Frisco Physician Looks to Expand Discount Program for Uninsured

Guy Culpepper, MD, president and chief executive officer of the Jefferson Physician Group, is ready to make another push to expand his discount program for the uninsured.

Culpepper, a Frisco family physician, created the Jefferson Independence Card program in 2009 to allow physicians and imaging centers to offer discounts to qualified patients. The program has grown to include about 400 physicians and six imaging and physical therapy centers. He estimates there are about 15,000-20,000 people with what the program calls “iCards.” The program is free for patients and providers. There has been no marketing. The program has grown simply through word-of-mouth.

The primary-care fees are posted online. Specialists are asked to charge the price they are willing to take or the lowest managed-care contract rate.

“Transparency is a moot point once you get to the doctor’s office. We may be a lot cheaper than what they thought,” he said.

Culpepper said he would like to expand the program to include non-medical services, such as dentists, chiropractors, over-the-counter medicines and even running shoes.

He said the market has shifted since he began the program. The uninsured rate has continued to rise and high-deductible plans have proliferated. He estimates about 10 percent of his patients pay out-of-pocket and can use the iCard.

“We need this (program) now more than ever,” he said.

Culpepper wishes employers with high-deductible plans would set aside $500 annually for employees to pay for primary care.

“What I need is for employers to wake up. They pay for all these wellness services. They just need to make sure their employees have a family physician. That’s how you keep costs down. Primary care is crazy inexpensive. It’s only about $300-$400 a year. You can’t get a cup of water in the emergency department for that amount,” he quipped.

Culpepper paid for the iCard program out of his own pocket because he thought it was the right thing to do.

“There is no revenue. It was a God-and-country thing. It was never meant to be a wealth generator,” he said.

Culpepper has quietly guided his group of about 200 primary-care physicians from the managed-care era in the 1990s to the current consolidation in the wake of accountable care. With primary care in such demand, he and his group has had to fend off suitors.

“They want to buy us, steal us, have us go away and break us up. When hospitals tell our doctors, ‘You can make 180 percent of Medicare rates instead of 125 percent,’ that is hard to turn down,” he said, acknowledging the market power of health systems in negotiating with insurers.

Despite that, Culpepper has lost only a handful of providers, primarily to retirement. Physicians pay $1800 a year to be part of Jefferson Group. In return, they get discounts on malpractice insurance, vaccines and office supplies. They negotiate with insurers as a group and share in any pay-for-performance revenue.

Culpepper believes the camaraderie of the group is even more important than the financial aspects. The practice managers meet monthly to discuss common concerns and share best practices. The physicians meet quarterly.

“You don’t have the feeling that you are all alone out there. Doctors work in 8’x10′ rooms. You often want to ask, ‘Does anyone know the problems I’m dealing with?’ You want to share the joy and warm feelings of being a primary care doctor,” he said.

Culpepper said Jefferson Group could be much larger, but it has turned away many candidates because of its requirements. Nearly all its physicians are board-certified and there is an annual 50-hour education requirement.

“We would be a lot bigger if we made the rules looser. We’d rather not. I want a Spartan army,” he said.

Steve Jacob is editor of D Healthcare Daily and author of the new book Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking Us. He can be reached at

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