So Krouse decided to set up a direct primary care practice. Earlier this month she opened Lotus Family Practice in Falmouth. She doesn't accept insurance. Instead, she charges patients a monthly membership fee. "So it's very direct. It's just patients and doctors. There's no one else in between."
Membership is $60 a month for adults, $20 for kids. It covers an unlimited number of visits, which last about 45 minutes. Patients can also call or text Krouse any time they want. She also provides generic drugs at wholesale cost. Those savings alone, she says, can cover the cost of membership. "Pennies. They cost pennies."
"I pay a yearly fee, and I can see him as many times as I want," Ronhave says. "And it allows him to do more doctoring. And I think that's - to me as a consumer - that's really the most important thing."
Ronhave has diabetes. He needs to see a doctor at least four times a year. Last year, he saw Ciampi nearly once a month. He says he has a better understanding of his health and more strategies to deal with issues that crop up.
Direct primary care doctors recommend patients carry catastrophic insurance to cover serious health needs. Ronhave has employer-based insurance. But he says his $50- a-month membership doesn't add up to an extra expense.
"I'd say I'm probably saving a little bit of money doing it this way," he says. "I don't think it's huge savings. But the difference is the quality of care I receive, I perceive to be much stronger than what I was getting before."