “Blood and tissue labs done as send-outs to a regional lab are heavily discounted.”

For example, some common test include a blood count, which costs $4.83, that looks at white and red cells and platelets. A comprehensive metabolic panel is $4.41 and looks at sugar, liver, kidney, salts and proteins; a cholesterol or lipid panel is $6.66; diabetic hemoglobin A1C is $5.94; or women’s saline based pap is $27.87.

These typically cost much more in traditional medical insurance-based medical practices.

“Laboratory fees alone can easily reach into several hundred dollars for an uninsured or high deductible insurance plan patient in a traditional insurance-based practice, but not at DIME Medical,” Robiolio said. “Members also get my cell number to call or text as well as a member-only email to contact me 24 hours a day and seven days a week. Membership in a Direct Primary Care has its benefits.” 

DIME Medical provides a spectrum of services for a family physician, including well-health physicals for women, men, children and infants; WIAA physicals and college physicals; chronic disease management like diabetes, high blood pressure, asthma, Chronic Obstructive Pulmonary Disease, thyroid disorders, depression, anxiety, high cholesterol, heart disease, congestive heart failure, some levels of chronic pain, and more; acute illness care such as infections, injuries; minor procedures such as skin and under skin lesions, suturing of lacerations, splinting and casting of injuries; basic office gynecology, nebulized breathing medications; and office-based counseling by a physician for mood disorders. 

“We treat the patient as a whole and as part of a family, as family physicians are trained to do,” said Dr. Robiolio, who attended George Washington University School of Medicine in Washington, D.C., on a U.S. Navy scholarship. He served his residency at the Naval Hospital in Jacksonville, Florida, where he met his wife Ann, who also is a family physician. 

While preparing to leave the U.S. Navy, the family considered that Ann’s family lived in Kansas and Michael’s brother, a cardiologist, lived in St. Louis, Missouri.

“Both of us liked the Midwest people, country, and lifestyle, so we knew what it was like and wanted to be here and in the rural area,” Robiolio said. “An excellent life and job offer in the Darlington area came along for us and it fit with our plans, so we accepted it and are still here 20 years later.” 

Robiolio also serves as a part-time physician while starting DIME Medical Direct Primary Care as a separate business.

“As an employee of DIME Medical, I see firsthand the relief our patients feel as they know they have a doctor who wishes to work with them, at a cost they can afford,” said DIME Medical staff member Tammy Biraki. “I feel a sense of purpose while working with Dr. Robiolio, because I know how much he cares about the community.” 

The benefits of direct primary care have been debated among critics and supporters.

“I believe it returns the medical practice control to the patient and the doctor while maintaining medical care standards,” Robiolio said. “It frees the doctor and the patient from many of the insurance and governmental bureaucratic inefficiencies that occurs. It reduces costs by significantly reducing the overhead expense to the doctor, which is then passed on to the patient. Patients know almost all of their costs up front and can better plan. It’s also simpler to understand than insurance. Patients, not the insurance company, remain in control of their care.” 

DIME Medical has about 30 members and is growing.

“As a half-time practice, the cap on patient members is 300, which is consistent with a typical Direct Primary Care patient cap of full-time physician at about 600,” Robiolio said. “This level gives a physician enough time to address each member’s needs in person and in remote contact as needed.” 

DIME Medical continues to network with other health agencies in the area to expand that network. 

“We hope to add a small pharmacy for low-cost dispensing of medications to members, as well as convenience, especially with our evening hours after local pharmacies are closed,” Robiolio said. “We will be exploring the possibility of offering immunizations to children and adults in the future.”

Direct Primary Care is one option to reduce office-based health care costs for working individuals and families while not sacrificing quality. Patients still need insurance or participation in a health sharing plan to couple with their Direct Primary Care membership. 

“More affordable insurance or health sharing plans can be chosen to complement their Direct Primary Care membership at a reduced cost over having a comprehensive insurance,” Robiolio said. “Many people have good employer-based insurance that is affordable, so this may not be for them. But there is a growing population of uninsured or high-deductible insured for whom this is a very good choice.”