Direct Primary Care (DPC) and Concierge Medicine are often confused. Both models accept payments directly from their patients, both have smaller panel sizes (allowing for improved relationships with patients), and both tend to advocate for advanced communication between the doctor and patient (via text, email, after-hours calls, virtual visits, etc.). To make matters even more confusing, some practices that follow a DPC model will advertise as “concierge” for brand recognition. So how, then, is one to know the difference?
If you look closely at the standard DPC setup and compare it to the standard Concierge set up, there are a few key differences:
- The “Membership Fee” In concierge practices, the membership fee is traditionally an annual fee; In DPC, your membership fee is traditionally a fee charged monthly, quarterly, or annually -- per the patient’s desire.
- Average Membership Cost. Concierge doctors often charge more in annual fees than the average DPC doctor. Although the average fee is around $1,800 a year, some charge as much as $25,000 annually! DPC fees typically range from $600 to $1,500 per year.
- Insurance. Generally, concierge doctors also accept insurance; in addition to your annual fee they bill your insurance for your visits. This means that you may get “surprise bills” several months later after your insurance pays their portion (of an amount typically not revealed to you until you get your bill). With DPC, insurance is not billed.
- Copays at your visit. With concierge, because they accept and bill your insurance, they are required to collect copays at each visit. DPC clinics do not bill insurance, so there are no copays with each visit. (That said, there are some exceptions to this rule as some practices charge a “per visit” fee.)
- Patient panel size. Both concierge and DPC traditionally maintain a patient panel of 600 patients or less. This enables both provider types to have longer, more in-depth appointments with their patients, and a deeper, more satisfying relationship between doctor and patient.
- Insurance Regulation. Because concierge doctors typically bill insurance, they are held to several insurance regulations including MACRA/MIPS and other documentation requirements. Since DPC does not bill insurance, they are not required to follow these regulations, enabling the physician to document more efficiently and not waste their time with checkbox documentation.
- Office overhead costs. Concierge physicians typically have high overhead costs, owing in large part to their acceptance of insurance. This causes care delivered in this model to be on the expensive side. Because DPC physicians do not accept insurance, they do not need to have staff to negotiate insurance contracts, bill insurance, process insurance payments, and then resubmit bills when the insurance fails to pay in a timely fashion (which happens all the time). This enables DPC physicians to have a very low overhead.