Direct Primary Care FAQs

 

For Healthcare Providers

What is Direct Primary Care?

Direct Primary Care (DPC) is an innovative practice model being sought out by patients, physicians, employers, payers and policymakers across the United States. A key aspect of DPC is a direct relationship between a patient and his or her primary care provider without interference of third parties like insurance or the government in health decisions.

What are the Main Benefits for Physicians?

1. Ability to remain independent and have greater practice autonomy
2. Firm and trusting patient relationships- nothing to interfere of cause conflicts of interests
3. No insurance coding or claims needed (forget ICD-10)
4. More time for personal life- less coding or charting after hours
5. Reduced practice overhead that makes financial viability much better for even solo physicians
6. Income potential similar to other specialists like Cardiology or Gastroenterology
7. Decreased malpractice costs-many companies offer discount due to lower risks

What are the Main Benefits for the Health Care System as a Whole?

1. Less unnecessary visits and less unnecessary procedures or tests
2. Prevention focus rather than sick focus
3. Metrics built into most practices to for Quality Improvement and population health
4. Less patient and health insurance costs and premiums
5. Reductions in hospital admission and readmissions
6. Reduces wasteful spending and put resources back into actual patient care

How are DPC practices paid differently as compared to conventional practices?

DPC minimizes or gets rid of fee-for-service (FFS) incentives in primary care. These incentives cloud healthcare decision-making by rewarding more procedures and visits versus keeping patients healthy. This can erode the integrity of the patient/phyisician relationship and rewards expensive and sometimes unnecessary testing, inappropriate referrals, and treatment. DPC replaces the FFS approach with a simple monthly fee that allows primary care services to be provided at a much lower cost.

How is DPC different than concierge practices?

• Both improve quality of care for patients
• Both improve physician experience/pay
• Concierge severely shrinks panel size
• Workforce improved with DPC and worsened with Concierge
• DPC generally affordable for the average person (Honda vs. Ferrari)
• DPC can be successful in rural and poor communities
• DPC can lower out of pocket costs and downstream costs
• DPC panel size is optimal

For Patients

What is Direct Primary Care?

Direct Primary Care (DPC) is a health care model that restores a personal relationship with your physician. The goal is to simplify the finances in order to provide more time with your physician, more personal care, and to place the incentive on keeping you healthy rather than on paperwork or getting paid. This is accomplished by removing insurance companies from the relationship between the patient and primary care physician.

How Does DPC Work?

The idea is to use health insurance only for unexpected and expensive problems. This is similar to how people commonly use car insurance. In the same way, you would not use car insurance for an oil change or a tune up. A Direct Primary Care practice can take care of 90% of your health care needs for a lower cost than an insurance based medical practice can. Insurance can then be used when really expensive and unusual health costs arise. In a similar manner, if you totaled your car, your car insurance would pick up the tab after the deductible making it an affordable expense. If car insurance worked the way health insurance does, your premiums would be much higher.

How does this make my experience as a patient better?

The most common feature of DPC is plenty of time spent between patient and physician, creating an enduring doctor-patient relationship. Supported by unrestricted access to care, DPC has unrushed visits and frequent discussions to assess lifestyle choices and treatment decisions aimed at overall health and wellness rather than illness. Making the Patient/Physician relationship stronger and improving the patient’s engagement in their health care is important to improving health outcomes, lowering costs, and an enhanced patient medical experience.

What are the main benefits for patients?

1. Reduced out of pocket costs for most patients
2. Plenty of time with provider-no rushed visits
3. Same day appointments available
4. Usually much shorter or no time in the waiting room
5. Can get care through advanced technology like video visits over smartphones
6. Great Patient/Doctor relationship with no middleman to interfere
7. Emphasis on health and wellness rather than just sick care

How can my DPC physician help me with other health care costs like specialists or X-rays?

DPC providers are consumer advocates for patients for all of their healthcare needs. They have time to make informed, appropriate referrals and support patient needs when they are outside of primary care. DPC providers accept the responsibility to be available to patients and even help them find the lowest cost treatment options. No matter where patients are in the system, physicians provide them with information about the quality, cost, and patient experience of care.

Am I restricted to a certain network or provider like insurance companies dictate?

Patients in DPC choose their own personal physician and are not restricted by narrow networks determined by insurance companies. Patients need to be given accurate information on costs and decisions at the time of service or even before as patients are engaged in making their own medical and financial choices. Transparent pricing is the mainstay of DPC practices.

Should l have insurance if I go to a DPC practice?

We encourage patients to have insurance to cover catastrophic costs that can be associated with health care like hospitalization and surgery. However, this model makes primary care affordable even if you do not use insurance. For patients that do have insurance, they can still come to this type of practice, sometimes even for less out of pocket expense than going to a practice that takes and files insurance.

How are DPC practices paid differently as compared to conventional practices?

DPC minimizes or gets rid of fee-for-service (FFS) incentives in primary care. These incentives cloud healthcare decision-making by rewarding more procedures and visits versus keeping patients healthy. This can erode the integrity of the patient/phyisician relationship and rewards expensive and sometimes unnecessary testing, inappropriate referrals, and treatment. DPC replaces the “only get paid when the doctor does something to you” strategy with a simple monthly fee that allows all of your primary care services to be provided at a much lower cost.

Latest News & Events

Blog

http://annals.org/article.aspx?articleid=2468810 Unfortunately, instead of going to sources they Read More »

Press

Apex, N.C. — A medical practice in Apex does what few in America do: It doesn't accept payment thr Read More »