By Staff Writer, The DPC Journal
JUNE 5, 2014 – Nationally, direct primary care practice is considerably newer than concierge practice — and there are considerably fewer direct primary care than concierge physicians. Michael Tetreault is Editor in Chief of 2 online journals: Concierge Medicine Today and The Direct Primary Care Journal and estimates that direct primary care physicians make up about 20% of the retainer medicine movement right now; the other 80% are concierge physicians.*
“Generally, direct primary care is a cash-only practice,” he says. “However, although we have no hard data, we estimate that less than 20% of direct primary care practices accept insurance. So there are some that do.”
Direct primary care physicians charge less than private or concierge physicians: “from $25 to less than $100 a month,” Tetreault says. “We believe that these fees represent about 90% of the direct primary care physician community.”
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That fees are payable by the month rather than by the quarter or year is important to many direct primary care patients, who may have cash flow problems in a tight job market. “That’s a big difference,” Tetreault says, “no long-term contract.”
Direct primary care practices may or may not offer same-day appointments. Most probably don’t, Tetreault says. The doctors probably won’t give out their cell phone numbers, meet patients in the ER if they have a late-night crisis, or make house calls — although some direct primary care doctors do make house calls, he adds.
If house calls are offered, they are typically billed separately, not included as part of the monthly fee. Flu shots and vaccinations are usually billed separately too.
Direct primary care (DPC) is an emerging model that has gained some attention nationally in recent years. Sometimes referred to as ”retainer practices,” DPC practices generally do not accept health insurance, instead serving patients in exchange for a recurring monthly fee — usually $50 to $80 — for a defined set of clinical services.
“Many direct primary care practices do not build in concierge medicine service components, such as 24/7 care, cell phone text messaging, and instant or same-day appointments,” Tetreault says. “And yet, some do.”
Concierge practices composed exclusively of concierge patients (most practices include a mix of concierge and traditional patients) generally limit their panels to 600 or fewer patients per physician. “Direct primary care practices, because they charge a lower fee, need more patients on their rosters,” Tetreault explains. “They typically have under 1000 patients.”
The distinctions between concierge medicine, private medicine, and direct primary care may be ultimately meaningless, since some doctors call themselves whatever they feel sounds better, and there are so many practice variations, many overlapping, that it often isn’t clear which is which.*
Still confused by this semantic hair-splitting? Join the club. Even concierge and direct primary care physicians may be confused about which type of doctor they are.*
“In polls, we’re asking the actual physicians, ‘Do you consider yourself a concierge doctor or a direct primary care doctor, or do you consider yourself both?’” Michael Tetreault, the journal editor, says. “Most say that they consider themselves a concierge doctor. But they still don’t understand the differences. A lot of doctors consider themselves to be both.”
Related Article … The Difference Between Concierge Medicine and Direct Primary Care >>
Collectively, direct primary care (sometimes linked to the term concierge medicine) has more than a half million people on their rolls, according to the California HealthCare Foundation. They highlighted five large direct pay practices that use the retainer model in an April 2013 report. These direct primary care patient rosters are estimations:
- Iora Health, with 2,400 patients
- MedLion, with 3,000 patients
- Paladina Health, with 8,000 patients
- Qliance, with 7,200 patients
- White Glove Health, with 40,000 patients via self-insured employers and 450,000 via health plans
Direct primary care providers help keep costs low by avoiding unnecessary referrals and by referring mainly to specialists willing to offer significant discounts. Despite this advantage, the DPC model may be hampered by low awareness among health plans and primary care physicians, resistance from some insurers, and resistance from competing hospitals and specialists.
The Direct Primary Care Coalition (DPCC) Defines DPC As:
Direct Primary Care (DPC) is an innovative alternative payment model for primary care being embraced by patients, physicians, employers,payers and policymakers across the United States.The defining element of DPC is an enduring and trusting relationship between a patient and his or her primary care provider.
Empowering this relationship is the key to achieving superior health outcomes, lower costs and an enhanced patient experience. DPC fosters this relationship by focusing on five key tenets:
- Service: The hallmark of DPC is adequate time spent between patient and physician, creating an enduring doctor-patient relationship. Supported by unfettered access to care, DPC enables unhurried interactions and frequent discussions to assess lifestyle choices and treatment decisions aimed at longterm health and wellbeing. DPC practices have extended hours, ready access to urgent care, and patient panel sizes small enough to support this commitment to service.
- Patient Choice: Patients in DPC choose their own personal physician and are reactive partners in their healthcare. Empowered by accurate information at the point of care, patients are fully involved in making their own medical and financial choices. DPC patients have the right to transparent pricing, access, and availability of all services provided.
- Elimination of Fee-For-Service: DPC eliminates undesired fee-for-service(FFS) incentives in primary care. These incentives distort healthcare decision-making by rewarding volume over value. This undermines the trust that supports the patient-provider relationship and rewards expensive and inappropriate testing, referral, and treatment. DPC replaces FFS with a simple flat monthly fee that covers comprehensive primary care services. Fees must be adequate to allow for appropriately sized patient panels to support this level of care so that DPC providers can resist the numerous other financial incentives that distort care decisions and endanger the doctor-patient relationship.
- Advocacy: DPC providers are committed advocates for patients within the healthcare system. 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 serving as patient guides. No matter where patients are in the system, physicians provide them with information about the quality, cost, and patient experience of care.
- Stewardship: DPC providers believe that healthcare must provide more value to the patient and the system. Healthcare can, and must, be higher-performing, more patient-responsive, less invasive, and less expensive than it is today. The ultimate goal is health and wellbeing, not simply the treatment of disease.
*Source: Neil Chesanow, MedScape, WebMD, May 19, 2014
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