Dr. Vance Lassey is building the family practice he always wanted, in more ways than one.

"I'm doing all my own renovation and building," said Lassey, a Peck native and 2003 grad of KU School of Medicine-Wichita who enjoys working with hammer and nail almost as much as stethoscope.

There's something else unusual about Lassey's new practice, at least for a rural physician: He's using the direct primary care (sometimes known as direct-pay) model. That means his patients will pay a monthly fee for his services, and insurance companies and the government won't be involved in the equation.

"I've wanted to do this since residency," said Lassey, former chief resident at Smoky Hill Family Medicine in Salina. Instead, he took a job at Holton Community Hospital, where he and some other KU docs are credited with getting the once-struggling hospital back on its feet.

"I wanted to get my confidence, and we had young children," Lassey said. "I wanted to get them out of the house and into school" before starting his own practice.

Lassey stresses that the direct primary care concept isn't new. "There's a doctor in Overland Park who's been doing this for 30 years," he said.

Six years ago in Wichita, he added, another alumni of the KU School of Medicine-Wichita, Dr. Josh Umbehr and a colleague launched Atlas MD, a direct primary care practice, and recently added a second location. Lassey said Umbehr has offered him valuable advice, as well as to doctors elsewhere who are following suit.

In Lassey's new practice, patients will pay between $10 (children) and $100 (older adults) a month, with the average being about $50 per person. For that, they get unlimited visits to his office, along with his private phone number for after-hours contact. They'll also get X-rays, blood tests, certain medications and other services at what he says will be a fraction of what other providers charge.

"We don't profit off medications or X-rays," he said. "Just the monthly fee."

Lassey will recommend that patients keep catastrophic health insurance to cover severe accidents or  illnesses.  But the net result for patients should be savings -- and more importantly, better care.

Lassey isn't shy when talking about what he feels are the bureaucratic influences that impact medical care. "I will make less money," he said. "It's not about money. It's about freedom from paperwork and other changes in medicine that have occurred. Doctors are staring at their screens instead of talking to patients. They're doing what I call chart care instead of patient care. I didn't go to medical school to shovel paperwork all day."

Because of the way reimbursement now works, Lassey said, many physicians feel pressure to see as many patients as possible, reducing the time they spend with each individual and making the building of relationships impossible.  "It's not that doctors are the problem, it's not the patients, it's the system. The only way to fix it is to get outside the system."

While the direct primary care movement is gaining momentum, Lassey said it's still rare in rural settings. He believes he's the second physician in the state to try it. The challenge, he said, is attracting enough patients to make the model work. That must be a larger percentage of the total available patients than a doctor in an urban setting would be required to attract.

"That's where it's really kind of a gamble, to see if it will work in a rural population. I need a much bigger percentage of my neighborhood."

Most physicians using the direct primary care model cap their patient list at 500, because otherwise it's difficult to carry through on the promise of delivering care "24/7" if needed.

Lassey distinguished the direct primary care model from "concierge," practices, which he said typically charge a much higher fee and may also seek reimbursement from insurance companies. 

Lassey has held two town meetings in Holton to get word out about his new practice. So far, he said, the response has been positive, although he said the hospital would naturally have preferred him to remain on its staff. "They get it," Lassey said, adding that he told hospital officials of his plans when he was hired. "They understand I'm not mad at them. I'm mad at the system."

He is working on an arrangement to keep his hospital privileges. He also has an agreement with a physician in Topeka to serve as each other's backup.

For his new office, Lassey is transforming some former office space in the front of a print shop and warehouse owned by a friend. It's a softball's throw from the hospital, which is convenient, but currently in an area zoned industrial, which would not permit a physician's office. Lassey is going through the process of getting it rezoned. 

In the meantime, he's got plenty to do, from buying supplies to the nitty-gritty renovation work he enjoys. He hopes to be open by mid-March.

"I gotta go in and paint and fix the walls and all that," he said. "We're putting new flooring in to replace 20-year-old carpet. I'll install cabinets and a sink, bring in medical equipment and an exam bed, and we'll be off and running."