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Tuesday Jun 19, 2018

AAFP Survey Reveals DPC Trends

"The headlines read, 'These are the worst of times.'"
-- Styx


I have devoted a fair amount of space in this blog to innovative, advanced primary care practice models -- the Advanced Primary Care Alternative Payment Model (APC-APM), patient-centered medical homes, accountable care organizations, the Independence at Home model, and direct primary care (DPC). My posts on these subjects typically produce a robust discussion regarding the pros and cons of the various models.

[Doug Nunamaker, M.D., in office with patient]

Doug Nunamaker, M.D., speaks with a patient at his direct primary care practice in Wichita, Kan. Only 3 percent of AAFP members practice in the DPC model, but more than 40 percent of members have expressed an interest in DPC.

The AAFP continues to have a healthy curiosity about how best to design delivery and payment systems that emphasize the important, foundational role of primary care; ensure all individuals have access; place a priority on care delivery and not on administrative functions; and deliver high-quality care to patients. It's a great set of goals, but to date, it has been an elusive unicorn to lasso. We also recognize that delivery and payment models need to have flexibility and nuances that reflect the physicians, the primary care team and the community served. And finally, we understand that models of care must also be adaptable to new technologies and innovations.

In May, CMS issued a request for information (RFI) on what it classified as direct provider contracting that asked for feedback on many of the issues outlined in the previous paragraph. In our response(22 page PDF), the AAFP provided input based on our more than three decades of work in this area. We discussed the need for greater investment in primary care and the importance of prospective payments for not only direct patient care, but also for population management and care coordination. And we outlined several steps CMS should take to reduce the administrative burden of coding/billing, quality reporting and the electronic health record.

We also devoted a significant portion of our response to the RFI on direct primary care (DPC). Although the RFI didn't focus on DPC exclusively, it allowed an opportunity for the AAFP to provide an overview of our policies and work on the practice model, as well as submit recommendations on how DPC could be incorporated into public health care programs (Medicare, Medicaid, CHIP).

This spring, the AAFP conducted a survey on DPC and DPC practices. We surveyed both DPC practices and non-DPC practices to ensure that we had a comparison group to determine interest in the model among physicians. The AAFP survey is the largest analysis of DPC to date. Our survey instrument was designed to identify and better understand the attitudinal factors that are driving interest and growth in the practice model among current DPC practices and non-DPC practices.

Here are some key findings:

  • Three percent of AAFP members are currently practicing in a DPC model -- either "pure" or "hybrid."
  • Eighty percent of DPC practices are pure DPC, meaning they charge a periodic fee to their customers for a defined set of services, and they do not bill any third-party payer.
    Fourteen percent of DPC practices are hybrid DPC, meaning they still engage in some manner with one or more third-party payers. Of the hybrid practices, 42 percent plan to operate the model "indefinitely."
  • Three percent of survey respondents indicated that they are actively transitioning to the DPC model.
  • Forty-one percent of those who are not currently operating a DPC practice would be interested in adopting the DPC model.
  • Fifty-four percent of physicians in a DPC practice setting are male. Fifty-six percent are greater than 15 years postresidency. About 20 percent of DPC physicians are less than seven years from completing residency training.
  • Ninety-two percent of DPC practices have a family medicine physician working at their primary locations. Nineteen percent have a general internist, and 13 percent have a pediatrician.
  • Seventy-two percent of DPC practices have been in operation less than three years, and 11 percent have been in operation less than one year. Less than 10 percent of practices have been open four or more years.
  • Fifty-four percent of DPC practices started from scratch, and 34 percent converted an existing practice into a DPC practice.The average number of months planning a transition before opening a DPC practice was 11.5 months.
  • Sixty-two percent of DPC practices transitioned directly to a DPC practice, and 30 percent partook in a hybrid transition.
  • The average DPC panel size is 345 patients. The average target panel size is 596 patients.
    Only 17 percent of DPC practices have achieved their ideal panel size. Of those that have achieved their ideal panel size, the average time to achieving a full panel was 20 months.
  • Fifty-seven percent of DPC practices have contracts with employers to provide services to employees. Of those not engaged with employers, 54 percent expressed an interest in doing so in the future.
  • Fifty-eight percent of DPC practices supplement their income through other practice opportunities either temporarily (19 percent) or continuously (39 percent).
  • Ninety-one percent would promote the model to other physicians.

The AAFP has a large collection of resources available to inform and educate you about DPC and, if appropriate, assist you in your transition to the model. I would start with our FAQ. From there, you can move to our toolkit for a step-by-step guide on how to transition your existing practice or open a new DPC practice. For ongoing support and technical assistance, I urge you to join our DPC Member Interest Group.

And, for those looking for more hands-on education and networking, I present to you the …

Direct Primary Care Summit

The AAFP is pleased to once again co-host the Direct Primary Care Summit(www.dpcsummit.org), which is scheduled for July 13-15 in Indianapolis. This is the premier DPC education and networking event, featuring a stellar faculty of nationally recognized DPC physicians who bring their real-life experiences to the educational programming. The program features two tracks -- Starting a Practice and Growing Your Practice, so regardless of where you are in your DPC journey, we have practical education content for you. In addition, the program has been approved for up to 14.75 Prescribed CME credits.

If you are a DPC physician or if you are interested in transitioning to a DPC practice, this is a must-attend conference. I urge you to register today and join us in Indianapolis.

Posted at 08:00AM Jun 19, 2018 by Shawn Martin

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ABOUT THE AUTHOR



Shawn Martin, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.