Direct Primary Care

Direct primary care is primary care offered direct to the consumer, without insurance intervention. It incorporates various health care delivery systems that involve direct financial relationships between patients and health care providers. One niche variant of direct primary care is concierge medicine. Direct primary care can remove many of the financial barriers to accessing care when needed. Often, there are no insurance co-pays, deductibles or co-insurance fees thus avoiding the overhead and complexity of maintaining relationships with insurers. Under this model, patients may pay a combination of visit fees and/or fixed monthly fees, which grant them access to a set of medical services, including same and next-day appointments, both in the form of house calls and office visits. A direct primary care arrangement benefits from pairing with either: a high-deductible health plan, as direct primary care alone will not cover catastrophic health care such as most surgeries, a health savings account, or health reimbursement account as the associated tax-benefits can generally be applied to direct primary care and other medical expenses. Direct primary care practices do not typically accept insurance payments, thus avoiding the overhead and complexity of maintaining relationships with insurers, which can consume as much as $0.40 of each medical dollar spent. Direct primary care payments are over time, rather than in return for specific services, the economic incentives are such that the long-term health of the patient is the most lucrative situation for the doctor. Preventative care gains greater emphasis under direct primary care. Because the primary care physician compensation is better than it would be under insurance billing, doctors can afford to spend more time with the patient, rather than simply referring them to a highly paid specialist after a short consultation. Boutique medicine is a type of medical practice now found in many metropolitan areas across the country. Also known as, concierge health care, concierge medicine, or retainer medicine, the concept has come to represent a higher level of healthcare for those who want a more personalized relationship with their physician. This model has proven successful for those physicians who want to see a fewer number of patients on a day to day basis, thus allowing them to spend more time nourishing individual patient relationships.

Medical Device

A medical device is a product used for medical purposes in patients, in diagnosis, therapy or surgery. Medicinal products achieve their principal action by pharmacological, metabolic or immunological, medical devices act by other means like physical, mechanical, physio-chemical or chemical means. Medical devices are a part of medical technology. Medical devices include a wide range of products varying in complexity and application. The Food and Drug Administration recognizes three classes of medical devices based on the level of control necessary to assure the safety and effectiveness of the devices. Class I devices are subject to the least regulatory control. "General Controls" apply to all Class I, II and III devices. General controls include provisions that relate to adulteration; misbranding; device registration and listing; pre-market notification; banned devices; notification, including repair, replacement, or refund; records and reports; restricted devices; and good manufacturing practices. Class I devices are not intended for use in supporting or sustaining life or to be of substantial importance in preventing impairment to human health, and they may not present a potential unreasonable risk of illness or injury. Most Class I devices are exempt from the pre-market notification and/or good manufacturing practices regulation. Class II devices are those for which general controls alone are insufficient to assure safety and effectiveness, and existing rules provide such assurances. In addition to complying with general controls, Class II devices are also subject to special controls. A few Class II devices are exempt from pre-market notification [10]. Special controls may include particular labeling requirements, mandatory performance standards and post-market surveillance. The FDA holds Class II medical devices to a higher level of assurance than Class I devices, as Class II devices must perform as indicated without causing injury or harm to patient or user. Examples of Class II devices include powered wheelchairs, infusion pumps and surgical drapes. A Class III device is one for which insufficient information exists to assure safety and effectiveness solely through the general or special controls sufficient for Class I or Class II devices. Such a device needs pre-market approval, a scientific review to ensure the safety and effectiveness of the device, and is subject to all the general controls of Class I devices. The FDA classifies Class III devices as those that support or sustain human life and are of substantial importance in preventing impairment of human health, or which present a potential, unreasonable risk of illness or injury. Examples of Class III devices (which currently require a pre-market notification) include implantable pacemaker pulse generators and endosseous implants.

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Dermatologist

The skin is the largest organ of the body and is the most visible. Although many skin diseases are isolated, some are manifestations of internal disease. Therefore, a demonologist has knowledge of all aspects of surgery, rheumatology (many rheumatic diseases can feature skin symptoms and signs), immunology, neurology (the "neurocuteaneous syndromes", such as neurofibromatosis and tuberous sclerosis), infectious diseases and endocrinology. Cosmetic dermatology has long been an important part of the field, and dermatologists have been the primary innovators in this area. In the 1900s, dermatologists used dermabrasion to improve acne scarring. Doctors used fat micro-transfer to fill in cutaneous defects. Dermatologists specializing in cosmetic dermatology typically use non-invasive procedures to reverse the signs of aging. Botox has been popular since the Food and Drug Administration approved it for the treatment of wrinkles. Botox minimizes wrinkles such as frown lines and crow's feet. Fillers are used to "fill in" lines on the face and to minimize the appearance of wrinkles. Brand name fillers include Restylane, Perlane, Juvederm, Radiesse and Cosmoplast among many others. Dermatologists are also the pioneers of energy-based treatments for the skin and these include lasers, intense pulsed light, radiofrequency, infrared light and photodynamic treatments.