Direct Primary Care (DPC) is an alternative practice model in which physicians and patients work together directly, without interference from third parties. DPC creates a stronger, healthier, more beneficial doctor-patient relationship. Essentially patients pay their physician a set recurring fee in exchange for improved access, longer appointments, and price transparency.
At this time, most use the definition of DPC put forth by Eskew et al in 2015: “A DPC practice must be a primary care practice that (1) charges a periodic fee for services, (2) does not bill any third parties on a fee-for-service basis, and (3) any per-visit charges are less than the monthly equivalent of the periodic fee.” What, exactly, does that mean for patients and physicians? Let’s examine each of those items separately to get a better idea.
- Charging a periodic fee: This means that patients pay their physician a recurring fee (monthly, quarterly or annually) in exchange for healthcare services. People often view this as sort of a membership fee or access fee. Typically this fee covers the majority of care and communication that occurs between the physician and patient. The advantage for the physician is that financial well-being is not predicated on how many patients they can see in a set amount of time. This enables the physician to empanel fewer patients and provide a more comprehensive service to patients. For the patient, this means increased access to and enhanced care from their physician.
- Not billing third parties on a fee for service basis: This means that when a patient sees the doctor, a bill is not sent to their insurance company. The advantages of this for the physician is no more chasing payments from insurance companies, no more jumping through hoops trying to ensure optimal reimbursement for their work, and no more headaches when insurance companies find excuses to deny coverage. The main advantage of this for the patient is that they will never see an unexpected bill from their insurance for the care their doctor provided.
- Visit fees are less than the equivalent of the periodic fee: This means that if the physician’s monthly fee is $50, and they also charge a per-visit fee, that per visit fee needs to be less than $50. If any per-visit fee is over the monthly fee, the practice shifts from a DPC arrangement to more of a traditional fee-for-service, where the main income to the practice is from service fees. Most DPC practices do not charge per visit fees. The advantage to physicians is that monthly billing (and thus bookkeeping) is easier to manage than FFS billing, and eliminates the overhead of office billing staff. For patients this means a flat, fixed fee will be charged.