An article in the Denver Post claims that more of the city’s physicians are converting their practices to direct primary care (DPC).
Colorado has 90 direct primary care practices seeing about 63,000 patients, which is 256% more patients than in 2018, according to data from Hint Health, a company that connects direct primary care practices with business customers. The state has one of the highest direct-care patient rates compared to population in the country, it says.
Colorado’s well-established direct primary care community has encouraged doctors who are considering a switch, said Dr. Brad Brown, a physician in Erie and medical director for Hint Health. Patients in the area also are particularly interested in a different model, he said.
DPC is a type of practice model where patients enroll as members of the practice and pay a monthly membership fee. DPC is something of a rebranding from an earlier practice model called concierge medicine. Whereas concierge medicine catered to the wealthy, DPC is aimed squarely at middle-class families. In return for a monthly subscription fee, patients get quicker access to primary care with longer appointments and more time with their doctors.
Direct primary care, a health care model under which patients pay a monthly fee and their doctors don’t bill an insurance provider, has been growing in Colorado and nationwide. How far it can scale up remains to be seen, however, since providers see fewer patients, and buying a membership isn’t feasible for everyone.
Patients appreciate the benefits of DPC, which is growing in popularity.
Demand for primary care services in general is growing fast in metro Denver. Its residents had about 5% more visits to primary care providers between January 2021 and March 2022 than they did between January 2019 and March 2020, according to Trilliant Health. Visits are expected to increase another 3.7% by 2026, more than double the average projected increase nationally — at least in part because so many people in late-middle age have moved to the area in recent years, Trilliant’s market trends report said.
The Post explores the experience of one primary care physician in Denver.
She was burned out from working long hours in primary care. An attempt to fix the problem by switching to a part-time schedule hadn’t helped, because she had to see the same number of patients in half the time. So she decided to strike out on her own, opening a direct primary care practice in Jefferson County where she sees only five to 10 patients in a day, compared to the 25 to 30 she previously juggled.
Many physicians are tired of the treadmill of seeing more patients than they feel they can adequately care for. Some are coming to grips with the fact that it is difficult to gather information and care for patients in a 10 to 15 appointment window. Insurance reimbursements are often low and the staff required to bill insurers are expensive to employ. Physicians across all specialties support the employment of about 14 people. The average primary care physician generates $1.4 million a year in revenue while only taking home $235,930, on average. That suggests the profit from each dollar of revenue is just $0.17 cents. At that rate, you have to see a lot of patients to bring home a good income. Plus, the first patients of the day pay the overhead. The most profitable from a business standpoint are those seen at the end of the day when the overhead has been covered. That perverse incentive leads to long hours and heavy workloads.
In a typical primary care practice, each provider could be responsible for anywhere from 1,000 to 4,000 patients, according to Fierce Healthcare. Direct primary care providers see far fewer.
Dr. Kyle Hampton, owner of Arktos Direct Care in Fort Collins, said he limits his patient load to 350 at any given time. Some can’t afford insurance but can manage a $100 monthly fee. Others just like having hour-long appointments where they can talk in-depth about nutrition and wellness, he said.
The monthly fees DPC practices charge often varies by age but not always. A physician near me in McKinney, Texas has two different fee schedules. McKinney Family Medicine charges $100 for the initial visit and $100 a month that includes:
Unlimited office visits, telemedicine visits (at the provider’s discretion), after-hour calls, EKGs, injections, in-house procedures, and no-show charges.
The second plan is $300 for the initial visit and additional physician visits are paid a la carte as follows:
- $200: Annual physical and lab follow-up visits
- $175: Sick visits
- $150: Telemedicine visits (billed at provider’s discretion)
- $75: After-hours calls
- $50: EKG and no-shows
- $25: Per injection (antibiotics, B12, steroids, other)
I know several doctors in the Dallas area that have reasonable cash-pay policies for those who lack insurance. Years ago, when my primary care physician was out of town he had a friend who was on-call for him. I happened to call for an appointment during that time and was told about the other doctor. The on-call physician did not accept insurance and would not make appointments. He accepted cash and it was walk-ins only on a first come, first served basis. This was 30 years ago and he charged me $35. Despite his practice to only accept walk-in patients my waiting time was only about 10 minutes.
There are an infinite variety of practice models that physicians can choose from beyond working for the private equity-owned practice, being in-network on insurance plans or being employed by the hospital. We should welcome the innovation and the variety.