Well-the ACP got it WRONG!

Unfortunately, instead of going to sources they have done much analysis in an ivory tower philosophy format without getting any real expertise or input on this.  I will enumerate some key points below and with ample time could provide lots of references to back them up but for now will just give my comments:
1-Defines DPC as cash at time of service practice-that is considered fee for service cash practice not DPC
2-Says Panel size is much smaller in the few hundred range- average panel limit in our network of practices in 20 states is 1000-at our practice we have 1200 each.
3-Less Diabetic patients/different population-incorrect, we have a study over 10 years with 3 DPC practices done by NCSU MBA program showing the exact same diagnosis distribution-the only difference in the population was that these practices served more uninsured patients (because this model is all they could afford without insurance)
4-Imply that DPC docs and practices are anti-insurance-every DPC doc I know encourages people to have insurance if they can and they use their insurance outside of the DPC practice as they normally would.
5-Definition of DPC,Concierge ,and DPCP- are completely inconsistent with current state definitions in the law and with the the current legislation in SB 1989.  By definition DPC practices charge a retainer and DO NOT BILL Insurance.  Concierge practices are who actually charge a retainer and then also bill insurance on top of that (like MDVIP)  They have these all mixed up and homogenized.  You cannot say the same bad things about DPC as Concierge, or about cash only fee for service and DPC, or about boutique practice and DPC- all of them are different.
6-More IMs than FPs doing this?  In our experience with 100s of independent DPC practices about 80%are FPs and only 20% are IM
7-Access Rhode Island- terrible example, almost nobody in the DPC community considers them DPC.  These are traditional practices that each have a few Concierge patients managed through a statewide network.  They used our membership software so I know what their patient enrollment is and for the whole state it is less than 400 patients-which means less than 20 patients for each practice that are in this model.
8-length of visit has been proven to improve outcomes and lower costs wheras they assert it has not-I can cite at least 3 references that prove this
9-Item 7 implies that this is bad for the poor when actually it was conceived as a safety net for poorer patients.  We actually have more minority, poor, uninsured, disadvantaged patients than any private practice in our community so the assertion that the model might create barriers for the poor or exacerbate racial and ethnic disparities is highly offensive and not a broad brush that should be used to paint with.  We even have published data showing the opposite.- I would agree it applies to some concierge practices and even some to more expensive DPC ones- but it is usually the only resource uninsured patients may be able to go to for primary care in a given community.  The local health department (county funded) refers patients to our clinic for PAP smears because we do it less expensively than they do even for sliding scale patients.  You do not see homeless patients coming to Concierge practices- but you can see that at many true DPC practices.
10-Retainer practices are Concierge?  Some are, some are not- by definition DPC practices have retainer practice as an option for patients- this has been codified in multiple state laws about DPC.  They called direct primary care in one paragraph cash at time of service for fee for service visits.  Whoever edited this article or wrote it left glaring inconsistencies and ignored real definitions accepted by most of the pioneers of this model.
11-Their definition of a DPCP makes no sense- they have homogenized all practice types to make their critiques and then basically said “oh by the way their are some exceptions.”
12-They exalt the PCMH model as an alternative-it is not an alternative from a supporting small independent practices to stay financially viable standpoint.  DPC practices exemplify all of the traits of the PCMH except that they can actually execute on some of the principles and have the financial viability to do so.  Even Joe’s Dad Paul Grundy said at one of our CQP meetings “Direct Primary Care is like PCMH on steroids.”  He went on to say that for chronic disease management it was a superior model because it did not dis-incentivize patient followup visits with “more copays.”
13-just for good luck-I have been told by more medical students and 65+ year old physicians that had planned to retire, that DPC is keeping them in family medicine or bringing them into family medicine than I can count.  DPC will not hurt the workforce- given the time delay of training and the transition rate it will actually improve the number of independent family physicians and their distribution into rural and poor areas as well.

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