A Rural Tennessee DPC Clinic Charges $30. It Says the State Pays Part.

Thirty dollars a month. That is the membership fee at Highland Hope Family Medicine, a direct primary care clinic that opened at 309 E. Main St. in downtown Rogersville, Tennessee. The Rogersville Review reported on Nov. 2 that the local Chamber of Commerce held its ribbon cutting the week before.

The American Academy of Family Physicians says monthly membership fees in DPC practices typically range from $50 to $100. Highland Hope sits below the bottom of that range. Its own FAQ explains how: the state is paying part of it.

Two farm kids and a vacant building

The clinic belongs to Drs. Grace and Christian Timmis, a married couple. They met in medical school, graduated in 2019 and both did their family medicine residency at ETSU, according to the Review. The clinic’s FAQ says both are board certified in family medicine.

They went looking for a place to practice together and found a vacant downtown building that had housed medical practices before. Christian Timmis told the paper why they chose the model.

“We’re both farm kids, and we knew that we wanted to practice in a rural area and serve people that we feel connected with,” he said. “That’s really our passion, to take care of people in more rural areas who maybe can’t afford market insurance. That’s why we’re doing the direct primary care model.”

The need is real in rural Tennessee. Tennessee Lookout reported in June that nearly 30 rural Tennessee counties have more than 4,000 residents per primary care physician, citing 2022 data from the University of Wisconsin Population Health Institute. Davidson, Williamson and Knox counties have fewer than 1,100.

What $30 buys, and what it doesn’t

The fee is per person. “You will need to pay $30/month for every member of your family that you want us to examine and treat,” the FAQ says, so a family of four pays $120 a month. There is no family discount.

The membership covers all in-person visits, televisits, phone calls and urgent after-hours calls, according to the clinic’s published price list. Ear wax removal and some in-office medicine are included too.

Everything else carries a fee, which the patient approves first. Routine labs start at $5, the price listed for a blood count, a metabolic panel or a cholesterol panel. Rapid flu and strep tests are listed at $10. Laceration repair with stitches starts at $40, and a skin biopsy with its pathology report is listed at $55. Both doctors are osteopathic physicians, and manipulative treatment of one area is listed at $35. X-rays, CT scans and MRIs go to Hawkins County Memorial Hospital, which bills separately.

The clinic never bills insurance, Medicare included. A Medicare patient pays the same $30, and the FAQ suggests that coverage may still help with outside imaging, referrals and prescriptions.

The schedule is a small-practice schedule. The clinic is open Monday, Tuesday, Thursday and Friday from 9 a.m. to 5 p.m. and closed on Wednesdays. There is no no-show fee. Members can cancel at any time without penalty, but rejoining carries a renewal fee that the FAQ doesn’t price.

The state’s share

Under the question “Why are your prices so low?”, the clinic’s FAQ answers directly:

“To help with this, the State of Tennessee has helped to fund our clinic in order to provide high quality medical services to Tennessee residents who might otherwise not be able to afford this quality of medical care. So, the State of Tennessee is actually paying for part of your membership fees. That is why our prices are so low.”

The clinic doesn’t name the program or the amount. The Review’s account of the couple’s comments is broader, saying the state “helps fund DPC model clinics as an alternative to the fee-for-service model.”

Tennessee does run money toward new rural primary care. The Department of Health’s Rural Healthcare Access Modernization Program, funded with TennCare shared savings, includes rural primary care seed grants of up to $500,000 per site for communities with provider shortages. Its page says applications are open and lists no recipients, so nothing there ties it to this clinic. The state also has a loan repayment program worth up to $200,000 for family physicians who commit five years to underserved areas, Tennessee Lookout reported.

A third payer, back in the room

The pitch on Highland Hope’s own FAQ is that a DPC clinic “cuts out the middleman between the patient and the doctor.” That is the core of the model, and the clinic means it. It won’t file a claim with any insurer, public or private.

Yet the thing that gets the price to $30 is a third party paying part of the bill. That party is the state, and its money comes from outside the patient relationship on terms the clinic hasn’t published.

The arithmetic shows how much rides on it. The AAFP puts the average DPC panel at about 413 patients. At $30 each, that is $12,390 a month in fees for one full panel. At the $50 floor of AAFP’s range, the same panel brings in $20,650.

For a family in Rogersville, the $30 fee is the whole point, and the subsidy is what makes it reachable. For the clinic, the same subsidy is a dependency. The FAQ doesn’t say how much the state pays, for how long, or what happens to the $30 price if that money stops.