Direct Primary Care (DPC) is a practice model in which physicians and patients work together directly, without interference from third parties. DPC enables a stronger, healthier, more beneficial doctor-patient relationship. Direct primary care doctors do not collect money for any insurer or government organization as it relates to the provision of health care services.
The DPC model gives family physicians a meaningful alternative to fee-for-service insurance billing, typically by charging patients a monthly, quarterly, or annual fee. This fee covers all or most functions that family medicine doctors do. The membership arrangement between the doctor and the patient does not cover other services such as hospitalizations or visits to outside subspecialists. For that reason, most DPC practices often suggest that patients acquire a high-deductible wraparound insurance policy or enroll in a much less expensive health share to cover non-primary care items.
Insurance and medical care are typically state defined. Each state may have their own definition of what is DPC. In Louisiana, DPC was defined in the 2014 legislative session as Act 867. It defines DPC in Louisiana as practice that:
- Is a primary care practice
- Collects a periodic fee
- Enters into a direct agreement with patients
- Does not bill or collect from “third parties.”
- Any “per visit charge” shall be less than the periodic monthly membership fee
- Codifies DPC as not an insurance company
A Different Paradigm
Less administrative burden
DPC practices do not have to concern themselves with CPT coding, ICD-10 coding, submitting claims (bills) to insurance companies, argue denials of payment, participate in the data collection scheme known as “value-based” payments. DPC practices typically do not charge for visits so there is no need for a billing system. All of this reduces office overheads as there is no need for billing software, staff or a billing department. DPC practices use software that automatically drafts the patient's checking accounts or credit cards.
A principal part of what we call “burnout” or “moral injury” is related to the high administrative burden that takes away from patient time. DPC reduces that administrative burden and generally improves levels of satisfaction within the DPC model.
Increased patient time
One of the main things both patients and physician yearn for is more time. DPC practices typically have more time with patients as the membership model allows sustainability of practice with a smaller panel. DPC practices are not incentivized by how many patients they can see in one day, a characteristic of the productivity models and model where payment is dependent on face-to-face visits.
Longer patient contact time creates better mindfulness and a through understand inf the patient. A small er panel enhances the ability to see patients in a timely fashion or at least to be in easy contact. Easy access makes for fewer urgent care visits and ED visits. More time can be devoted to wellness and disease prevention.
Grass roots independence
DPC practices are rarely part of corporate entities. Essentially all DPC practices are comprised of individual doctors who made the choice to get off the insurance grid and create their own DPC practice. There is no requirement to be part of any bigger DPC organization. DPC practices operate autonomously, yet cooperatively.
Membership model
The physician is completely focused on the patient as that is the only other party in the question. The physician is not beholden to opinions or interference with an employer or an insurance company. Payment to the practice or DPC doctor is not contractually determined by any insurance agreement where the insurance companies set the rate of payment. The physician-patient relationship is clearly defined. Calculating practice income is very straightforward and a patient has a clear understanding of what their primary car health care expenses will be.
Insurance participation is not necessary
Most patients who are enrolled in a DPC practice already have their own insurance or health share although that is not a requirement. Any person, regardless of their insurance status, be it governmental or commercial or none, can enroll in a DPC practice.
DPC Challenges
Marketing and Community Outreach:
DPC is an unknow model to a lot of people. Some may confuse it with a corporate “VIP” strategy. Developing a marketing strategy to effectively communicate the benefits of DPC to potential patients is essential. This might include online presence, community events, or partnerships with local businesses.
Patient Acquisition
Attracting and retaining patients can be challenging, especially in a new market. Building a patient base and getting the word out about your practice is crucial.
Business Ownership
Starting any business has its challenges, but when you are starting and building a model of care which directly threatens the current model, you may be faced with contrarians and opposers who may propagate their assumptions about what DPC is. This can make growth difficult initially. That is until you prove them wrong – which you will do.
Financial risk
You will need to prepare for and accept the risk of receiving less income initially. You may need to supplement your income in other venues such as Urgent Care Clinics, Emergency Departments, etc as your practice grows. (Review the Member Only article Moonlighting and Side Hustles for more information)
DIY Medicine
It can be very nerve-wracking as you may have to find “hacks” to help save patients money or even venture into areas of medicine which you hadn’t fully considered such as performing venipuncture, scheduling patients, answering your phone calls, and/or re-learning procedures you may not have done in a while. This is a "bug” and a “feature” as the “change on a dime” mentality tends to have a net positive benefit.
Patient Relationship Management
Building strong, trusting relationships with patients in a membership-based model requires a shift in how you interact with them compared to traditional fee-for-service models. Some patients may overestimate their relationship with you or grow to feel entitled to the care and attention they receive from you. Setting clear boundaries early in the patient-physician relationship is highly recommended. Specific patient populations may pose certain challenges. “Low utilizers” may not find value in a monthly membership for a service they don’t regularly use. “High utilizers” may have a false sense of entitlement of what they think you should be providing to them. Other patients may overestimate their relationship with you assuming that, in addition to being their physician, you have a more personal relationship that can easily be abused. Those unique situations may occur but are easily handled with boundary setting and are rarely an issue.
Recruitment and Staffing
Typically, physicians would not have any experience with hiring/firing or creating the healthcare team that they work with daily as this was formerly done by the employer. However, in DPC, you’ll have full responsibility to create the team that will embody your vision of practicing good medicine. This can be both exciting and challenging.
DPC stats
See how DPC physicians described their practices. Download the 2024 direct primary care data brief for more details.