After close to two decades of building frustration with the state of the healthcare industry and insurance companies, Karen Ottenstein and Cathleen Hood had enough. So they stopped taking insurance altogether.

The Dartmouth residents, board certified family doctors, and owners of Westport’s Primary Care Partnership have adopted what is called “direct primary care,” a billing model for primary care practitioners.

It does away with insurance companies, copays, and networks in favor of a single monthly fee paid directly to Ottenstein and Hood’s practice.

Hood, who has been in family medicine since 1993 and has operated her own practice since 2000, said her frustration with insurance companies had been building for some time. In 2002, she penned an op-ed in the Standard-Times expressing her issues with the system.

With insurance companies demanding more metrics, mandates, and measures than ever before, she said the time-consuming process of tracking them is detracting from individual care.

“It’s very similar to what teachers are going through. It’s the medical version of that,” Hood said, likening it to the teacher performance and standardized testing debate in education.

Ottenstein, who joined Hood's practice from Maine four years ago, agreed.

Patients receive as much care as Hood and Ottenstein and their clinical and clerical staff can provide with no need to worry about deductibles, copays, or additional fees, although members must also maintain traditional health insurance for other services and referrals.

Since making the change last October, many patients elected to stay with the new program. Those that did not were assisted with referrals through Prima CARE, which the practice joined in 2013.

“At the moment we are way beyond where our projections were for six months, but we still do have some spots remaining,” Hood said, adding the practice currently has somewhere in the mid-300s for patients.

It’s allowed Hood and Ottenstein to reduce their workload significantly to better focus on each person individually — part of an overall mission to focus on the quality of their care, as opposed to the quantity demanded by insurance companies to cover overhead costs.

“What we’re really talking about is going full circle back to the original doctor-patient relationship, which was intended to be a personal, longitudinal relationship,” Hood said.

That means developing a firm understanding of their patients on an individual level, and being available 24/7 through secure smartphone apps and text. It also means Hood and Ottenstein can discuss both western medicine and other approaches to wellness like holistic medicine and acupuncture.