DPC: An Alternative to Fee-for-Service
The Direct Primary Care Model
The direct primary care (DPC) model gives family physicians a meaningful alternative to fee-for-service insurance billing, typically by charging patients a monthly, quarterly, or annual fee (i.e., a retainer) that covers all or most primary care services including clinical, laboratory, and consultative services, and care coordination and comprehensive care management. Because some services are not covered by a retainer, DPC practices often suggest that patients acquire a high-deductible wraparound policy to cover emergencies. Direct primary care benefits patients by providing substantial savings and a greater degree of access to, and time with, physicians.
At the close of the Louisiana Legislative Session, there was the passage of Senate Bill 516. Louisiana became one of four of the first states to pass direct primary care (DPC) legislation for primary care physicians. This legislation provides a framework for health care purchasing that gives family physicians and their patients a meaningful alternative to the conventional fee-for-service (FFS) payment paradigm for primary care services.
What Members Need to Know
The defining characteristic of a DPC practice is that it offers patients the full range of comprehensive primary care services—including acute and urgent care, regular checkups, preventive care, chronic disease management, and care coordination—in exchange for a flat, recurring membership fee that typically is billed to patients monthly.Direct primary care benefits patients by providing a greater degree of access to—and time with— their physician. The DPC model promotes the development of more meaningful physician-patient relationships. It also rewards family physicians for providing comprehensive, longitudinal care for the whole person, while reducing the overhead costs and negative incentives associated with FFS billing of a third-party payer. Direct primary care and concierge care are not synonymous. In practices offering concierge care, the patient typically pays a high retainer fee in addition to insurance premiums and other plan obligations (e.g., copays, out-of-pocket expenditures), and the practice continues to bill the patient’s insurance carrier.
Direct primary care rewards family physicians for caring for the whole person while reducing the overhead and negative incentives associated with fee-for-service, third-party-payer billing. Other benefits to physicians include:
- decreased practice overhead
- fewer medical errors / less exposure to risk
- improved practice collections rates
- more time with patients
- reduced patient volume
- zero insurance filing
Because DPC physicians are no longer generating revenue solely on the basis of how many patients they see per day, many report that they have significantly more time to spend with patients in face-to-face visits. Additionally, many DPC physicians provide a larger array of non-face-to- face services, such as tele-visits or e-visits, for their patients, to ensure primary care services can be accessed in a manner most convenient for patients and their families.There are a number of reported outcomes of increasing visit time, including improved patient experience of care and improved clinical outcomes as patients become more engaged in managing their own health care. The only outcomes registering an increase were the number of primary care visits (which is to be expected and desired) and an almost-unanimous patient approval rating.