Many physicians who practice direct primary care (DPC) offer the same range of care and bill in similar ways, although they may refer to their practice model by different terms, according to a new study.
In an attempt to establish clear terms, two researchers attempted to crack the code by analyzing physician practices that use "DPC," "concierge," "boutique" or a similar term to describe themselves.
Philip Eskew, D.O., J.D., M.B.A., a visiting scholar at the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, and Kathleen Klink, M.D., former medical director at the Robert Graham Center, examined data from 141 primary care practices that met their definition of a DPC practice, which is one that
- charges a periodic fee for services,
- does not bill a third party on a fee-for-service basis and
- charges less than the periodic membership fee for each office visit.
Their study, "Direct Primary Care: Practice Distribution and Cost Across the Nation,"(www.jabfm.org) published in the November/December issue of the Journal of the American Board of Family Medicine, describes the typical DPC practice, including its fee structure and internal administration.
- A new study seeks to distinguish the direct primary care (DPC) practice model from similar models, such as concierge care.
- DPC practices charge $77 per month in membership fees, on average, compared with $183 for concierge practices.
- Some practices employ a hybrid model that combines DPC with fee-for-service.
Eskew said patients and physicians are confused about the differences between practices that use the term concierge care and those that use DPC, largely because the concept of operating without billing insurance is still new. The study noted that the most well-known concierge practices use third-party, fee-for-service billing in addition to a membership fee, while DPC practices generally are financed through membership fees.
"From a health policy standpoint, the more confusion stays around, the more concierge medicine benefits while DPC will be held back," said Eskew.
Practices that refer to themselves as DPC practices charge $77 per month in membership fees, on average, compared with $183 for practices that use the term concierge. For DPC practices that charge for office visits in addition to membership fees, the average visit fee was $16. Several DPC practices studied also charge a one-time enrollment fee that averaged $78.
The researchers found that 93 percent of the practices they studied include four physicians or fewer.
"It is popular for small practices because it lets them take advantage of being small," Eskew said. "Everything in health care is about getting bigger and bigger so you can negotiate better. This turns that idea on its head. You can have transparent prices and you can change quickly if you want and not be held back by administrative requirements that can bog down innovation."
Another prime advantage that DPC offers is longer office visits -- 35 minutes, on average, compared with eight minutes in the traditional model.
Medicare in DPC
Of the 84 practices for which the researchers could determine Medicare participation, 77 percent opted out of the program. Of the 87 practices that provided billing information sufficient to permit analysis, the researchers found that 84 percent were "pure" DPC and the rest included some elements of fee-for-service.
Physicians who work in a DPC model but still accept Medicare patients have several
options for billing. They can
- continue treating Medicare patients on a fee-for-service basis,
- opt out of Medicare and treat all patients the same way via a membership fee or
- charge a fee that applies to services not covered by Medicare.
Eskew suspects that some physicians choose the hybrid model because they are unsure about the long-term prospects of opting out of Medicare. Physicians who do opt out of Medicare but continue to contract with private insurers have the option of continuing hospital work, something they cannot do if they accept Medicare.
A drawback of the hybrid model, Eskew said, is that a physician's patients who participate in traditional payment arrangements may receive brief visits compared with the same physician's patients who are in a DPC arrangement. Physicians could avoid that scenario by subsidizing their Medicare patients with the periodic membership fees paid by DPC patients, he said.
"It's hard to treat Bob different from Mary because one patient is paying one way and another pays in a different way," Eskew said.
Saving Money for Some Patients
The DPC model can save money for many patients by charging them less in annual membership fees than insurance copays and deductibles would cost them.
As an example, Eskew cited a patient who had a series of sinus infections. Under the traditional model, each infection would require an office visit because that would be the only way the physician could be paid. But the patient and physician could choose to replace some visits with phone calls or email under the DPC model.
But as attractive as the DPC model is for physicians who are tired of insurance hassles and patients who need frequent care, it is not appropriate for everybody.
"If you are really healthy, take no meds and have no health problems, it may not be in your best interest to sign up for DPC," Eskew said. "The more you use the health care system, the more this saves you."
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