123s of Direct Primary Care Practices

October 10, 2022

 “The U.S. health care system is broken” is a phrase that we hear all too often. While there is no simple solution to combat this widespread belief, Direct Primary Care practices are a part of a catalyst movement for the transformation of our health care system. Opponents to the current health care system argue that the system undervalues primary care and the doctor-patient relationship. They see Direct Primary Care practices as a solution to this broken system.

What is a Direct Primary Care Practice?

A Direct Primary Care (DPC) is a practice and payment model where patients and physicians enter into a contract for either a monthly, quarterly, or annual fee in exchange for a broad range of primary care services. Under the contract, most DPCs cover clinical and laboratory services, consultative services, care coordination, and comprehensive care management. Not only does the fee cover most services that primary practices perform, but patients also get extended visits, virtual appointments, and access to doctors by phone or email outside of regular business hours. Indeed, patients are able to receive more personalized services and enhanced communication with their physicians, establishing a stronger doctor-patient relationship that is hard to come by in primary practices.

Advantages of Direct Primary Care

There are many reasons why patients are attracted to DPC practices. By agreeing to a payment model, patients will not be surprised by expensive health care bills because they know how much their primary care will cost ahead of time. Furthermore, patients will be able to build a stronger relationship with their doctor because the appointments are unrushed and there is more frequent communication with the doctor. Indeed, appointment availability is also more convenient, with same-day appointments or telemedicine consultations often available.

Not only do DPCs benefit patients, but DPC practices relieve the headache that primary care physicians constantly deal with due to insurance companies. In fact, the DPC model completely eliminates third-party billing and typically does not accept any form of insurance. Instead, the periodic payments replace the insurance coverage. This reduces the administrative burden and minimizes the amount of insurance paperwork for doctors, allowing for more time to be spent with patients. 

Disadvantages of Direct Primary Care

When considering a DPC practice, there are also some limitations to take into account. Even though DPCs do not deal with insurance companies, it is still important for patients to maintain at least a high-deductible health insurance plan in case of emergencies, as DPCs do not cover hospital visits or specialty care. Also, unlike a regular practice where most patients are able to receive free vaccines because of insurance coverage or Medicaid, the vaccines are typically not included in DPC services. Because the physicians are not listed on insurance plans, building a DPC practice can be more challenging.  Much of the patient population cannot afford the cost of a DPC relationship and health insurance to cover other needs.    

How is Direct Primary Care Different From Concierge Medicine?

DPCs are actually a type of concierge medicine.  Concierge medicine is a broad term with a few different non-traditional models for primary care practices and patients.  While concierge medicine may charge the patient and bill insurance in some models, DPCs do not. DPCs deal solely with the patient/physician contract and their only source of income is from the patient. Sometimes, on the other hand, a concierge medicine practice, though following the DPC model, brands itself as a concierge medicine practice.  In those instances, the level of services typically are expanded, there is more white glove in the treatment, and it is more expensive.

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DPC practices can be both productive for the patient and the doctor, but it will be subject to certain compliance regulations depending on state law and your state’s medical board.

At ByrdAdatto we are working hard to ensure our clients are well equipped and ready for operating their business. If you have questions regarding this article, reach out to info@byrdadatto.com.

ByrdAdatto founding partner Michael Byrd

Michael S. Byrd

As the son of a doctor and entrepreneur, ByrdAdatto attorney Michael S. Byrd has a personal connection to both business and medicine.

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