Medscape Medical News has discovered direct primary care (DPC). Medscape, owned my WebMD, is a medical news, peer-reviewed medical journal and educational website for doctors and other medical professionals. Dr. George Lundberg became its editor-in-chief in 1999, after 17 years as the editor of the Journal of the American Medical Association. Medscape recently wrote this wrote about DPC:
Continuity of care, no third-party billing, and price transparency: direct care and concierge medicine have long embraced some of the benefits that traditional medicine lacks, and these models have gained somewhat in popularity over the past two decades.
The author goes on to say there are more than 2000 direct primary care practices in the United States. Physicians who practice direct primary care report higher job satisfaction and higher patient satisfaction.
Physicians who practice within these alternative models enjoy personal relationships with their patients, provide extended appointment times, and eschew fee-for-service billing.
The benefits include same-day appointments, longer appointments, and a doctor who has the time to treat the underlying condition rather than just write a prescription and send patients on their way after a 10-minute office visit. Medscape counts among the downsides of DPC as a lack of scalability and a practice model that limits the number of patients who can be treated. Medscape also worries that these practices will fill with healthier patients. I have heard the opposite. Most of the people I’ve talked to who decided to go with direct primary care said it was because they have chronic conditions and value the services of a primary care physician to help manage their care.
Medscape notes that more patients are receptive to direct primary care. Price may be one reason. Direct primary care went through a rebranding a few years back from what was once called concierge medicine. While concierge medicine is a premium service, direct primary care does not have to be. DPC practices vary in how they are set up. Some DPC practices function like an ordinary doctor’s office but require a small retainer to be their patient. Others may charge much higher fees, not accept insurance and offer personalized premium services at a premium price. In my area McKinney Family Medicine offers two different pricing models. One model is $150 a month, while a pay-as-you-go model is $300 a year with transparent à la carte pricing for other services. A firm called Wild Health charges $20,000 annually for high touch personalized wellness medicine. Some clinics specialize in small segments of the health marketplace, such as wellness or hormone replacement.
Medscape reports that a typical DPC practice has less than 1,000 patients, or about 40% of a typical practice. However, the number of patients direct primary care practices need to be profitable depends on a variety of factors. One physician interviewed suggested it takes two years to build a practice to the point of earning a “good living.”
Because DPC fees are in addition to insurance, physicians must make their case to attract clients who want to be their patients. That requires more personalized services, transparent prices and convenience. Direct primary care physicians must articulate how they are different and what patients get for the monthly fee.
A physician who has researched and written on DPC told Medscape that occasionally a DPC clinic fails:
The most common reasons for failure included poor or stagnant growth, personal health or family health issues, pricing, personality issues, or the physician’s heart wasn’t in it. However, “Everyone I interviewed was asked if they still would do DPC or recommend it for others, and they all said a resounding yes.”
Direct primary care practices are different. That’s the attraction. DPC practices are innovative, working to provide additional services to their patients such as telemedicine, which is convenient for doctor and patient alike. One doctor reported:
“Patients want convenience, specialization, and more personalized and proactive care. They want to work in tandem with their physicians and be proactive in improving their health,” goals that may not always be possible in traditional insurance-based practices.
“My clients have always wanted that, but now that desire has gone mainstream. As the DTC category has grown, we’re seeing much more specialization — companies offering very targeted services vs generalized care.
About 60% pf DPC members have insurance. Although practices do not take insurance, they often help facilitate members filing claims with insurance. It is sometimes a challenge to get reimbursed, however. DPC practices are always out of network and many Obamacare plans do not allow any reimbursement for out-of-network care.
Direct primary care is changing the landscape of primary care. Medscape reports direct specialty practices are also growing in popularity.
The entire article is worth reading at Medscape.