For many physicians, direct primary care is the prescription modern medicine needs to cure the ever-growing bureaucracy that surrounds the treatment of patients today.
Direct primary care seems to have a lot to offer. After all, it’s an approach that places doctors — rather than politicians, insurance companies, codes, and forms — at the center of a patient’s healthcare universe.
If you’ve wondered about DPC and whether it is right for you, below are three factors to consider.
The Difference Between Direct Primary Care and Concierge Medicine
It’s helpful to keep in mind the differences between direct primary care and concierge medicine. Some people use the terms as if they’re synonymous. They are not. Direct primary care and concierge medicine are dissimilar in a number of respects. Here are just a few.
Direct Primary Care
- Patients pay a monthly fee; they can leave — and end those monthly payments — at any time.
- Providers do not accept insurance, freeing them of the cost, effort, and requirements related to Medicare billing.
- Since providers do not belong to an insurance network, complications when referring a patient to a specialist — who is part of a network — may arise.
- Identified in the Affordable Care Act as an acceptable non-insurance option.
- Tends to attract younger patients.
- Patients pay an annual fee.
- Providers accept insurance. This requires the office to maintain processes (and staffing) capable of supporting Medicare-related billing and coding.
- Providers remain in-network and readily refer patients to other network physicians (specialists) when the need arises.
- Not identified in the Affordable Care Act.
- Tends to attract older patients since Medicare is accepted as part of the model’s process.
There’s one other item worth noting. At this point in the still-developing world of alternative healthcare models, concierge medicine elicits unfounded claims of “elitism” and similar negative terminology. Direct primary care, to date, has seemed to avoid such labels.
Changing the Way You Conduct Business
If you’re wondering what direct primary care services look like, below are two samples.
Johns Hopkins Health System launched a direct primary care program for employees for 2019. Covered under the program:
- 8 office visits
- 1 annual physical
- 1 flu vaccine
- 6 rapid tests (flu, strep, urine, pregnancy, A1c)
- 1 EKG
- Unlimited telephone consultations, blood draws and urine collections, prescription refills, prior authorizations of medications, referral management, and care coordination
Johns Hopkins offers this program for free, as an employee benefit.
It’s a safe bet you don’t have the resources of a Johns Hopkins. Let’s look at the much smaller direct primary care provider Epiphany Health. The services included in their plan:
- Annual wellness exam
- 25 office visits
- Extended appointments
- Same-day or next-day priority appointments
- In office testing such as strep, urinalysis, hemoglobin A1c, and urine pregnancy, if indicated
- An annual colon cancer screening, if indicated
- Electrocardiogram (EKG), if indicated
Additional services and their costs include:
- Annual flu vaccine: $10
- Pap test: $35
- Wellness bloodwork (complete blood count, Lipid panel, glucose, kidneys, liver, electrolytes, TSH, hemoglobin A1c): $45
- Screening mammogram: $100
To cover the plan’s services, the cost is $60 per month for adults, $25 per month for one child, and $10 for each additional child.
Epiphany Health collects payments with automated electronic funds transfer. Doing so helps them save on expensive and labor-intensive invoicing and collections efforts.
Both examples present real-world snapshots of direct primary care programs. If you want to develop a better understanding of how you can provide such valuable offerings, keep reading.
Expanding Your Team
Physicians invest so much of themselves into caring for patients that they often don’t invest enough time in themselves. This can carry over into their business.
As special a calling as running a medical practice is, it’s still a business. Laying the foundation for a successful direct primary care practice will require input from accountants, business advisers, and lawyers.
Your very own super-team:
- Working closely with a business adviser and accountant will help you determine the price and patient capacity numbers you’ll need to establish a viable practice. This is the sort of undertaking required to map out your portfolio of patient services.
- A lawyer and insurance broker can help devise plans to protect you, any partners, and your practice.
- A marketing agency can help you launch your direct primary care practice within the region.
A warning: Don’t rely on a paint-by-number business plan. You need one designed specifically for you — and you need experienced professionals to help.
Supplementing your team-making skills with effective negotiating will go a long way. One of Epiphany Health’s co-founders described how he arranged for cost reductions for their direct primary care patients despite their being out of network.
The plan: to negotiate with other practitioners a patient-friendly price for labs and devices that otherwise sat idle — facilities still requiring payments but not generating income. The practitioners received cash to boost their revenue and direct primary health patients received the services they needed.
As the physician put it: “We ended up buying labs and imaging wholesale, and the prices we got were ridiculously low pennies on the dollar. We had eliminated their largest expense — labor costs and time for the purpose of collecting money.”
A Partner Ready to Help Today
As one direct primary care provider noted, the model “takes a number of steps towards some desperately needed changes: lower cost, less over-utilization, happier doctors and healthier patients.
If this sounds an avenue you wish to explore further, Complete Medical Services is ready to help. Our decades of service in the healthcare field, working with a variety of business models and revenue streams, makes us well-suited to help you begin taking immediate steps necessary to introduce meaningful, and positive, changes to your practice. Contact us today.