More primary care physicians are turning toward direct patient care (DPC) practice models.
A DPC practice is not the same as concierge medicine, nor is it necessarily a cash-only practice. However, DPC practices can be simpler to operate—relatively speaking— than fee-for-service healthcare.
By some estimates, 75% or more of patient care can take place in the primary care setting. Many DPC practices take insurance out of that 75%, directly charging business owners or patients a monthly fee to provide comprehensive primary care, health maintenance, and wellness services, including health coaches or care coordinators. Some practices include basic lab work or minor procedures in the fee. Others negotiate discounted rates with area providers for services such as imaging.
“DPC is the epitome of value-based medicine,” says Katherine Restrepo, a Forbes contributor who covers Obamacare.
Practices that are considering the switch to DPC should first answer two questions:
- How “direct” will the DPC practice be? Dropping insurance altogether might not be an option. Practices must determine if they will completely bypass insurance coverage, keep or drop Medicare and Medicaid, and whether they want to qualify for Affordable Care Act exchanges by being bundled with a wrap-around insurance policy. Many patients may still need insurance to cover catastrophic illness and serious accidents.
- Will the DPC model include all the physicians in a practice? The answer to the first question will likely help answer this one. Although DPC practices often spend less on overhead, driving costs down, a “hybrid” of DPC/traditional model will likely cost more to run.
There are other considerations as well.
The practice’s marketing budget will probably need to grow. Advertising may be less expensive and time-consuming than filling out paperwork for reimbursement and contesting denied payment claims, but the new DPC practice should prepared to get the word out early and often to potential patients. In addition, practices that migrate to DPC might lose patients who don’t want to (or can’t) make that transition. But keep in mind that DPC practices often receive free publicity from local media because the care model is considered new and interesting.
Consider the practice’s IT systems. Are practitioners capable of taking advantage of technology, including telehealth and smartphone apps, to facilitate care? Does the practice’s EMR have a built-in, automated billing feature? Converting to a DPC practice could potentially lower malpractice costs because physicians can spend more time with patients if they’re not under pressure to see as many possible every day. Nevertheless, the practice will need legal representation to navigate the laws regarding practice setup and the legal mandates under the Affordable Care Act and state laws.
DPC offices that opt to accept Medicaid might help reduce the costs of the program as well. Paying for primary care on a scheduled, monthly basis brings some needed predictability to Medicaid costs. This is one reason DPC organizations and state Medicaid directors are discussing contracting for Medicaid patients. In Washington State, Medicaid managed care companies are already contracting with DPC practices, according to Dan Way, writing in the November issue of the Carolina Journal.
With physician burnout at historic levels, especially in the area of primary care, measures that can cut bureaucratic paperwork and enable better patient care—such as DPC—might be worth more than a look.
