May-June 2014 Table of Contents

Practice Transformation: Taking the Direct Primary Care Route



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This practice cured its insurance headaches by switching to a cash-only payment model and charging annual retainer fees.

Fam Pract Manag. 2014 May-June;21(3):10-15.

Author disclosure: no relevant financial affiliations disclosed.

With the ever-changing rules and reimbursement restrictions being imposed by Medicare and private payers, many family physicians have embraced “cash-only” and “retainer-based” payment models to bypass insurers entirely.

These models, which include “direct primary care,” “direct pay,” “concierge,” and other subtly different forms, are collectively seen as a way for physicians to focus more tightly on patient care while normalizing reimbursement.

David Albenberg, MD, has operated Access Healthcare LLC for more than a decade, serving around 350 patients in Charleston and Mount Pleasant, S.C., in his retainer-based practice.

He didn't anticipate operating this type of practice when he walked out of his Charleston-based independent practice association (IPA) in 2002, turning his back on five years of traditional medical practice. He simply had a goal of never dealing with insurance again after becoming frustrated by the pressures and dictates of payers, including having to see 30 to 35 patients a day, feeling his care was compromised because of the rush, and not understanding the financial rules under which he worked.

But he said the retainer model made more sense if he considered it as just another capitated system. He has used it to dramatically transform his practice, which allows him to spend more time with his patients and concentrate on their care, improve his work-life balance, increase revenue, and generally restore his joy of practice.

“The biggest step was coming to an emotional point of understanding and enlightenment that this (traditional model) was not working,” Albenberg said. “After that, it's sort of ‘Build it and they will come.’”

David Albenberg, MD, opened Access Healthcare in downtown Charleston, S.C., in 2003 after becoming disillusioned with traditional medical practice. He now offers patients a mix of retainer- and cash-based services.

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David Albenberg, MD, opened Access Healthcare in downtown Charleston, S.C., in 2003 after becoming disillusioned with traditional medical practice. He now offers patients a mix of retainer- and cash-based services.


David Albenberg, MD, opened Access Healthcare in downtown Charleston, S.C., in 2003 after becoming disillusioned with traditional medical practice. He now offers patients a mix of retainer- and cash-based services.

How does it work?

Most retainer-based practices act as a miniature insurance company, charging patients an annual fee that covers a portion or all of their regular medical care, including check-ups, primary care, preventive care, and coordinating care with specialists. Not all retainer-based practices are completely severed from insurers; some work with insurers to pay for portions of a patient's care.

Direct-pay practices that don't use a retainer or where the retainer covers only a portion of the costs may also charge patients fees at the time of service.

Concierge plans also use retainers but are f

About the Author

David Twiddy is associate editor for Family Practice Management.

Send comments to fpmedit@aafp.org, or add your comments below.

 

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