AAFP MEETING: ‘What’s All the Buzz About Direct Primary Care?’

By Sheri Porter

Brian Forrest, M.D., tells attendees at his presentation on direct primary care that the model initially appealed to him, in part, because he wanted to spend more time with patients.

Brian Forrest, M.D., tells attendees at his presentation on direct primary care that the model initially appealed to him, in part, because he wanted to spend more time with patients.

May 06, 2014 08:45 pm – Kansas City, Mo. – How does a plenary speaker keep his family physician audience totally engaged and yearning for more discussion late on a Friday afternoon — especially after a 75-minute presentation that includes a slide show packed with statistics?

The answer is simple. Enthrall that audience with details about direct primary care (DPC), a practice model that is sweeping the nation and re-energizing physicians and their patients.

Presented as part of the AAFP’s 2014 Annual Leadership Forum (ALF) held here May 1-3, last Friday’s session, titled “Hope for Independent Family Physicians — How a Direct Care Model Can Allow Small Practices to Thrive,” did just that.

Plenary speaker and family physician Brian Forrest, M.D., opened his DPC practice, Access Healthcare,( ) 12 years ago, in Apex, N.C., to a chorus of negative comments from well-meaning colleagues. They insisted that Forrest was crazy and jeopardizing his business.

Fast forward to 2014, and it’s clear those naysayers were wrong. Access Healthcare not only thrived, but now facilitates a network of clinics in 16 states.

Defining Direct Primary Care

So what’s all the buzz about DPC? In his opening statement, Forrest clarified that he wasn’t giving a presentation on concierge medicine, a model of care associated with high-cost membership practices that often target wealthy Americans and cater to business executives with deep pockets.Instead, direct primary care offers accessible and affordable health care services to patients in all socioeconomic groups by charging reasonable fees that are paid directly by patients or their employers.

Importantly, insurance companies are not a part of this picture. “In 13 years, I’ve never taken a single dollar from an insurance company,” Forrest told his audience.

Keep in mind, it’s the absence of insurance hassles — and the necessary army of staff members needed to deal with those daily eruptions — that help practices achieve huge decreases in their overhead expenses. That’s what enables physicians in DPC practices to keep their patient panel sizes reasonable and their prices affordable.

Physicians in traditional practice models envy Forrest’s daily patient volume. “I see about 12 patients a day; 16 is the max,” he said. Furthermore, DPC allows him to offer “high-quality, equal-access care for everyone.”

Forrest recounted for his audience what he called “the most powerful and rewarding moment” he’d ever experienced in his practice.

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“I looked out the (inner office) glass window one day, and sitting in the waiting room was this guy (a photo of a disheveled patient appeared on the screen at the front of the room), and sitting next to him was a multimillionaire.

“In an instant, I realized I had fulfilled my dream,” said Forrest.

To those critics who argue that Forrest is cutting out patients without insurance, he pointed out that uninsured patients make up about 35 percent of his Access Healthcare patient base. He said his fastest-growing patient segment — currently at about 22 percent — is Medicare patients.

In a nutshell, the DPC model offers physicians and their patients a multitude of benefits, including

  • substantial patient savings,
  • improved practice collections rates,
  • decreased practice overhead,
  • reduced patient volume,
  • more time with patients,
  • zero insurance filing,
  • less stress and
  • fewer medical errors that mean less risk exposure for the physician.

As for Forrest, he said DPC has allowed him to earn a better income with “fewer bureaucratic hassles and a less stressful work day.”

He put a new spin on the familiar adage that physicians who aren’t at the policy discussion table would instead be on the menu. “We’re sick of standing at the edge of the table waiting for crumbs to fall off ,” said Forrest.

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The DPC movement is not about the kind of slow, steady incremental change that policymakers favor, change that takes years to make a difference for physicians and their patients who need good affordable health care today, he said. The direct primary care model is decidedly different.

“This is radical, in-your-face, ‘we-fixed it’ change,” said Forrest.

AAFP Gets in the DPC Game

So, what’s the AAFP’s take on the DPC model?

Well, in 2013, the Academy issued its first-ever DPC policy statement. And currently, the Academy is scheduling a series of regional workshops aimed at giving family physicians all the information they need to know before they make decisions about transitioning to the DPC model of care. Interested physicians should mark their calendars for

  • November 2014 in Phoenix,
  • January 2015 in Wilmington, Del., and
  • February 2015 in Atlanta.

More information about these events will be available soon.

Forrest noted that the invitation he received to speak at the AAFP’s 2014 ALF — an invitation that included two additional sessions on Saturday morning — illustrated that direct primary care is a hot topic.

“I’m here today, so the AAFP at least thinks this is worth talking about,” said Forrest. “This is good for family docs. You need to go back and tell doctors in your state that there is hope,” he added.


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