In the current healthcare climate, a strong one-on-one relationship with one’s physician can seem like the relic of a bygone era.
Crunched by a nationwide shortage of primary care doctors, most providers are forced to see several dozen patients a week. Anything beyond a quick meeting between doctor and patient can be hard to come by.
However, a non-traditional model known as direct primary care, or DPC, is seeking to change that.
A Different Model of Primary Care
Unlike the fee-for-service approach that most providers use, direct primary care physicians charge their patients a flat monthly rate.
Many of these physicians work with patients on the individual health market. But some also partner with employers and insurance companies – even Medicare Advantage plans – which then contract with them to provide all-inclusive primary care. (For more, read: Five Distinct Features of Medicare Advantage.)
Doctors who employ a cash-only model tend to spend more time communicating with patients – often via phone or email. Those are activities that aren’t reimbursed in the standard healthcare paradigm, so there’s no real financial incentive to spend much time on out-of-the-office interactions.
DPC practitioners say they’re more likely to follow up with patients and handle chronic ailments in a hands-on fashion. And that, they argue, leads to better long-term health outcomes, especially for those with complicated medical histories.
Direct primary care may sound a lot like concierge medicine, but there’s an important difference. The latter is marketed to more affluent patients, with monthly fees often running several hundred dollars or more a month. DPC is a more affordable model, with rates typically running anywhere from $25 to $90 a month. That will get patients access to a menu of services like wellness examinations and basic screenings.
Because physicians don’t bill for each exam and test they provide, they can dramatically cut back on the expense of office staff. That allows them to charge less than they otherwise would for a similar level of care.
There are certain needs that direct primary care doesn’t include, however, such as hospitalization and more advanced testing. Most patients still need a separate insurance plan that covers those things – and helps them meet the requirements of the Affordable Care Act. Often, they’ll choose a relatively low-cost, high-deductible plan to handle those more expensive services. Note that DPC payments do not count toward fulfilling deductibles for these insurance plans.
A Shortage of DPC Doctors
While a more intimate relationship with one’s physician might sound appealing to a lot of patients, there are still some big hurdles.
One example: IRS rules currently prevent individuals from using funds in their Health Savings Account to pay monthly DPC costs. Bills reversing that prohibition have been introduced in Congress, although without success so far. (See: Pros and Cons of a Health Savings Account.)
And then there’s the fact that DPC is still a very small part of the U.S. healthcare system. According to the Direct Primary Care Coalition, a trade association, there are just over 500 physicians using this approach across the country. That number has increased in recent years, though at a modest pace.
Switching to a cash-only model can be risky, especially for younger doctors who don’t have the capital or experience managing a practice to venture out on their own. Those who do make the transition usually see fewer patients than their peers in order to spend more time with each one. A traditional practice might provide care for 2,000 patients, whereas DPC practitioners might treat fewer than 30% of that amount.
Consequently, finding a DPC group that’s accepting new patients can be tricky. A simple web search is one way to find practices in your area. There’s also a list of practices affiliated with the Direct Primary Care Coalition on the group’s website. Of course, when you do find a practitioner, do the same research on his or her education, experience and hospital affiliations that you'd do with any physician you are considering.
The Bottom Line
Many patients yearn for a closer relationship with their doctor. Flat-fee medical practices offer considerable hope in that regard, but finding an available provider is still a tall order in most parts of the country. It's also important to make sure any plan you accept has provisions to meet ACA requirements. As DPC practices are designed to provide primary care, be especially careful to cost out the option if you or someone in your family has a health condition requiring regular visits to specialists.