Direct Primary Care

Is Direct Primary Care Replacing Health Insurance?

What is Direct Primary Care?

The direct primary care (DPC) model is intended to improve quality of care by allowing physicians to spend more time with their patients. It seeks to lower the amount of paperwork and overhead associated with third-party payment systems. It attempts to reduce complications and costs attributed to legislation regulations.

With a direct primary care model, patients pay a monthly or annual fee directly to the doctor. This fee gives the patient priority access to their doctor with longer appointments and reduced wait time. The goal of this model is to allow doctors the opportunity to develop a personal relationship with their patients.

This type of relationship improves patient care by bringing more awareness to the patient’s ongoing needs. Some patients and providers of direct primary care report that it improves long-term patient prognosis. Patients with chronic conditions require a more personal and engaged relationship with their physician and benefit from the increased appointment duration.

How is Concierge Medicine Different?

With the concierge medicine model, the physician takes a subscription from the patient but can also choose to accept payments from certain insurance companies.

“There are many varieties of concierge medicine, but the traditional form is where the patient pays a monthly fee or annual fee that gives them direct access to the physician.  The practice profits not only from this fee but also bills insurance companies for visits.”(1)

This model is attractive because it allows patients to use insurance and it puts physicians in direct control of their practice. With concierge medicine, physicians can decide how many patients they want to care for, rather than being forced to carry a patient load in the thousands.

The Pros and Cons of Private Healthcare

The rise of direct primary care and concierge medicine have raised quite a number of debates. Are these models elitist? Can patients get quality care if they are unable to pay directly? How will these new models impact access to doctors? Will these models increase wait times to see a doctor?

“Many physicians and medical ethicists have expressed concern about the impact of concierge medicine if a larger proportion of physicians practiced it. With the rising rate of uninsured, medical ethicists and others worry that concierge medicine may further divide the population into people who can afford medicine and those who cannot, and that it may increase the shortage of primary care doctors.” (2)

While these concerns cannot be discounted, many believe that the idea that these new models of care will further the divide between the haves and have nots is largely overstated. In fact, some doctors who have switched to the DPC/Concierge models have found that they are able to provide more time to community clinics and other low/no cost services. In many cases, patients have found that the services are surprisingly affordable.

“Although some of the early concierge services were targeted at the wealthy, nowadays the annual fee amounts to roughly $4-5 per day… This is within the means of many middle class families.”(2)

Will the pool of available doctors be negatively effected by direct primary care/concierge medicine? That is a legitimate question; however, there is evidence that doctors are already leaving medicine because of complicated reporting and billing requirements. Doctors are frustrated because they are spending more time doing paperwork than treating patients and physician burnout is a real problem starting to affect us all.

The appeal of the DPC/concierge models for both doctors and patients is the opportunity to provide better care and establish better doctor/patient relationships. While there is not a significant amount of data yet available, there is good reason to believe that doctor availability may be positively vs negatively impacted by DPC/concierge medicine. Instead of rushing through appointments to complete volumes of paperwork, physicians will be able to spend more time doing what they were trained to do.

Legislation Affecting Direct Primary Care

As more and more physicians make the switch to direct primary care, federal and state governments are scrambling to keep up the pace and put legislation into place.

On April 16, 2015, the President signed H.R. 2, The Medicare Access and CHIP Reauthorization Act. According to dpcare.org, “The new law permanently ends the flawed “Sustainable Growth Rate” (“SGR”) physician payment formula and begins the process of transforming Medicare from fee-for-service into value based payment and delivery models, including direct primary care.” (3)

The good news is that this opens DPC to Medicare patients.

There are currently 13 states that have passed State direct primary care laws with Texas passing H.B. 194 on May 12, 2015. These laws attempt to provide a clear definition of direct primary care outside of insurance regulation. Other states are expected to follow suit.

Outlook for the Future

The volume of physicians and patients currently switching to DPC/Concierge medicine suggests that these new models are growing fast. A recent report from MDVIP, the largest network of private physicians in the U.S. shows a 200% growth in the number of concierge doctors and patients since 2007.(4)

A report by Accenture, a management consulting, technology services and outsourcing company, estimates that “one in three remaining independent physicians—their ranks decline by 5% each year—will look to adopt subscription-based practice models to achieve higher yields, and that trend will continue to increase by 100% annually over the next 3 years.” (5)

Although these numbers point to positive outcomes for these new models of care, will patients embrace the positive aspects of these models, such as improved access to medical care, or reject them due to higher up-front costs? As insurance companies feel the sting of physicians and patients leaving the grid, can we can expect lobbyists to take action? How will federal and state authorities respond to the pressure? Will regulations, the very things DPC/concierge physicians and patients are trying to escape, become a new nightmare?

Perhaps it is too early to tell. In the mean time, physicians and patients who have already made the switch can enjoy a break from the red tape.

 

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(1) Concierge Medicine vs. Direct Pay Care, from www.physicianspractice.com/concierge-medicine-vs-direct-primary-care (membership may be required)

(2) Concierge Medicine: Legal Issues, Ethical Dilemmas and Policy Challanges

(3) Permanent SGR Fix Signed by the President

(4) Will Concierge Medicine get Bigger?

(5) The direct primary care model is gaining traction. Is it right for you?
http://medicaleconomics.modernmedicine.com/medical-economics/content/tags/david-usher-md/direct-primary-care-model-gaining-traction-it-right-yo?page=full