Direct Primary Care

Overview

The direct primary care (DPC) payment 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 rewards family physicians for caring for their patients 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

In July 2015, AAFP hosted the Direct Primary Care Summit, which educated attendees on practice management under and advocacy for this payment model. Recently, the Primary Care Enhancement Act of 2015 (S 1989) was introduced by Sen. Bill Cassidy (R-LA). This bipartisan legislation – which is now co-sponsored by Sen. Maria Cantwell (D-WA) – would remove the legal barrier that prevents patients with Health Savings Accounts (HSAs) from entering into DPC arrangements with family physicians and other primary-care providers. Also, by clarifying DPC as medical care, this legislation would allow family physicians who accept Medicare reimbursements to enter into primary care contracts with patients.

The American Academy of Family Physicians supports the physician and patient choice to, respectively, provide and receive health care in any ethical health care delivery system model, including the DPC practice setting. For more information on the AAFP's stance, view its policy on DPC.