Direct Primary Care - What it's missing!

Direct Primary Care seems to be the "new" model of delivering healthcare on the block that physicians all across the U.S. have been talking about, but we believe that there is something missing from it.

While DPC is not really that new, having been around for almost 20 years now, it's been gaining more traction in the last few years as physicians look for ways to reduce overhead expenses in a system with ever increasing healthcare costs. 

The idea behind DPC is simple: to get access to a primary care doctor, a patient pays a doctor a relatively small retainer fee per month. 

In return, the patient can then see the doctor as many times as he or she likes, with no copays and no insurance.  The doctor would provides basic services such as in office EKGs, urine test, strep tests, and simple mole removals.  

This sounds a lot like concierge medicine, a practice where patients pay doctor’s high retainer fees in order to get exclusive and personalized access to primary care services.  

After all, both DPC and concierge medicine involve patients paying primary care doctors directly, circumventing insurance companies, with the intent to save both time and money.

The main difference between DPC and concierge medicine is price - DPC models offer low monthly premiums that most patients that are much more affordable whereas most concierge practices charge high retainers to weed out up to 80% of potential patients. 

So, let’s leave concierge practice alone for the time being — after all, those patients are making an unforced decision to pay high retainers and they have a right to do so.

DPC seems to combine both concierge medicine and affordability. Doctors now have more time to take care of the patients and no need at all to deal with insurance companies. 

So what’s the catch then?  

Well, DPC does NOT cover medications, laboratory services, specialist consultations, immunizations,  or hospitalizations.  

For these additional services, patients would still need to have insurance coverage! So this effort to simplify the healthcare system would not really do much, because patients would still need to rely on insurance companies for any escalated level of testing or treatment. 

So if we can’t get rid of insurance companies anyways, why not integrate them into the DPC model? The current DPC model places the burden on the patient to pay their doctor ‘directly’. But consider this: It is always in the insurance companies’ best interests to have patients as healthy as possible and keep them out of the hospital. 

So, why not place the burden on them to pay primary care doctors the $100 or so per month fee per patient as would be arranged in a DPC model?

The primary care doctors would get the exact same benefits as they would under the DPC model, steady cashflow and a steady amount of patients, while the insurance companies would benefit from having healthier networks of insured patients since they would be able to visit a primary care doctor at any time. 

Furthermore, this modified DPC model could create a positive rewards system for physicians and insurance companies.

If a particular DPC physician’s patients were kept out of hospitals or did not do expensive testing as a result of having been treated in their practice, then that physician could be rewarded by increasing his or her panel size or per member compensation - because healthier patients means reduced costs for insurers.

So, let’s stop the madness and never ending spending on the patient’s side of healthcare and let’s do something good for a change! Insurance companies have a pool of money that they can allocate as they see fit, and most patients do NOT! 

DPC is an innovative model to deliver healthcare, but let’s place the burden on the insurance companies to make it successful!