What is Direct Primary Care?
February 26, 2020Blog
What is direct primary care?
Direct primary care (DPC) is a subset model of the retainer-based practice framework for primary care practices. There is not a single DPC practice model; rather the model represents a broad array of practice arrangements that share a common set of characteristics. Perhaps the defining characteristic of DPC practices is that they offer patients the full range of comprehensive primary services, including routine care, regular checkups, preventive care, and care coordination in exchange for a flat, recurring retainer fee that is typically billed to patients on a monthly basis. DPC practices are distinguished from other retainer-based care models, such as concierge care, by lower retainer fees, which cover at least a portion of primary care services provided in the DPC practice.
What is the retainer fee?
The practice retainer fee is a set recurring charge billed directly to patients to cover the comprehensive and coordinated primary care services provided by the DPC physicians and practice staff under the terms of a practice retainer or membership contract. The value of the practice retainer fees is most commonly based on the breadth of primary care services covered under the retainer contract.
The intent of the retainer fee structure in the DPC model is to ensure that family physicians are appropriately paid for the entire range of value-added services they provide for their patients. In the current fee-for-service (FFS) payment system, nearly 50% of a family physician’s workday is spent outside of face-to-face visits, often in conducting vital follow-up or helping to coordinate care for patients as they communicate with other clinical providers. Under FFS, these critical non-face-to-face services often go uncompensated. Under a DPC retainer fee, the practice can ensure that family physicians are appropriately compensated for providing comprehensive care, and not just the care provided during an office visit.
How does direct primary care differ from traditional primary care?
The opportunity to spend more time interacting with patients and providing ongoing follow-up services is at the heart of the patient-centered care provided in DPC practice settings. The regular and recurring revenue generated by the practice retainer fees allows physicians participating in DPC practices to overcome some of the pressures associated with the traditional FFS payment system. 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.
Why would I want to consider a a DPC doctor?
The core result of the DPC practice model is that physicians and patients have the opportunity to spend more time interacting. The consequence of spending more time with each patient, however, is that family physicians practicing in a DPC setting typically have much smaller patient panels than they would in the traditional FFS system. Generally, DPC physicians have a panel of between 600 and 800 patients. In typical FFS settings, the patient panels tend to range from between 2,000 and 2,500 per family physician. This often results in patients losing access to their personal physicians if they elect to not participate in the DPC contract or if their physicians cannot take on new DPC contract patients.
Patients who do receive personal care in the DPC practice will find their primary care services significantly altered when compared with care received in traditional practice settings (e.g, increased time spent with their family physicians). 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.
DPC patients will also find it much easier to access their physicians and the DPC practice offices. This facilitates care that is timely and convenient. A number of DPC practices offer non-face-to-face visit options, such as e-visits, to empower patients to access care in a manner that best fits their needs. Additionally, many DPC practices also have expanded their operating hours while opening scheduling for same-day visits. Finally, some DPC practices provide patients a means to contact their physicians, or an on-call physician from the practice, 24 hours a day.
Can a DPC practice treat patients with insurance coverage?
Patients who receive health care insurance coverage, either through employers or individual insurance plans, can receive primary care in a DPC practice. This is true even if the DPC practice does not participate in any insurance contract. The reality is, however, that receiving care in a DPC setting can increase the responsibility of patients to manage their health care-related finances. Insured patients can typically receive reimbursement from insurance carriers for care received in a DPC practice via the claims process. The process typically requires the patient to submit an itemized bill for review and approval by the insurance carrier.
It is up to DPC practice owners and administrators to determine how much support the practice will provide to patients in managing claims. Some DPC practices provide fully itemized bills at each visit that can be submitted to insurance carriers. Others will submit itemized bills to insurance carriers as a non-participating practice on behalf of patients but elect to forgo managing the patient’s ongoing claims-review process.
Gottschalk A, Flocke SA. Time spent in face-to-face patient care and work outside the examination room. Ann Fam Med. 2005;3(6):488-493.
Solomon J. How strategies for managing patient visit time affect physician job satisfaction: a qualitative analysis. J Gen Intern Med. 2008;23(6):775-780.
American Academy of Family Physicians. Teamwork within a practice can relieve patient overload. AAFP News Now. October 9, 2012. www.aafp.org/online/en/home/publications/news/news-now/practice-professional-issues/20121009teambasedcare.html.
Murray M, Davies M, Boushon B. Panel size: how many patients can one doctor manage? FPM. 2007:14(4):44-51.
Kong MC, Camacho FT, Feldman SR, Anderson RT, Balkrishnan R. Correlates of patient satisfaction with physician visit: differences between elderly and non-elderly survey respondents. Health and Quality of Life Outcomes. 2007;5(62). www.hqlo.com/content/5/1/62.
Dugdale DC, Epstein R, Pantilat SZ. Time and the patient–physician relationship. J Gen Intern Med. 1999:14(S)S34-S40.
Wasson JH, Anders SG, Moore LG, Ho L, Nelson EC, Godfrey MM, et al. Clinical microsystems, art 2. Learning from micro practices about providing patients the care they want and need. The Joint Commission Journal on Quality and Patient Safety. 2008:34(8):445-452.