A twist on primary care 5 things to know about direct primary care Over the past decade, this practice model has grown immensely. It’s popular with independent, entrepreneurial DOs. March 13, 2019Wednesday Seka Palikuca Contact Seka Facebook Twitter LinkedIn Email Topics concierge caredirect primary care As a pre-med student, Matthew Abinante, DO, MPH, shadowed 10-12 physicians and each told him to not go into medicine due to their disillusionment with the profession. For Dr. Abinante, who was passionate about his career choice, this level of burnout was disheartening. But the last physician he shadowed had a different story to tell. He loved what he did and told Dr. Abinante to definitely go into medicine. That physician practiced a version of concierge medicine for which he charged patients a flat monthly fee in exchange for a higher level of service. Dr. Abinante began researching and discovered a more affordable primary care practice model called direct primary care (DPC). For a monthly fee that is typically under $100, DPC patients have direct, unlimited access to their primary care physicians with longer appointment times and no insurance billing. Physicians have more time to spend with patients and the simplified fee structure leads to decreased practice overhead and reduced administrative burdens. Dr. Abinante opened his own DPC practice in 2016. If this growing practice model has piqued your interest, read on for five things to know about DPC today and take our quiz on whether DPC is right for you. 1. DPC docs foster an enduring doctor-patient relationship Developing an enduring doctor-patient relationship through adequate appointment time is a hallmark of DPC. A typical DPC practice has about 600 patients, compared with 2,500 patients for an average fee-for-service primary care practice. Instead of seeing up to 30 patients a day, DPC providers typically see less than 10. “A lot of medicine can be done electronically,” says Dr. Abinante, who has capped his practice at 450 patients. Matthew Abinante, DO “I know all my patients by name. I have time for them,” he says. “I probably interact with about 20 patients a day when you factor in the electronic communication.” The longer appointments in the DPC model allow time for discussions between a physician and patient that encompass lifestyle choices with the aim of long-term health and well-being. “What everyone really needs to know is that patients do get better care when their doctor is more satisfied with what they’re doing. And that takes time. That is what the [fee-for-service] system cannot provide us, is time with the patient,” says Tiffanny Blythe, DO, who runs a DPC practice in Kansas City, Missouri. Tiffanny Blythe, DO 2. DPC is growing and DOs are joining in In the past decade, the DPC model has grown from just 21 practices to over 1,000 practices in 49 states that care for an estimated 500,000 patients, according to the Direct Primary Care Coalition (DPCC), an advocacy group. “The movement has been particularly popular among DOs,” says Jay Keese, executive director of the DPCC, who estimates that 30-40 percent of the group’s members are DOs, osteopathic residents and medical students. The high level of interest in DPC by DOs may be attributed to an already higher percentage of DOs practicing primary care, says Keese. “But DOs also tend to be a bit more entrepreneurial and independent,” he adds. 3. Efforts are underway to enhance DPC The AOA supports the DPC model, and urged Congress at DO Day on Capitol Hill last week to support a Primary Care Enhancement Act (PCEA) that includes a DPC model which would allow physicians to provide health care to the full extent of their scope of practice, including providing diagnostic services and dispensing prescription drugs. Currently, the IRS views DPC as a type of health insurance and bars the use of health savings account funds to pay for DPC. The PCEA would allow patients to use the funds from their HSA to pay for DPC. One of the downsides of direct primary care is that it can be challenging to find patients who can afford their membership dues, particularly in medically underserved areas. “An arrangement like direct primary care or concierge medicine … is a great option if you’re in an environment where people can afford it,” Seger S. Morris, DO, MBA, told The DO recently. “In many areas, especially rural and underserved areas, either there are not enough people to make it work or [the patient population] doesn’t have the money to do it.” For a primer on the AOA’s DPC advocacy, see these frequently asked questions. 4. DPC offers upfront pricing DPC practices offer transparent pricing upfront. A monthly membership fee (typically under $100 per member, often with family discounts) covers unlimited primary care office visits and services. Patients are encouraged to buy a complementary insurance plan, such as a high deductible health plan, to pay for any complex or catastrophic medical services outside of primary care. While both concierge and DPC charge a periodic membership fee to the patient, most DPC physicians don’t accept insurance. Concierge practices, on the other hand, typically still bill insurance and often add an annual retainer fee. At Dr. Abinante’s Elevated Health in Huntington Beach, California, patients pay an average of $75 monthly. This includes same- and next-day visits, 30-60 minute appointments, and the ability to call, email, text or video chat with a physician 24/7. Elevated Health offers patients free diagnostic EKG and spirometry testing, as well as procedures such as laceration repair, skin lesion removal and ear lavage. Labs, medications and imaging are available to patients at contracted wholesale prices. 5. DPC embraces the ‘quadruple aim of medicine’ The triple aim of medicine—to enhance the patient experience, improve population health and reduce health care costs—is well-documented, says Dr. Abinante, but he and other DPC providers are focused on “the quadruple aim of medicine,” which acknowledges that improving the work-life balance of physicians is necessary in order for the other three aims to happen. For Dr. Blythe, who was on the verge of leaving the medical profession after spending three years employed by a hospital-owned clinic where “the only thing that mattered was the numbers,” she says discovering the DPC model made medicine a viable option again. “I needed to feel like I was being the doctor I intended to be,” Dr. Blythe says. One of the criticisms of direct primary care is that its doctors’ smaller patient loads will only add to the primary care physician shortage. But Dr. Blythe is hopeful that DPC will revive interest in primary care among today’s future physicians. “With DPC, we’re recruiting a new generation of doctors who wouldn’t even consider primary care before,” she says. Learn more To learn more about direct primary care, visit the DPC Coalition’s website. You can also join the American Association of Family Physicians’ Direct Primary Care Member Interest Group. Further reading Direct primary care: A way out of the labyrinth? More in Profession The best and worst states for doctors in 2024 Montana leads WalletHub’s new list, while Hawaii comes in last. See where your state landed. AOA now accepting applications for volunteer leadership positions Serve on an important governing body that helps shape AOA programs and policies. Previous articleIn Memoriam: March 12, 2019 Next articleEight DO schools rank in top 10 for producing the most primary care residents
The best and worst states for doctors in 2024 Montana leads WalletHub’s new list, while Hawaii comes in last. See where your state landed.
AOA now accepting applications for volunteer leadership positions Serve on an important governing body that helps shape AOA programs and policies.
Correction: DPC providers foster an enduring doctor-patient relationship. Thanks! Mar. 14, 2019, at 5:28 am Reply
I am a testament to the final statement in this article. DPC will not exacerbate the primary care physician shortage. It will help fix the problem. I am a physician assistant who was happily working for 4 years when I first heard about DPC care. It sparked a passion and creativity in me that I did not know was there. I decided to go back to med school, a daunting choice at age 30, and eventually enter a family med residency just so that I could one day open a DPC practice in my area in CA where the closest one is 2 hours away (which happens to be Dr. Abinante’s practice). For years the primary care track has been many medical students “back up” choice if they did not get their specialty that they really wanted. In my recent med school experience I would guess that <1% of medical students even know about DPC at this point. It is my 100% belief that as young physicians learn about this model, you will see a dramatic shift of aspiring physicians going into primary care. It is not just the fewer patients in the day that is the draw. Physicians, by nature, are generally willing to work hard. It is the underlying promise of DPC that one can utilize the full scope of a primary care skill set to practice unhindered quality medicine that changes a community. So no, DPC practices will not worsen the physician shortage, it will help solve it. Mar. 14, 2019, at 8:11 am Reply
I don’t have a primary care doctor, don’t want one, and don’t need one. I have a cardiologist that I see as needed, a rheumatologist, a dermatologist, an old fashioned D.O. who only does manipulation, and a dentist. What do I gain by seeing a primary care doctor? They really don’t offer me anything. Primary care is promoted by Medicare, Medicaid, and the insurance companies. It’s a bunch of folks who who shuffle paper work for the insurance companies, and have some general knowledge about medicine. Mar. 14, 2019, at 8:58 am Reply
Obviously written by someone who knows nothing about medical economics, or what primary care is about. Mar. 14, 2019, at 9:33 am Reply
Wow, this is from a physician…? Oh, retired surgeon, makes sense now. The value of primary care is well studied and documented (retired and not keeping up on CME I guess). Its true that annual physicals may not have much evidence of benefit, but that’s not all PCPs do. Pushing paperwork is what 3rd parties have levied on us and DPC is a way to move away from this and back to more time with patients with restoration of job satisfaction and outcomes. Relying on specialists is an expensive drain on the system, fragments care, and does not produce better outcomes (actually worse) than utilizing a primary care provider who has the whole person in mind and a vast knowledge of the healthcare arena to guide their patients through. Mar. 14, 2019, at 9:38 am Reply
But you are a Physician. You don’t need primary care to help organize your medical plan. By the way, I am in Family Medicine and I don’t have someone else be my PCP either. Mar. 14, 2019, at 11:07 am Reply
I agree. In addition, this type of medicine enhances care, keeps people out of Urgent Care, EDs and hospital. I have my own micro practice, I charge fee for service, I don’t have a retainer and I don’t take insurance. This is what DOs did back in the day! We saw patients and we knew them like the back of our hand. Patients text me and I save them so much in healthcare costs. And I’m on a mission to show others that it can be done. I will be vlogging about how I opened my clinic! Mar. 14, 2019, at 3:17 pm Reply
I practice DPC and do all the things your specialists do except dental care. I do not bill or do any paperwork for any insurance companies, medicare or medicaid. I offer all medications, labs, and radiology studies at a contracted discount just like your insurance does. I can refer to a trusted specialist when and IF needed. Plus I can spend time with you and develop a coordinated care plan and do it all for $79 a month. Mar. 22, 2019, at 5:29 pm Reply
So members pay a monthly fee in addition to their traditional monthly cost of health benefits? This is a great plan ONLY for those who have the extra money. Mar. 14, 2019, at 11:05 am Reply
I am currently working in Urgent Care but by the end of the year I am hoping to have my own DPC clinic, probably a hybrid as I am also passionate about having an “Ideal Medicine Clinic” (search Pamela Wible, M.D.) As for costs? Let me tell you: I have lots of patients that come into Urgent Care 2-3 times a month, paying anywhere from 20-160$ copays because their PCPs are packed and they can’t get in to see them for urgent things and sometimes not even for critical refills. Many people don’t even have a PCP and only come to Urgent Care and pay exorbitant copays along with their insurance payments. And these are your average, working class people, not wealthy by any means. Many don’t even have insurance so they pay $140 + the cost of any tests sometimes more than once per month depending on what is going on, certainly, several times per year. I guesstimate that most – the vast majority – of people would save money on their copays alone by joining a DPC clinic. For the rest, there are still plenty of traditional FFS clinics. So no offense, but your assessment indicates a very limited knowledge of the health care situation and costs in this country. DPC is not for everyone, but it CAN be one of the solutions to the problem. A really good one for lots of us and has the potential to save many lives (including Doctor’s lives by the way. Do you know how many doctors commit suicide because of the way health care is now? Look it up!) Cheers! Mar. 14, 2019, at 2:52 pm Reply
Thanks for your feedback, Dr. Anderson. As an FYI, we’ve written about Pamela Wible in the past and her involvement with the “Do No Harm” documentary: http://thedo.osteopathic.org/2017/09/documentary-puts-spotlight-physician-depression-suicide/ Mar. 14, 2019, at 3:55 pm
P.S. I just joined the DPCC, didn’t know they existed until I read this. Thanks for this article! Mar. 14, 2019, at 3:03 pm Reply
I respect what is being done here, and by all means keep it up – but it is only a respite for the ills of our healthcare system, overall. It will not improve the 9% of us without health insurance. It encourages people to buy “cheap” underinsurance policies, which potentially expose families to bankruptcy if ever used (worse, some people won’t buy any). It leaves private insurers at the helm of our most expensive care – currently wasting ~$500 billion annually. It does not gain leverage against the pharmaceutical industry, to significantly affect out of control prices / patent practices. Despite best of intent – it just can’t cover many procedures. It does not fully cover dentistry, or vision, or hearing aids. One air-transport may be billed at $10-20,000. It does not cover long term nursing home. Goodness, the list goes on. However. Improved Medicare for All does all of this and more. How do we pay for it? It’s easy to pay for something that costs less. Government takeover? No. Control will be by local, state, and national boards (of physicians, business leaders, patient advocates) – routinely updating policy based on best practices, not profit. Will dive us into socialism? Who in their right mind believes that Canada, UK, France, Denmark, Germany, etc will become socialist countries because they have universal healthcare, or a public fire department. I was sad when I heard that DPC was the main thing discussed at DO day on Capitol Hill, rather than single payer Mar. 14, 2019, at 4:06 pm Reply
Single payer puts all providers at the whim of those who hold the money. DPC puts the consumer in charge. Which do you think improves quality of care and reduces expenses? If you think single payer you need to take a course in basic economics. I practice DPC and my patients pay a $79 a month fee. Most of my patients have other insurance in case of a catastrophe. They pay less than the cost of comprehensive insurance and get better service. My patients get generic medications direct from me for less than the price at pharmacies. They get labs, radiology studies and referrals at contracted lower rates. They can go where they want, see who they want and pay less to do it. For the $79 monthly fee they have unlimited access, free OMT, EKG’s, PFT’s, in office procedures, skin biopsies (pay pathology costs), cryotherapy, laceration repair, ear lavage, email, phone, text access, and time with a physician who will listen and make lifestyle improvement recommendations, orders for mammograms, radiology studies, consults and referrals *(When needed) all included in the monthly fee. I review and email test, radiology, and lab results. I do phone visits for those who are at work or can’t make it into the clinic. I have patients that are om private insurance, employer provided insurance, medicare and medicaid. Most of my patient’s monthly dues are paid by their employers along with a major medical type insurance because DPC saves the employers money too and employees get better care. Mar. 22, 2019, at 5:17 pm Reply
If you think single payer is the way to go, look at the wait lists for things like joint replacements. The rich still have private insurance and everyone else has second rate care with long wait times. Mar. 28, 2019, at 4:02 pm Reply
We converted our practice to DPC 3 years ago and it was the best decision I ever made (other than my spouse and being a DO!). The combination of Health Sharing and DPC provides protection for families as well as comprehensive primary care access- many of our patients have this and it works! We have the time to educate and support our patients in a healthy lifestyle to help them stay healthy as well as treat those who are sick and help them get back to health. We are incentivized to keep them healthy and they are incentivized to ask for help as often and as early as possible in the course of a problem. The incentives are aligned. Mar. 14, 2019, at 8:32 pm Reply
Jean Golden-Tevald, DO: Absolutely correct. Patients get better care for less money and since many pay the dues themselves they take more ownership in their medical care. Mar. 22, 2019, at 5:21 pm Reply
Well, if someone who smokes one pack of cigarettes a day would cut down to 1/2 PPD, that would free up enough money for them to spend on DPC. People who believe that a government controlled single payor system is the answer, has never worked for the government in a position where they have to deal with the waste, systemic problems and contradictions routinely imposed by policy decision makers with more ego than information to support their policies. The level of government control of a system is inversely proportional to the amount of personal responsibility that can and will be exercised in any such system. Compliance is mandated and enforced with punitive measures that ineffective against nimble fraudsters and scofflaws. I recommend to all that they read “Living Long & Loving It” by Irvin M. Korr & Rene J. McGovern. There is much about the book to recommend but focus on the discussion of each individual’s status as the CEO of their own ‘Internal HMO’ as the primary dimension required for successful healthy living provides a sign post to a reality that must be taken into account by any health care reformers that wish to be taken seriously. If you want advice on how to live a long, healthy, productive life, listen to those who have done just that. I also recommend the American Association of Physicians and Surgeons (AAPS) as another professional association that advocates and supports independent physician practices. Jun. 26, 2019, at 1:41 pm Reply
My doctor is converting to this in January. He does not do regular bloodwork, just if you are sick. Otherwise it is off-site. He has no coverage to speak of as a single practitioner, it is generally just him. So, one is reluctant to call unless in dire shape, after office hours. Which kept changing continually the past 2 years. I can not imagine why I would want a 30-60 minute visit ever. I have no idea yet what the cost will be. He has not disclosed it. This may be great for him, but I see no benefit for me and my very expensive Medicare supplement. Aug. 31, 2020, at 2:34 am Reply